Proton beam therapy – adult/young adult (TYA): A guide for patients and their carers

Since 2018, The Christie has been treating patients in the first of only 2 high-energy NHS proton beam therapy (PBT) centres in the UK. We provide specialised treatment for UK patients with complex and hard-to-treat cancers, who would otherwise be required to have this treatment abroad at centres in either Europe or in the USA.

The Christie proton team will offer you as much support as possible. You have been assigned a specialist nurse or a specialist radiographer who will be your main point of contact and who will also provide help and support throughout your proton therapy planning and treatment.

Teenage and young adults will also be assigned a youth support coordinator who can offer practical and emotional support tailored to this age group. They also provide workshops, activities and organise social events for you to take part in with other young people.

Please let us know how you would like to be known, which pronoun(s) you use to describe yourself and anything else you think we might need to know to ensure you are well looked after and comfortable at The Christie.

What happens during treatment?

Proton beam therapy is given on an outpatient basis – 5 days a week over the course of several weeks. This may include weekends or bank holidays. Your doctor will discuss how long your treatment will be with you.

On the day of your first treatment, you will need to check in at the ground floor reception and one of the proton therapy support team will confirm your contact details and you will receive your appointment schedule.

You will be collected by a radiographer who will explain the treatment process and possible side effects again and confirm you are still happy to proceed with treatment. Please use this as an opportunity to ask any additional questions you may still have.

Your treatment

Before entering the treatment room, you will be taken to a cubicle to change into a gown if required. You will be asked to select some music/radio station which will be played during your treatment. You may also bring your own playlist/audiobook if you wish.

You’ll be taken to the treatment room and assisted onto the treatment bed. The radiographers will make you as comfortable as possible, whilst ensuring that you are in the correct position for treatment. If you have had a mask or cast made, this will be positioned as it was when you were scanned. All you need to do is remain as still as you can throughout the session.

Each session may take between 20 to 90 minutes to complete, depending on the area being treated. Most of this time is used to confirm you are in a suitable position for treatment using X-rays. The radiographers will remain in the treatment room with you until they are ready to deliver treatment. They will then move to the control area and monitor you on a series of cameras.

There can be a delay before the treatment starts because the beam is shared between 3 treatment rooms, but the radiographers will update you over the intercom when the treatment is about to start. There is nothing to see or feel when the machine is delivering the treatment; however, you may hear a buzzing noise.

Cameras inside the room give the radiographers a clear view of you at the control desk. They are watching you all the time and if required can stop the machine and come in immediately. Once treatment is finished, the radiographers will help you off the treatment couch.

The Christie is a training hospital, so you may meet students in the department who may be involved in the delivery of your treatment. If you have any objections to students being present, please let the radiographers know.

Side effects

Side effects from your proton beam therapy will vary depending on where on the body you are being treated. Even people who have had very similar treatments can have different side effects.

During the consent process, your doctor will explain the potential side effects of your treatment and ask you to sign a consent form. This consent form will contain all potential side effects discussed, and you will receive a copy to take home. Please contact your specialist nurse or radiographer if, at any point, you have more questions.

Most people notice the side effects during the second half of their course of treatment. These may well continue after you have finished your treatment, but they should gradually reduce 4 to 6 weeks after treatment.

You will be supported throughout your treatment by your proton team. If you are experiencing any side effects, please mention this to the team as in most cases these can be managed with medication.

The Christie Hotline is available 24 hours a day, 7 days a week for urgent support and specialist advice on 0161 446 3658. Please call 999 immediately if you experience chest pain or difficulty in breathing.

Machine unavailability

During your treatment, there may be occasions where the machine is not available to deliver your treatment. This can be due to several reasons:

  • Machine breakdown
  • Planned machine service
  • Bank holiday

Machine breakdowns

Machine breakdowns are unexpected and unavoidable. When this happens, we will always try to deliver your treatment that day with protons, but due to the complexity of the machine this is not always possible.

Your consultant will be informed and kept up-to-date with the situation. A plan of action, specific to each individual patient, will be made to account for the missed treatment. This may include:

  • Adding the missed treatment/s to the end of your treatment schedule.
  • Treating you twice in one day with a minimum 6-hour gap between treatments.
  • Treating you on our monthly Saturday catch up session.

If the breakdown lasts for longer than one day, or there is more than one breakdown during treatment, we may consider treating you with photon (X-ray) therapy in the radiotherapy department. If this treatment option is deemed appropriate for your tumour type, this will have been discussed with you during your initial proton consultation, and you will have signed an additional consent form specifying this.

This decision is made by your consultant and is decided on an individual basis, taking in to account your tumour type and any treatments missed so far.

Planned maintenance

For planned machine maintenance, and some bank holidays, we will treat you on a Saturday or Sunday to make up for the missed treatment. You will be informed of these dates in advance.

