Managing Side Effects of Radiation Therapy
Managing Side Effects of Radiation Therapy
Managing Side Effects of Radiation Therapy
Are Side Effects the Same for Everyone?
The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. Some people do experience serious side effects, however. The side effects that you have depend mostly on the radiation dose and the part of your body that is treated. Your general health also can affect how your body reacts to radiation therapy and whether you have side effects. Before beginning your treatment, your doctor and nurse will discuss the side effects you might experience, how long they might last, and how serious they might be.
Side effects may be acute or chronic. Acute side effects are sometimes referred to as “early side effects.” They occur soon after the treatment begins and usually are gone within a few weeks of finishing therapy. Chronic side effects, sometimes called “late side effects,” may take months or years to develop and usually are permanent.
The most common early side effects of radiation therapy are fatigue and skin changes. They can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, temporary or permanent hair loss may be a side effect of radiation treatment to the head. Appetite can be altered if treatment affects the mouth, stomach, or intestine. This chapter discusses common side effects first. Then the side effects that involve specific areas of the body are described.
Fortunately, most side effects will go away in time. In the meantime, there are ways to reduce discomfort. If you have a side effect that is especially severe, the doctor may prescribe a break in your treatments or change your treatment in some way.
Be sure to tell your doctor, nurse, or radiation therapist about any side effects that you notice. They can help you treat the problems and tell you how to lessen the chances that the side effects will come back. The information on this website can serve as a guide to handling some side effects, but it cannot take the place of talking with the members of your health care team.
Will Side Effects Limit My Activity?
Not necessarily. It will depend on which side effects you have and how severe they are. Many patients are able to work, prepare meals, and enjoy their usual leisure activities while they are having radiation therapy. Others find that they need more rest than usual and therefore cannot do as much. Try to continue doing the things you enjoy as long as you don’t become too tired.
Your doctor may suggest that you limit activities that might irritate the area being treated. In most cases, you can have sexual relations if you wish. You may find that your desire for physical intimacy is lower because radiation therapy may cause you to feel more tired than usual. For most patients, these feelings are temporary.
What Causes Fatigue?
Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It may be due to the disease itself or to treatment. It may also result from lowered blood counts, lack of sleep, pain, and poor appetite, coming in for your daily treatments.
Most people begin to feel tired after a few weeks of radiation therapy. During radiation therapy, the body uses a lot of energy for healing. You also may be tired because of stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells. Feelings of weakness or weariness will go away gradually after your treatment has been completed.
You can help yourself during radiation therapy by not trying to do too much. If you do feel tired, limit your activities and use your leisure time in a restful way. Save your energy for doing the things that you feel are most important. Do not feel that you have to do everything you normally do. Try to get more sleep at night, and plan your day so that you have time to rest if you need it. Several short naps or breaks may be more helpful than a long rest period.
Sometimes, light exercise such as walking may combat fatigue. Talk with your doctor or nurse about how much exercise you may do while you are having therapy. Talking with other cancer patients in a support group may also help you learn how to deal with fatigue.
If you have a full-time job, you may want to try to continue to work your normal schedule. However, some patients prefer to take time off while they’re receiving radiation therapy; others work a reduced number of hours. Speak frankly with your employer about your needs and wishes during this time. A part-time schedule may be possible or perhaps you can do some work at home. Ask your doctor’s office or the radiation therapy department to help by trying to schedule treatments with your workday in mind.
Whether you’re going to work or not, it’s a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors may be able to help by picking up groceries for you when they do their own shopping. You also could ask someone to drive you to and from your treatment visits to help conserve your energy.
How Are Skin Problems Treated?
You may notice that your skin in the treatment area is red or irritated. It may look as if it is sunburned, or tanned. After a few weeks your skin may be very dry from the therapy. Ask your doctor or nurse for advice on how to relieve itching or discomfort.
