Patient care cheat sheet

Daily verification

Two identifiers, consent, and site laterality — every fraction

Before treatment: confirm two patient identifiers (name + DOB), verify the informed consent covers the exact site and laterality, and cross-check the prescription against the plan in the record. Any mismatch stops treatment.

Never treat on an ambiguous identification — a "close enough" match is the top preventable event in radiation oncology.

Skin care & radiodermatitis

Moisture is the enemy — wash, moisturize, avoid friction

Grade reactions with CTCAE criteria: mild erythema → dry desquamation → moist desquamation. Advise gentle washing with mild soap, fragrance-free moisturizer, loose cotton clothing, no adhesive tape, and no sun exposure on the treatment field.

Moist desquamation needs prompt wound care and physician review — do not just coach the patient, document and escalate.

Mucositis & oral care

Frequent, gentle oral hygiene beats treatment of established ulcers

Head & neck patients: baseline dental evaluation before RT, then saltwater or baking-soda rinses several times daily, avoid alcohol-based mouthwash, spicy or acidic foods, tobacco, and alcohol. Pain may need topical anesthetics or systemic analgesics.

A new sore throat, odynophagia, or poor intake mid-course signals mucositis progression — check weight and hydration and escalate.

Fatigue management

The most common side effect — exercise helps more than rest

RT-related fatigue builds over weeks and often lingers after treatment. Recommend moderate physical activity (short walks building up), regular sleep, balanced nutrition, hydration, and pacing of activities rather than bed rest.

Rule out contributors first — anemia, hypothyroidism, depression, or uncontrolled symptoms — before attributing fatigue to treatment alone.

Nutrition & hydration

Weekly weights, early dietitian referral, proactive symptom control

Weight loss during treatment degrades setup accuracy and outcomes. Weigh patients weekly, flag losses over ~5%, refer to dietitian early, and manage taste changes, dysphagia, and nausea with small frequent meals and symptom-directed medications.

For head & neck patients, discuss gastrostomy thresholds up front — a planned feeding tube beats an emergency placement.

Psychosocial support & distress screening

Screen every patient — distress is a vital sign

Screen with a validated tool (e.g., NCCN Distress Thermometer) at baseline and key transitions. Offer counseling, social work, financial navigation, and support groups; refer urgently for suicidal ideation or severe psychiatric distress.

Document the screen, the score, and the referral — untracked distress screening quietly becomes no screening.

On-table emergencies

Recognition, code activation, and coordinated response

Common events: falls, vasovagal syncope, seizures, hypoglycemia, cardiac arrest. Stay with the patient, call for help with a known code word, know where emergency equipment is, and rehearse the drill so roles are automatic. Do not move a patient with suspected fracture unless unsafe to stay.

Stop the machine, keep the patient on the couch if safe, and call for the physician and code team — speed of recognition is the intervention.

Oncologic emergencies

Spinal cord compression, SVC syndrome, hypercalcemia, tumor lysis

Red flags: new back pain with neuro deficit (cord compression — steroids + urgent RT), facial/arm swelling with dyspnea (SVC syndrome), confusion with high calcium (hypercalcemia — fluids + bisphosphonate), and metabolic collapse after chemo start (tumor lysis).

A new neurologic deficit in a patient with known metastases is an emergency until proven otherwise — escalate the same day.

Concurrent chemo considerations

Sensitizers amplify both efficacy and toxicity

Concurrent systemic therapy increases acute reactions — mucositis, cytopenias, fatigue. Verify blood counts per protocol, reconcile medications, watch for drug-specific effects, and coordinate timing between oncology and RT schedules.

Check the weekly count schedule before each fraction when cytopenia thresholds could hold treatment — document any hold decision.

Documentation & handoffs

If it is not documented, it did not happen

Record identifiers verified, setup and devices, imaging and shifts, dose delivered, deviations, skin scores, weights, symptoms, and patient conversations. Hand off plan, setup, and patient-specific needs at simulation and again on day one.

Chart in real time — end-of-day reconstruction is where errors and omissions are born.