Nursing And Precision Proton Therapy (Part I)

Ashley Hay, BSN, RN, BSN, RN

In this two part article we'll first take a look at the basic principles of proton therapy and later walk through a typical day as a nurse at the proton center. Working in Oncology for over a decade I've sometimes felt like we are at a stalemate in terms of progress. Don't get me wrong, I'm certainly not trying to diminish the massive amount of work that continues to be done in my field. There's billions of dollars in funding, piles of research and a notable amount of philanthropy - all lending a hand to the incredible advances in the Oncology world. During my few years on the job I've seen big changes in pediatric survival rates, antiemetic control, a rise in the use of integrative medicine and administration of new biologic therapies. I even had the opportunity to work on an exciting immune modulating phase I clinical trial as a research coordinator.

Despite seeing all of these advances first hand, my feelings somehow remained the same. Afterall, I still administer the same IV chemotherapies that my father received over thirty years ago. However, every so often something new comes along in your field that gets you excited for the future. Proton therapy? What's that? Ooh, tell me more! I was bewildered and utterly fascinated.

I'm definitely no expert. In fact, the original purpose of this article is was to walk you through what it's like to work as a nurse working in this type of facility. This can be difficult to explain without first discussing how this therapy actually works. Here's a basic overview of what I do know about this modality:

Proton beam therapy is a type of radiation therapy. This treatment delivers a beam of positively supercharged particles (protons) directly to the cancer site (Mayo Foundation for Medical Education and Research, 2016). I'm not sure if every proton therapy center uses the exact same technology. Where I work they (not sure exactly who 'they' is - magical ion gnomes? More likely scientists in a nearby lab, I guess) actually separate hydrogen atoms to create the protons. Incredible! It involves the ionization process and the delivered energy release at the Bragg peak - see this website for a great explanation and even a comprehensive video on the principles of proton therapy:

Principles of Proton Therapy - Proton Therapy Center, cancer treatment in Europe

In pediatrics I've mostly seen proton therapy used on brain and CNS tumors although I've heard they use it for other types of solid tumors in adults. This type of radiation allows for more precise delivery of treatment to the tumor - allowing higher doses to be given without intense effects to surrounding tissue (The University of Texas MD Anderson Cancer Center, 2016). The easiest way to think about the comparing the delivery of traditional radiation therapy to proton therapy is to imagine a spray bottle. When you have it on a wide spray - that's traditional radiation therapy (covering a larger area). When you change it to a direct narrow stream - that's proton therapy.

For an even more in depth look of the incredible science behind proton therapy read:

There are currently only 25 proton therapy centers in the United States (The National Association for Proton Therapy, 2016). I was lucky enough to fall into a per diem position at one. The center is calm, quiet, serene even. The overall feeling seems to promote an environment of healing. There's no loud overhead paging system, only a handful of staff and usually no more than two patients at the same time.

Then there's the gantry (the treatment room where proton beam is administered). Google image "proton therapy" to see more of what I'm trying to describe here. It will not disappoint). My mouth was probably wide open the whole time when I first laid eyes on it. The sheer mass of the gantry is intimidating. Truth be told, I'm mildly spastic so I'm still convinced I might one day fall into the huge gap in the floor between treatment table and the bottom of the gantry. There's a lot of moving parts and as the only nurse in the room, I'm responsible for a few.

In part two of this article, I will go through a day at the proton center so I can better explain my role in such an amazing place.

References:

Global Vision. (n.d.). PROTON THERAPY CENTER - Principles of Proton Therapy. Retrieved December 13, 2016, fromPrinciples of Proton Therapy - Proton Therapy Center, cancer treatment in Europe

Mayo Foundation for Medical Education and Research. (2016). Proton therapy. Retrieved December 08, 2016, from Overview - Proton therapy - Mayo Clinic

The National Association for Proton Therapy. (2016). Proton Therapy Centers Location Map and Listings. Retrieved December 08, 2016, from Proton Therapy Centers Location Map and Listings

The University of Texas MD Anderson Cancer Center. (2016). Benefits of Proton Therapy. Retrieved December 08, 2016, fromProton Therapy Benefits | MD Anderson Cancer Center

Nursing And Precision Proton Therapy (Part I)

About Ashley Hay, BSN, RN, BSN, RN

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Day In the Life of a Proton Therapy Nurse (Part II)