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Radiation Therapy and You
Managing Side Effects
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. Or you may have
more serious side effects. The side effects that you have depend mostly on the treatment
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, ask your doctor and nurse about the side effects you might experience, how
long they might last, and how serious they might be.
There are two main types of side effects: acute and chronic. Acute, or short-term, side
effects occur close to the time of the treatment and usually are gone completely within a
few weeks of finishing therapy. Chronic, or long-term, side effects may take months or
years to develop and usually are permanent.
The most common side effects are fatigue, skin changes, and loss of appetite. 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. This chapter discusses common side effects first. Then
side effects involving specific body parts are described.
Fortunately, most side effects will go away in time. In the meantime, there are ways to
reduce the discomfort they cause. If you have a side effect that is particularly severe,
the doctor may prescribe a break in your treatments or change the kind of treatment you're
receiving.
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 in this document can serve as a guide to
handling some side effects, but it cannot replace talking with your health care team.
Will Side Effects Limit My Activity?
- Not necessarily. It will depend on what side effects you have and how severe they are.
Many patients are able to go to work, keep house, and enjoy leisure activities while they
are receiving radiation therapy. Others find that they need more rest than usual and
therefore cannot do as much. You should try to do 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. Your desire for
physical intimacy may be lower because radiation therapy may cause you to feel more tired
than usual. For most patients, these feelings are temporary. (See Sexual Relations.)
What Causes Fatigue?
- During radiation therapy, the body uses a lot of energy healing itself. Stress related
to your illness, daily trips for treatment, and the effects of radiation on normal cells
all may contribute to fatigue. Most people begin to feel tired after a few weeks of
radiation therapy. Feelings of weakness or weariness will go away gradually after your
treatment is finished.
You can help yourself during radiation therapy by not trying to do too much. If you feel
tired, limit your activities and use your leisure time in a restful way. Do not feel that
you have to do all the things you normally do. Try to get more sleep at night, and rest
during the day if you can.
If you have been working a full-time job, you may want to continue. Treatment visits are
time consuming. You can ask your doctor's office or the radiation therapy department to
help by trying to schedule treatments with your workday in mind.
Some patients prefer to take a few weeks off from work while they're receiving radiation
therapy; others work a reduced number of hours. You may want to speak frankly with your
employer about your needs and wishes during this time. You may be able to agree on a
part-time schedule. Perhaps you can do some work at home.
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 may begin to look reddened,
irritated, sunburned, or tanned. After a few weeks you may have very dry skin from the
therapy. Ask your doctor or nurse for advice on relieving 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 keep these areas dry. (See Helpful Tips)
During radiation therapy you will need to be very gentle with the skin in the treatment
area. Avoid irritating treated skin. When you wash, use only lukewarm water and mild soap.
Don't wear tight clothing over the area. It's important not to rub, scrub, or scratch any
sensitive spots. Also avoid putting any thing that is very hot or very cold, such as
heating pads or ice packs, on your treated skin. Don't 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 week afterward (unless approved by your doctor or
nurse). Many skin products can leave a coating on the skin that may interfere with
radiation therapy or healing.
Avoid exposing the area to the sun during treatment and for at least 1 year after your
treatment is completed. 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.
The majority of skin reactions to radiation therapy should go away a few weeks after
treatment is finished. In some cases, though, the treated skin will remain darker than it
was before.
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. However, radiation to 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, but accepting the loss of hair-whether from scalp, face, or body-can be a
hard adjustment. The amount of hair that grows back will depend on how much radiation you
receive and the type of radiation treatment your doctor recommends. Other types of
treatment, such as chemotherapy, also can affect how your hair grows back. For example, if
your radiation therapy is for palliative care, your hair probably will grow back slowly.
However, if the goal of your radiation therapy is to cure rather than to relieve the
symptoms of your cancer, then your hair may not grow back, and if it does, it probably
will be very fine.
Although your scalp may be tender after the hair is lost, you may want to cover your head
with a hat, turban, or scarf while you're in treatment. Also, you should wear a protective
cap or scarf when you're in the sun. If you prefer a wig or toupee, be sure the lining
does not irritate your scalp. 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 so that you can match the
color and style to your own hair.
What About Side Effects on the Blood?
- Sometimes radiation therapy can cause low white blood cell counts or low levels of
platelets. These blood cells help your body fight infection and prevent bleeding. If your
blood tests show this side effect, treatment might be delayed for about a week to allow
your blood counts to increase.