With some kinds of radiation therapy, treated skin may develop a "moist reaction," especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It’s important to notify your doctor or nurse if your skin develops a moist reaction. They can give you suggestions on how to care for these areas and prevent them from becoming infected.
During radiation therapy you will need to be very gentle with the skin in the treatment area. The following suggestions may be helpful:
- Avoid irritating treated skin.
- When you wash, use only lukewarm water and mild soap; pat dry.
- Do not wear tight clothing over the area.
- Do not rub, scrub, or scratch the skin in the treatment area.
- Avoid putting anything that is hot or cold, such as heating pads or ice packs, on your treated skin.
- Ask your doctor or nurse to recommend skin care products that will not cause skin irritation. Do not use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you’re being treated and for several weeks afterward unless approved by your doctor or nurse.
- Do not apply any skin lotions for 2 hours before a treatment.
- Avoid exposing the radiated area to the sun during treatment. If you expect to be in the sun for more than a few minutes you will need to be very careful. Wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunblocking lotions. After your treatment is over, ask your doctor or nurse how long you should continue to take extra precautions in the sun.
The majority of skin reactions to radiation therapy go away a few weeks after treatment is completed. In some cases, though, the treated skin will remain slightly darker than it was before and it may continue to be more sensitive to sun exposure.
What Can Be Done About Hair Loss?
Radiation therapy can cause hair loss, also known as alopecia, but only in the area being treated. For example, if you are receiving treatment to your hip, you will not lose the hair from your head. Radiation of your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after the treatments are finished. The amount of hair that grows back will depend on how much and what kind of radiation you receive. You may notice that your hair has a slightly different texture or color when it grows back. Other types of cancer treatment, such as chemotherapy, also can affect how your hair grows back.
Although your scalp may be tender after the hair is lost, it’s a good idea to cover your head with a hat, turban, or scarf. You should wear a protective cap or scarf when you’re in the sun or outdoors in cold weather. If you prefer a wig or toupee, be sure the lining does not irritate your scalp. The cost of a hairpiece that you need because of cancer treatment is a tax-deductible expense and may be covered in part by your health insurance. If you plan to buy a wig, it’s a good idea to select it early in your treatment if you want to match the color and style to your own hair.
How are Side Effects on the Blood Managed?
Radiation therapy can cause low levels of white blood cells and platelets. These blood cells normally help your body fight infection and prevent bleeding. If large areas of active bone marrow are treated, your red blood cell count may be low as well. If your blood tests show these side effects, your doctor may wait until your blood counts increase to continue treatments. Your doctor will check your blood counts regularly and change your treatment schedule if it is necessary.
Will Eating Be a Problem?
Sometimes radiation treatment causes loss of appetite and interferes with eating, digesting, and absorbing food. Try to eat enough to help damaged tissues rebuild themselves. It is not unusual to lose 1 or 2 pounds a week during radiation therapy. You will be weighed weekly to monitor your weight.
It is very important to eat a balanced diet. You may find it helpful to eat small meals often and to try to eat a variety of different foods. Your doctor or nurse can tell you whether you should eat a special diet, and a dietitian will have some ideas that will help you maintain your weight.
If it’s painful to chew and swallow, your doctor may advise you to use a powdered or liquid diet supplement. Many of these products are available at drugstores and supermarkets and come in a variety of flavors. They are tasty when used alone or combined with other foods such as pureed fruit, or added to milkshakes.
Some of the companies that make these diet supplements have recipe booklets to help you increase your nutrient intake. Ask your nurse, dietitian, or pharmacist for further information.
You may lose interest in food during your treatment. Fatigue from your treatments can cause loss of appetite. Some people just don’t feel like eating because of stress from their illness and treatment or because the treatment changes the way food tastes. Even if you’re not very hungry, it’s important to keep your protein and calorie intake high. Doctors have found that patients who eat well can better cope with having cancer and with the side effects of treatment.
The list below suggests ways to perk up your appetite when it’s poor and to make the most of it when you do feel like eating.
- Eat when you are hungry, even if it is not mealtime.