Please do not book public transport to return home immediately following treatment, as any of the delays detailed above could have an impact on when you finish your treatment.

Health and wellbeing

It is important to look after your general health as much as possible during your treatment. This can minimise the side effects of your treatment and allow you to continue doing the things you enjoy.

Eating a balanced diet and keeping active can help you to maintain muscle strength, keep energy levels high and aid your recovery. Please keep in mind that your proton beam therapy plan has been tailored to your current weight/ shape. It is important that you do not intentionally attempt to gain or lose significant weight during your treatment.

Smoking and alcohol consumption during treatment can negatively impact any side effects experienced and may affect the outcome of cancer treatment itself. Smoking and alcohol cessation and alcohol advice services are available to help you stop or reduce your intake.

Please contact your specialist nurse/radiographer should you need any more information.

Sexual health

You must not be/ become pregnant during proton beam therapy as this could result in significant harm to an unborn child and cause delays to your treatment that could potentially impact its effectiveness. If you suspect you could be pregnant, you should notify your treatment team immediately.

  • If you are receiving chemotherapy, you must use a barrier method of contraception (condoms and dams) as chemotherapy can be passed from one individual to another via bodily fluids.
  • Some cancer treatments can leave you susceptible to bleeding and infections. It is important to speak to a member of staff about any precautions to follow if you want to have sex while you are on treatment.
  • If you suspect that you may have contracted a sexually transmitted infection (STI) please speak to your specialist nurse/ radiographer so that you can be supported to access the appropriate advice and treatment. Do not start treatment for an STI without speaking to a member of staff.

For general contraceptive advice, please call The Hathersage Centre in Manchester on 0161 701 1555 or via their website. If you choose to speak to them directly, please tell them if you are on active treatment as their advice may differ.

End of treatment

Once your course of treatment has been completed, a letter will be sent to you, your GP and your local team with treatment details including side effects.

Follow up is at 6 weeks, 6 months and then annually for 5 years. The Christie team will be following up on the effects specifically of the proton beam therapy. Your local team will be responsible for organising routine follow up appointments, scans and any further treatment if required.

If you have not received an oncology follow-up appointment within 4 weeks of completing proton beam therapy, please contact the secretary of your Christie proton therapy consultant or alternatively via The Christie switchboard on 0161 446 3000.

If you have any problems or concerns after treatment, please contact your specialist nurse / radiographer; however, if you feel unwell and need urgent medical attention, please contact your GP, out of-hours GP or in an emergency the Accident and Emergency Department (999).

For the first month following proton beam therapy you can also contact The Christie Hotline (24 hours) on 0161 446 3658.

Useful contact numbers

  • Ground floor main reception: 0161 918 7577
  • Second floor clinic reception: 0161 918 3600
  • Scheduling team: 0161 918 7170
  • Specialist nurse/radiographer – head and neck/sarcoma/others: 0161 918 7232
  • Specialist nurse/radiographer – neuro/base of skull: 0161 918 7235
  • Youth support coordinator: 0777 4332 560
  • The Christie Pharmacy: 0161 446 3433
  • Ambulance hospital transport service for in-area patients: 0161 446 8114 or 8143
  • The Christie Hotline – Available 24 hours a day, 7 days a week: 0161 446 3658

Support services

The following support services will be offered to you if needed:

  • Speech and language therapy – provides support for disorders of swallowing and communication.
  • Physiotherapy – supports patients to maintain physical activity and function.
  • Occupational therapy – provides practical support to help essential day-to-day tasks that will increase independence and quality of life.
  • Dietetics – specialise in assessing, managing and treating nutritional problems and giving dietary advice, including help with using feeding tubes.
  • Robs Day Unit (Palatine outpatients) – For patients aged 16-24 who require day case chemotherapy, injections and transfusions. This is by appointment only and your specialist nurse/radiographer will arrange this for you. Patients are encouraged to use the social hubs on the first and second floors of Palatine outpatients where they can join in with activities and events to help pass the day.
  • Ambulatory care – some patients aged 16 to 24 who require chemotherapy over a few days are eligible for ambulatory treatment. This means you will be able to go home or to your accommodation with a small electronic pump rather than staying on an inpatient ward. Your specialist nurse/ radiographer will arrange this for you.

The following support services are available at the proton beam therapy centre upon request, please discuss with your named specialist nurse/radiographer.

  • Complementary health and wellbeing – uses a holistic approach to support emotional, psychological and physical wellbeing. Support is available for a variety of conditions such as: anxiety, panic attacks, insomnia, claustrophobia and alcohol and smoking cessation.
  • Chaplaincy – The chaplaincy and spiritual care team help people of any faith, or no faith, with their religious, spiritual or pastoral needs. This includes holding regular Christian and Muslim worship.

Last updated: April 2024