What if There Are Eating Problems?
- Many side effects can cause problems with eating and digesting food, but you always
should try to eat enough to help damaged tissues rebuild themselves. It's very important
not to lose weight during radiation therapy. Try to eat small meals often and eat a
variety of different foods. Your doctor or nurse can tell you whether your treatment calls
for a special diet, and a dietitian will have a lot of ideas to help you maintain your
weight.
Coping with short-term diet problems may be easier than you expect. There are a number of
diet guides and recipe booklets for patients who need help with eating problems. An NCI
booklet, Eating Hints, tells how to get more calories and protein without eating more food
and provides further tips to help you enjoy eating. The recipes it contains can be used
for the whole family and are marked for people with special concerns, such as low-salt
diets. (See Resources.)
If you have pain when you chew and swallow, your doctor may advise you to use a powdered
or liquid diet supplement. Many of these products, available at the drugstore without
prescription, are made 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 diet supplements have produced recipe booklets to help you increase
your nutrient intake. Ask your dietitian or pharmacist for further information.
You may lose interest in food during your treatment. Loss of appetite can happen when
changes occur in normal cells. Some people just don't feel like eating because of stress
from their illness and treatment or because the treatment changes the way foods taste.
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 handle both their cancer
and 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, or turn on the radio or television.
- 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 or neck. (See more information on effects to the mouth and throat)
- When you feel up to it, make some simple meals in batches and freeze them to use later.
- Keep healthy snacks close by for nibbling when you get the urge.
- If other people offer to cook for you, let them. And don't be shy about telling them
what you'd like to eat.
- If you live alone, you might want to arrange for "Meals on Wheels" to bring
food to you. Ask your doctor, nurse, local American Cancer Society office, or Cancer
Information Service about "Meals on Wheels." This service is active in most
large communities.
- Add butter or margarine if you like the flavor.
- Mix canned cream soups with milk or half-and-half rather than water.
- Drink eggnog, milkshakes, or prepared liquid supplements between meals.
- Add cream sauce or melted cheese to your favorite vegetables.
- Some people find they can handle 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 liquid supplements.
Does Radiation Therapy Affect the Emotions?
- Nearly all patients treated for cancer feel some degree of emotional upset. It's not
unusual to feel depressed, afraid, angry, frustrated, alone, or helpless. Radiation
therapy may affect the emotions indirectly through fatigue or changes in hormone balance,
but the treatment itself is not a direct cause of mental distress.
Many patients help themselves by talking about their feelings with a close friend, family
member, chaplain, nurse, social worker, or psychologist with whom they feel at ease. You
may want to ask your doctor or nurse about meditation or relaxation exercises that could
help you unwind and feel better.
American Cancer Society nationwide programs can provide support. Groups such as the United
Ostomy Association and the Lost Chord Club offer opportunities to meet with others who
share the same 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 and other materials on this subject. The Cancer
Information Service can direct you to reading matter and other resources in your area.
(See Resources)
What Side Effects Occur With Radiation Therapy
to the Head and Neck Area?
- Some people who receive radiation to the head and neck experience redness and irritation
in the mouth, a dry mouth, 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,
earaches (caused by hardening of ear wax), and swelling or drooping of skin under the
chin. There may be changes in your skin texture. Your jaw may also feels stiff and you may
be unable to open your mouth as wide as before your treatment. Jaw exercise may help this
problem. Report any 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 you teeth, gums, mouth, and throat. Side effects from treatment to these
areas most often 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.
- Don't smoke, chew tobacco, or drink alcohol.
- Stay away from sugary snacks that promote tooth decay.
- Clean your mouth and teeth often, using the method your dentist or doctor recommends.
- Do not use a commercial mouthwash; the alcohol content has a drying effect on mouth
tissues.
- Dental Care
- Radiation treatment for head and neck cancer can increase your chances of getting
cavities. Mouth care designed to prevent problems will be a very important part of your
treatment. Before starting radiation therapy, notify your dentist and arrange for a
complete dental/oral checkup. Ask your dentist to consult with your radiation
oncologist before your radiation treatments begin.
Your dentist probably will want to see you often over the course of your radiation therapy
to give you detailed instructions about caring for your mouth and teeth to reduce the risk
of tooth decay and help deal with possible problems such as soreness of the tissues in
your mouth. It is important to your total well-being that you follow the dentist's advice
while you're receiving radiation therapy. Most likely, you will be advised to:
- Clean teeth and gums thoroughly with a soft brush after meals and at least once more
each day.