- Eat several small meals during the day rather than three large ones.
- Use soft lighting, quiet music, brightly colored table settings, or whatever helps you feel good while eating.
- Vary your diet and try new recipes. If you enjoy company while eating, try to have meals with family or friends. It may be helpful to have the radio or television on while you eat.
- Ask your doctor or nurse whether you can have a glass of wine or beer with your meal to increase your appetite. Keep in mind that, in some cases, alcohol may not be allowed because it could worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head, neck, or upper chest area including the esophagus.
- Keep simple meals in the freezer to use when you feel hungry.
- If other people offer to cook for you, let them. Don’t be shy about telling them what you’d like to eat.
- Keep healthy snacks close by for nibbling when you get the urge.
- If you live alone, you might want to arrange for "Meals on Wheels" to bring food to you. Ask your nurse or social worker or local social service agencies about "Meals on Wheels." This service is available in most large communities.
- If you are able to eat only small amounts of food, you can increase the calories per serving by:
- Adding butter or margarine.
- Mixing canned cream soups with milk or half-and-half rather than water.
- Drinking eggnog, milkshakes, or prepared liquid supplements between meals.
- Adding cream sauce or melted cheese to your favorite vegetables.
Some people find they can drink large amounts of liquids even when they don’t feel like eating solid foods. If this is the case for you, try to get the most from each glassful by making drinks enriched with powdered milk, yogurt, honey, or prepared nutritional ie. protein supplements.
Will Radiation Therapy Affect Me Emotionally?
Nearly all patients being treated for cancer report feeling emotionally upset at different times during their therapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Radiation therapy may affect your emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress.
You may find that it’s helpful to talk about your feelings with a close friend, family member, chaplain, nurse, social worker, or psychologist with whom you feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that might help you unwind and feel calmer.
Nationwide support programs can help cancer patients to meet others who share common problems and concerns. Some medical centers have formed peer support groups so that patients can meet to discuss their feelings and inspire each other.
There are several helpful books dealing with the emotional effects of having cancer.
What Side Effects Occur With Radiation Therapy to the Head and Neck?
Some people who receive radiation to the head and neck experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. Try not to let these symptoms keep you from eating.
Other problems that may occur during treatment to the head and neck are a loss of taste, which may diminish appetite and affect nutrition, and earaches (caused by hardening of ear wax).
You may notice some swelling or drooping of the skin under your chin as well as changes in the skin texture. Your jaw may also feel stiff and you may be unable to open your mouth as wide as before treatment. Jaw exercises may help ease this problem. Report all side effects to your doctor or nurse and ask what you should do about them.
If you are receiving radiation therapy to the head or neck, you need to take especially good care of your teeth, gums, mouth, and throat. Side effects from treatment to these areas commonly involve the mouth, which may be sore and dry.
Here are a few tips that may help you manage mouth problems:
- Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
- Remember that acidic foods and liquids can cause mouth and throat irritation.
- Don’t smoke, chew tobacco, or drink alcohol.
- Stay away from sugary snacks because they can promote tooth decay.
- Clean your mouth and teeth often, using the method your dentist or doctor recommends.
- Use only alcohol-free mouthwash; many commercial mouthwashes contain alcohol which has a drying effect on mouth tissues.
Radiation treatment for head and neck cancer can increase your chances of getting cavities in your teeth. Mouth care designed to prevent problems will be a very important part of your treatment. Before starting radiation therapy, make an appointment for a complete dental/oral checkup. Ask your dentist and radiation oncologist to consult before your radiation treatments begin.
Your dentist probably will want to see you often during your radiation therapy to help you care for your mouth and teeth. This is a good way to reduce the risk of tooth decay and help you deal with possible problems such as soreness of the tissues in your mouth. It’s important that you follow the dentist’s advice while you’re receiving radiation therapy.
Most likely, your dentist will suggest that you:
- Clean your teeth, gums and tongue thoroughly with a soft brush at least 4 times a day (after meals and at bedtime).
