The Christie Charity
Patient pathway when you are approved for proton beam therapy at The Christie
- Referral and appointments
- Phone call from your key worker
- Appointment letter and information pack received by email
- Assessment visits (up to 7 days)
- Key worker meeting
- Agreeing to treatment (consent)
- Cast/mask making process
- CT and MRI scan
- Any additional appointments in your appointment letter
- Treatment plan produced (2 to 3 weeks)
- Treatment (3 to 8 weeks)
- Treatment Monday to Friday for up to 8 weeks
- Weekly doctor review
What happens next?
You will need to attend the proton beam therapy centre at The Christie for a consultation with the doctor and on several treatment planning days before your proton treatment can start. These appointments will be completed over approximately 1 week. You may not be needed every day for the entire day. Please refer to your accompanying appointment letter for the exact dates and times you will be required to attend during the planning days.
You will be allocated a key worker who will give assistance and support throughout your proton treatment. Your key worker will call you before your assessment visit to discuss any questions you have before you arrive at the hospital. Please read all information you have received before this phone call so that they can best manage your questions.
If you are eligible for accommodation, this will be provided for the duration of your assessment visit and the whole of your treatment. Further details will be found in your appointment letter and the accompanying accommodation guide if this applies to you. More detailed information will be given to you on your arrival at the centre.
Assessment visits
Key worker meeting
You will meet your key worker and they will provide you with a tailored information folder. This will contain all the information you may require during the whole process.
This includes information about the following:
- your treatment
- available support
- local amenities
You will have frequent contact with your key worker throughout both the assessment visit process and the treatment itself.
Agreeing to treatment (consent)
When you arrive with us, you will receive an information booklet related to the area you are having treated. It will contain information on the possible treatment side effects.
You will have a consultation with your doctor to make sure you are fully informed about the possible early and late side effects associated with your treatment. At any point along the treatment pathway, you will have the chance to ask any questions and discuss anything you do not understand.
We will ask you to sign a consent form agreeing to accept the treatment you are being offered. The basis of the agreement is that you have had The Christie’s written description of the proposed treatment and that you have been given an opportunity to discuss any concerns.
You are entitled to request a second opinion from another doctor who specialises in treating this cancer. You can ask your own consultant or your GP to refer you. Your consent may be withdrawn at any time before or during this treatment. Should you decide to withdraw your consent, a member of your treating team will discuss the possible consequences with you.
Cast/mask making
Due to the accuracy and complexity of the treatment you will have, it is vital that you lie very still during your scans and treatments. To help with this, most patients are fitted with a mask or cast.
The type of mask or cast varies depending on the area of the body you are having treated. The radiographers will decide what is most suitable for you.
We will ask you to undress as necessary depending on the type of cast/mask made. During the process, it may be necessary to use a small amount of X-rays/radiation to assist in the making of the cast/mask.
During the planning session, the radiographers will put small radiotherapy tattoos on your skin. These are permanent. These will help the radiographers set you up in the correct position for treatment every day. If possible, these marks may be placed directly on your mask or cast, meaning that in some cases it may not be necessary to put the small tattoos on your skin. The marks created during your mask/cast making will be used by the radiographers each day of your treatment to set you up in the correct position.
About X-rays and radiation
Everyone receives some ionizing radiation every day from background radiation. This comes from our environment. Your age and size will influence the amount of radiation used. We ensure we keep the amount of radiation we use as low as possible.
Our CT equipment is regularly maintained and is subject to checks by both the radiographers and medical physics teams. It is important to let the radiographers know if there is any possibility that you may be pregnant.
CT scan
A CT scan is required to plan your proton treatment. You may have more than 1 CT scan during this session,
regardless of whether you have had one recently. This is a technical scan which requires you to be positioned as you will be for treatment. We ensure we keep the amount of radiation used as low as possible, and our priority is to ensure these X-rays benefit you and assist the consultant when planning your treatment.