- Use a fluoride toothpaste that contains no abrasives.
- Floss gently between teeth daily, especially if you flossed regularly before your
illness.
- Use a disclosing solution or tablet after brushing to reveal plaque that you've missed.
- Rinse your mouth well with a salt and baking soda solution after you brush. Use 1/2
teaspoon of salt and 1/2 teaspoon of baking soda in 1 quart of water.
- Apply fluoride regularly as prescribed
by your dentist.
- Your dentist can explain how to use disclosing tablets, how to mix the salt and baking
soda mouthwash, and how to use the fluoride treatment method that best suits your needs.
Most likely you can get printed instructions for proper dental care at the dentist's
office.
- Handling Mouth or Throat Problems
- Soreness in your mouth or throat may appear in the second or third week of external
radiation therapy. It is likely to decrease from the fifth week on and end a month or so
after your treatment ends. You may have trouble swallowing during this time because your
mouth feels dry. Your doctor or dentist can prescribe medicine for mouth discomfort and
advise you about methods to relieve other mouth problems.
If you wear dentures you may notice that they no longer fit well. This may happen if the
radiation causes swelling in your gums. It's important not to let your dentures cause gum
sores that may become infected. You may need to stop wearing your dentures until your
radiation therapy is over.
Your glands may produce less saliva than usual, making your mouth feel dry. It's helpful
to sip cool drinks often throughout the day. Water probably is your best choice. In the
morning, fill up a large cup or glass with ice, add water, and carry it with you so you
have something to drink during the day. Keep a glass of cool water at your bedside at
night, too. Many radiation therapy patients say that drinking carbonated beverages helps
relieve dry mouth. Sugar-free candy or gum also may help. Avoid tobacco and alcoholic
drinks because they will dry and irritate your mouth tissues even more. Moisten food with
gravies and sauces to make eating easier. If these measures are not enough, ask your
dentist about artificial saliva. Dry mouth may continue to be a problem even after
treatment is over.
- Tips on Eating
- If you are having radiation therapy to the chest, you may find swallowing difficult or
painful. Some patients say that it feels like something is stuck in their throat.
Soreness or dryness in your mouth or throat can make it hard to eat. However, there are
several ways to ease your discomfort:
- 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 that can help you eat and swallow more
easily by reducing the pain in your throat.
- Ask your doctor about liquid food supplements. These can help you meet your energy
needs.
- If you are being treated for lung cancer, and you get your doctor's okay, try to drink
extra fluids. This will help keep mucus and other secretions thin and manageable.
- If your sense of taste changes during radiation therapy, try different methods of food
preparation.
- Also, many helpful suggestions can be found in the NCI booklet, Eating Hints.
(See Resources)
What Side Effects Occur With Radiation Therapy
to the Breast and Chest?
- Radiation treatment to the chest may cause several changes. You will notice some of
these changes yourself, and your treatment team will keep an eye on these and others. For
example, you may find that it is hard to swallow or that swallowing hurts. You may develop
a cough. Or you may develop a fever, notice a change in the color or amount of mucus when
you cough, or feel short of breath. It is important to let your treatment team know right
away if you have any of these symptoms. Your doctor also may check your blood counts
regularly, especially if the radiation treatment area on your body is large. Just keep in
mind that your doctor and nurse will be alert for these changes and help you deal with
them.
If you are receiving radiation therapy after a lumpectomy or mastectomy, it's a good idea
to go without wearing a bra whenever possible. If this is not possible, wear a soft cotton
bra without underwires. This will help reduce the irritation to your skin in the treatment
area. You may have several other side effects if you are receiving radiation therapy for
breast cancer. For example, you may notice a lump in your throat or develop a dry cough.
Or, your shoulder may feel stiff; if so, ask your doctor or nurse about exercises to keep
your arm moving freely. Other side effects that may appear are breast soreness and
swelling from fluid buildup in the treated area. These side effects, as well as skin
reddening or tanning, most likely will disappear in 4 to 6 weeks. If fluid buildup
continues to be a problem, your doctor will tell you what steps to take.
Women who have radiation therapy after a lumpectomy may notice other changes in the breast
after therapy. These long-term side effects may continue for a year or longer after
treatment. The redness of the skin will fade, and your skin may be slightly darker, just
as when a sunburn fades to a sun tan. The pores 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 fibrous
tissue. Many women have little or no change in size.