- Use a fluoride toothpaste that contains no abrasives – avoide toothpaste that contains mouthwash such as Scope or Listerine.
- Floss gently between teeth daily if you flossed regularly before your illness. Use waxed, non-shredding dental floss.
- Rinse your mouth gently and frequently with a salt and baking soda solution especially after you brush. Use 1/2 teaspoon of salt and 1/2 teaspoon of baking soda in a large glass of warm water. Follow with a plain water rinse.
- Apply fluoride regularly as prescribed by your dentist. Your dentist can explain how to mix the salt and baking soda mouthwash and how to use the fluoride treatment method that best suits your needs. You can probably get printed instructions for proper dental care at the dentist’s office. If dry mouth continues after your treatment is complete, you will need to continue the mouth care recommended during treatment. Always share your dentist’s instructions with your radiation nurse.
DEALING WITH MOUTH OR THROAT PROBLEMS
Soreness in your mouth or throat may appear in the second or third week of external radiation therapy and it will most likely have disappeared within a month or so after your treatments have ended. You may have trouble swallowing during this time because your mouth feels dry. Your doctor or dentist can prescribe medicine for mouth discomfort and tell you about methods to relieve other mouth problems during and following your radiation therapy. If you wear dentures you may notice that they no longer fit well. This occurs if the radiation causes your gums to swell. You may need to stop wearing your dentures until your radiation therapy is over. It’s important not to risk denture-induced gum sores because they may become infected and heal slowly.
Your salivary glands may produce less saliva than usual, making your mouth feel dry. Unfortunately dry mouth may continue to be a problem even after treatment is over. You may be given medication to help lessen this side effect. It’s helpful to sip cool drinks throughout the day. Although many radiation therapy patients have said that drinking carbonated beverages helps relieve dry mouth, water probably is your best choice. In the morning, fill a large container with ice, add water, and carry it with you during the day so that you can take frequent sips. Keep a glass of cool water at your bedside at night, too. Sugar-free candy or gum also may help; be careful about overuse of these products as they can cause diarrhea in some people. Avoid tobacco and alcoholic drinks because they tend to dry and irritate your mouth tissues. Moisten food with gravies and sauces to make eating easier. If these measures are not enough, ask your dentist, radiation oncologist, or nurse about products that either replace or stimulate your own saliva. Artificial saliva and medication to increase saliva production are available.
TIPS ON EATING
You may find that it’s difficult or painful to swallow. Some patients say that they feel as if something is stuck in their throat. Soreness or dryness in your mouth or throat can also make it hard to eat. The earlier section on eating problems on this page may be helpful. In addition, some of the following tips may help to make eating more comfortable:
- Choose foods that taste good to you and are easy to eat.
- Try changing the consistency of foods by adding fluids and using sauces and gravies to make them softer.
- Avoid highly spiced foods and textures that are dry and rough, such as crackers.
- Eat small meals, and eat more frequently than usual.
- Cut your food into small, bite-sized pieces.
- Ask your doctor for special liquid medicines to reduce the pain in your throat so that you can eat and swallow more easily.
- Ask your doctor about liquid food supplements that are easier to swallow than solids. They can help you get enough calories each day to avoid losing weight.
- If you are being treated for lung cancer, it’s important to keep mucus and other secretions thin and manageable; drinking extra fluids can help.
- If familiar foods no longer taste good, try new foods and use different methods of food preparation.
What Side Effects Occur With Radiation Therapy to the Chest?
Radiation treatment to the chest may cause several changes. For example, you may find that it is hard to swallow or that swallowing hurts. You may develop a cough or a fever. You may notice that when you cough the amount and color of the mucus is different. Shortness of breath is also common. Be sure to let your treatment team know right away if you have any of these symptoms. Remember that your doctor and nurse have seen these changes in many radiation patients and they know how to help you deal with them.
Are There Side Effects With Radiation Therapy for Breast Cancer?