These scans are not diagnostic and do not give sufficient information to assess the status of your cancer or any other abnormalities. In some cases, scans may occur prior to proton treatment consent being undertaken. If this is applicable, the team will make you aware.
The mask/cast and CT scan process will take around 1 hour and 30 minutes. If you take regular pain relief, please bring this medication with you.
MRI scan
You may be required to have an MRI scan. If so, this will be detailed on your appointment letter.
An MRI scan is a type of scan that uses strong magnetic fields and radio waves to produce detailed pictures of the body. This sort of scan does not use radiation.
The MRI scan process is very similar to the CT scan; the scan will take around 1 hour. You will be given some headphones and can listen to some music during your scan.
Some clothing and makeup may contain small amounts of metal that can interact with the magnet and affect the images. They can also create a heating effect during the scan.
When attending for your scan, we ask that you refrain from wearing the following items:
- hairspray, clips, grips and hair accessories,
- mascara and other eye make-up,
- magnetic eyelashes,
- anti-microbial clothing such as sportswear, as this can contain small amounts of silver or copper within the fabric,
- any clothing which contains copper (such as specialist underwear or socks etc. or radio frequency shielding clothing)
- any specialist magnetic clothing
- jewellery (including facial and body piercing). If you have any issue removing piercings, please discuss this with your key worker
Injection of contrast agent
During the CT and/or MRI scanning process, it may be necessary to see your organs and vessels more clearly. To do this, a cannula will be inserted into your hand or arm and the contrast agent will be injected in during the scan.
If you have another form of venous access (for example, a PICC line or portacath) we may be able to use this instead.
Another method to see your organs more clearly is to give you a special drink prior to your scan. A member of staff will explain which you will require and why.
You may eat and drink as normal before the CT and MRI scans unless informed otherwise by a member of staff.
Additional clinic appointments
Depending on your age, treatment site and management plan, you may be required to attend other appointments during the assessment visit. Examples of these include:
- general anaesthetic appointment
- physiotherapy
- speech and language therapy (SALT)
- occupational therapy
- dietitian
- chemotherapy
- social worker
- health play specialist
If you need to attend any of these, it will be clearly highlighted on your appointment letter. Once you finish your assessment visit appointments, your treatment appointments will be provided to you.
Paediatric information
If your child requires chemotherapy during the time of their proton beam therapy, they will also attend Royal Manchester Children’s Hospital, ward 86.
The health play specialist team will work very closely with your child to prepare them for the preparation process and treatment. Age-appropriate patient information will be given to you and your child by the health play specialist when you arrive at the proton beam therapy centre.
Infants and some younger children may require a daily general anaesthetic for their treatment. This allows the treatment staff to accurately deliver the treatment to your child by keeping them in the same position every day during treatment. You and your child will be fully supported throughout this procedure.
When will proton beam therapy begin?
Once the assessment visit is completed, the specialist planning team at The Christie will be working to produce a treatment plan tailored for you. This is a complex process and takes an average of 2 to 3 weeks to complete. If you are staying in accommodation, you will return home and come back to the centre once your plan is ready and your treatment will begin.
Treatment is usually given Monday to Friday but there may be times when treatment needs to be given over the weekend or on a Bank Holiday. This will be discussed with you in advance. Appointment times will be between 7am and 9pm and will be booked in advance. Unfortunately, you may not be able to have the appointment time of your choice.
The treatment may take up to 8 weeks to complete.
Prescriptions
Prescriptions for medication made by Christie doctors during your treatment can only be collected from The Christie Pharmacy. Any prescriptions relating to your cancer diagnosis will be free of charge. Please speak to your key worker for more information.
If you are taking any medication, please ensure you bring them with you if you are staying in Manchester for the assessment visits and treatment.
Car parking
Minimal parking is available directly outside the proton beam therapy centre. For information on patient car parks, please check our car parking page for the latest details, or refer to the leaflet ‘Travelling to The Christie for patients and patient’s visitors’.
There is also a shuttle bus service available from your accommodation (if provided) and from Royal Manchester Children’s Hospital. Ask your key worker for a timetable.