Your radiation therapy plan may include implants of radioactive material a week or two
after external treatment is completed. 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, follow the advice given above and let
your doctor know about any problems that persist.
After 10 to 12 months, no further changes are likely to be caused by the radiation
therapy. 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 to deal with an upset stomach, nausea, or diarrhea. Your doctor can prescribe
medicines to relieve these problems. Do not take any home remedies during your treatment
unless you first check with your doctor or nurse.
- Managing Nausea
- Some patients report feeling queasy for a few hours right after radiation therapy to the
stomach or abdomen. If you have this problem, do not eat for several hours before your
treatment time. You may be able to handle the treatment better on an empty stomach. After
treatment, you may find it helpful to wait 1 to 2 hours before eating again. If the
problem persists, ask your doctor to prescribe a medicine (an antiemetic) to prevent nausea. If antiemetics
are prescribed, try to take them when your doctor suggests, even if you sometimes feel
that they are not needed.
If your stomach feels upset just before your treatment, eat a bland snack such as toast or
crackers and apple juice before your appointment. This type of side effect may be related
to your emotions and concerns about treatment. Try to unwind a bit before you have your
treatment. Reading a book, writing letters, or working a crossword puzzle may help you
relax. - Here are some tips to help an unsettled stomach:
- Stick to any special diet that your doctor 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 a severe upset stomach, try a clear liquid diet (broth and juices) or bland foods
that are easy to digest, such as dry toast and gelatin.
- How To Handle Diarrhea
- Diarrhea most often begins in the third or fourth week of radiation therapy. Your doctor
may suggest you change your diet, prescribe 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 also 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. Apple juice, peach nectar, 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, beans, cabbage, whole grain breads and cereals, sweets, and
spicy foods.
- Eat frequent small meals.
- Avoid milk and milk products if they irritate your bowels.
- When the diarrhea starts to improve, try eating 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 a very important part of radiation treatment of the stomach and
abdomen. Keep in mind that these problems will be reduced greatly when treatment is over.
In the meantime, try to pack the highest possible food value into even small meals so that
you will have enough calories and vital nutrients.
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 one or more of the digestive problems already described. You also
may have some irritation to your bladder. This can cause discomfort or frequent urination.
Drinking fluids can help relieve some of your discomfort. Your doctor can prescribe some
medicine to deal with these problems.
There are also certain side effects that occur only in the reproductive organs. The
effects of radiation therapy on sexual and reproductive functions depend on which organs
are treated. Some of the more common side effects for both men and women do not last long
after treatment. Others may be long-term or permanent. Before your treatment begins, ask
your doctor about possible side effects and how long they might last.
- Effects on Fertility
- Scientists are still studying how radiation treatment affects fertility. If you are a
women in your childbearing years, you should discuss birth control measures with your
doctor. It is not a good idea to become pregnant during radiation therapy. Radiation may
injure the fetus. In addition, pregnancy, childbirth, and caring for a very young child
can add to the physical and emotional stress of having cancer. If you are pregnant before
beginning radiation therapy, special steps should be taken to protect the fetus from
radiation.
Depending on the radiation dose, women having radiation therapy in the pelvic area may
stop menstruating and may have other symptoms of menopause. Treatment also can result in
vaginal itching, burning, and dryness. You should report these symptoms to your doctor or
nurse, who can suggest treatment.
For men, radiation therapy to an area that includes the testes can reduce both the number
of sperm and their effectiveness. This does not mean that conception cannot occur,
however. If you're having this type of treatment, discuss your concerns and your birth
control measures with your doctor. If you want to father a child and are concerned about
reduced fertility, you can look into the option of banking your sperm before treatment.
Sexual Relations - During treatment to the pelvis, some women are advised not to have intercourse. Others
may find that intercourse is painful. You most likely will be able to resume having sex
within a few weeks after your treatment ends.
Some shrinking of vaginal tissues occurs during radiation therapy. After your radiation
therapy is finished your doctor will advise you about sexual intercourse and how to use a
dilator, a device that gently stretches the tissues of the vagina.
With most types of radiation therapy, neither men nor women are likely to suffer 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. This effect most likely will go away when the treatment
ends, so it should not become a major concern. A booklet on sexuality and cancer is
available without charge from your local American Cancer Society office. There are
different versions for male and female patients.
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