The most common side effects with radiation therapy for breast cancer are fatigue and skin changes. However there may be other side effects as well. If you notice that your shoulder feels stiff, ask your doctor or nurse about exercises to keep your arm moving freely. Other side effects include breast or nipple soreness, swelling from fluid buildup in the treated area, and skin reddening or tanning. Except for tanning which may take up to 6 months to fade, these side effects will most likely disappear in 4 to 6 weeks.
If you are being treated for breast cancer and you are having radiation therapy after a lumpectomy or mastectomy, it’s a good idea to go without your bra whenever possible or, if this makes you more uncomfortable, wear a soft cotton bra without under-wires. This will help reduce skin irritation in the treatment area.
Radiation therapy after a lumpectomy may cause additional changes in the treated breast after therapy is complete. These long-term side effects may continue for a year or longer after treatment. The skin redness will fade, leaving your skin slightly darker, just as when a sunburn fades to a sun tan. The pores in the skin of your breast may be enlarged and more noticeable. Some women report increased sensitivity of the skin on the breast; others have decreased feeling. The skin and the fatty tissue of the breast may feel thicker and firmer than it was before your radiation treatment. Sometimes the size of your breast changes–it may become larger because of fluid buildup or smaller because of the development of scar tissue. Many women have little or no change in size.
Your radiation therapy plan may include temporary implants of radioactive material in the area around your lumpectomy. A week or two after external treatment is completed, these implants are inserted during a short hospitalization. The implants may cause breast tenderness or a feeling of tightness. After they are removed, you are likely to notice some of the same effects that occur with external treatment. If so, let your doctor or nurse know about any problems that persist.
Most changes resulting from radiation therapy for breast cancer are seen within 10 to 12 months after completing therapy. Occasionally small red areas called telangiectasias appear. These are areas of dilated blood vessels and the color may fade with time. If you see new changes in breast size, shape, appearance, or texture after this time, report them to your doctor at once.
What Side Effects Occur With Radiation Therapy to the Stomach and Abdomen?
If you are having radiation treatment to the stomach or some portion of the abdomen, you may have an upset stomach, nausea, or diarrhea. Your doctor can prescribe medicines to relieve these problems. Do not take any medications for these symptoms unless you first check with your doctor or nurse.
It’s not unusual to feel queasy for a few hours right after radiation treatment to the stomach or abdomen. Some patients find that they have less nausea if they have their treatment with an empty stomach. Others report that eating a light meal 1 to 2 hours before treatment lessens queasiness. You may find that nausea is less of a problem if you wait 1 to 2 hours after your treatment before you eat. If this problem persists, ask your doctor to prescribe a medicine (an antiemetic) to prevent nausea. If antiemetics are prescribed, take them within the hour before treatment or when your doctor or nurse suggests, even if you sometimes feel that they are not needed.
If your stomach feels upset just before every treatment, the queasiness or nausea may be caused by anxiety and concerns about cancer treatment. Try having a bland snack such as toast or crackers and apple juice before your appointment. It may also help to try to unwind before your treatment. Reading a book, writing a letter, or working a crossword puzzle may help you relax.
Here are some other tips to help an unsettled stomach:
- Stick to any special diet that your doctor, nurse, or dietitian gives you.
- Eat small meals.
- Eat often and try to eat and drink slowly.
- Avoid foods that are fried or are high in fat.
- Drink cool liquids between meals.
- Eat foods that have only a mild aroma and can be served cool or at room temperature.
- For severe nausea and vomiting, try a clear liquid diet (broth and clear juices) or bland foods that are easy to digest, such as dry toast and gelatin.
WHAT TO DO ABOUT DIARRHEA
Diarrhea may begin in the third or fourth week of radiation therapy to the abdomen or pelvis. You may be able to prevent diarrhea by eating a low fiber diet when you start therapy: avoid foods such as raw fruits and vegetables, beans, cabbage, and whole grain breads and cereals. Your doctor or nurse may suggest other changes to your diet, prescribe antidiarrhea medicine, or give you special instructions to help with the problem. Tell the doctor or nurse if these changes fail to control your diarrhea. The following changes in your diet may help:
- Try a clear liquid diet (water, weak tea, apple juice, clear broth, plain gelatin) as soon as diarrhea starts or when you feel that it’s going to start.
- Ask your doctor or nurse to advise you about liquids that won’t make your diarrhea worse. Weak tea and clear broth are frequent suggestions.
- Avoid foods that are high in fiber or can cause cramps or a gassy feeling such as raw fruits and vegetables, coffee and other beverages that contain caffeine, beans, cabbage, whole grain breads and cereals, sweets, and spicy foods.
- Eat frequent small meals.
- If milk and milk products irritate your digestive system, avoid them or use lactose-free dairy products.
- Continue a diet that is low in fat and fiber and lactose-free for 2 weeks after you have finished your radiation therapy. Gradually re-introduce other foods. You may want to start with small amounts of low-fiber foods such as rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast.
- Be sure your diet includes foods that are high in potassium (bananas, potatoes, apricots), an important mineral that you may lose through diarrhea.
Diet planning is very important for patients who are having radiation treatment of the stomach and abdomen. Try to pack the highest possible food value into every meal and snack so that you will be eating enough calories and vital nutrients. Remember that nausea, vomiting, and diarrhea are likely to disappear once your treatment is over.
What Side Effects Occur With Radiation Therapy to the Pelvis?
If you are having radiation therapy to any part of the pelvis (the area between your hips), you might have some of the digestive problems already described. You also may have bladder irritation which can cause discomfort or frequent urination. Drinking a lot of fluid can help relieve some of this discomfort. Avoid caffeine and carbonated beverages. Your doctor also can prescribe some medicine to help relieve these problems.
The effects of radiation therapy on sexual and reproductive functions depend on which organs are in the radiation treatment area. Some of the more common side effects do not last long after treatment is finished. Others may be long-term or permanent. Before your treatment begins, ask your doctor about possible side effects and how long they might last.
Depending on the radiation dose, women having radiation therapy in the pelvic area may stop menstruating and have other symptoms of menopause such as vaginal itching, burning, and dryness. You should report these symptoms to your doctor or nurse, who can suggest treatment.
EFFECTS ON FERTILITY
Scientists are still studying how radiation treatment affects fertility. If you are a woman in your childbearing years, it’s important to discuss birth control and fertility issues with your doctor. You should not become pregnant during radiation therapy because radiation treatment during pregnancy may injure the fetus, especially in the first three months. If you are pregnant before your therapy begins, be sure to tell your doctor so that the fetus can be protected from radiation, if possible.
Radiation therapy to the area that includes the testes can reduce both the number of sperm and their effectiveness. This does not mean that conception cannot occur, however. Ask your doctor or nurse about effective measures to prevent pregnancy while you are having radiation. If you have any concerns about fertility, be sure to discuss them with your doctor. For example, if you want to have children, you may be concerned about reduced fertility after your cancer treatment is completed. Your doctor can help you get information about the option of banking your sperm before treatment.
With most types of radiation therapy, neither men nor women are likely to notice any change in their ability to enjoy sex. Both sexes, however, may notice a decrease in their level of desire. This is more likely to be due to the stress of having cancer than to the effects of radiation therapy. Once the treatment ends, sexual desire is likely to return to previous levels.
During radiation treatment to the pelvis, some women are advised not to have intercourse. Others may find that intercourse is uncomfortable or painful. Within a few weeks after treatment ends, these symptoms usually disappear. If shrinking of vaginal tissues occurs as a side effect of radiation therapy, your doctor or nurse can explain how to use a dilator, a device that gently stretches the tissues of the vagina.
If you have questions or concerns about sexual activity during and after cancer treatment, discuss them with your nurse or doctor. Ask them to recommend booklets that may be helpful.