Not all patients experience side effects from radiation therapy. However, your radiation oncologist will carefully go over what side effects you might expect, how long they will last, how serious they might be, and how best to relieve symptoms.
Some side effects become apparent during the course of treatment. Others, because of the cumulative nature of radiation, may not appear until after treatments have finished.
Typical side effects during treatment include fatigue, skin changes, and loss of appetite. These can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, hair loss may be a side effect of radiation treatment to the head. Side effects tend to go away with time.
During the course of treatment and after treatment, inform your doctor, nurse, or radiation therapist if you are experiencing side effects. They can help you treat the problems and inform you how to lessen the chance of the problems recurring.
Are Side Effects the Same For Everyone?
Side effects vary by person. You may have none, a few mild ones, or more serious side effects. Side effects depend mostly on the treatment dose and which part of your body is being treated. Your general health also can affect how your body reacts to radiation therapy. Side effects are also typically greater if chemotherapy is used at the same time as radiotherapy.
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 within a few weeks of finishing therapy. Chronic, or long-term, side effects may take months or years to develop and are sometimes permanent. Treatment is planned so that the risk of these long-term side effects is rare.
Most side effects go away with time. Your doctor and nurse can give you ideas for treating or reducing the discomfort of side effects. If you experience a particularly severe side effect, your doctor may prescribe a break in your treatments or change the kind of treatment you are receiving.
Will Side Effects Limit My Activity?
Not necessarily. Most patients are able to go to work, take care of their daily needs, and enjoy leisure activities while they are receiving radiation therapy. Others find they need more rest than usual. You are encouraged to try to do things you enjoy as long as you do not become too tired.
If you work a full-time job, you may want to continue. However, treatment visits can be time consuming. You may ask your radiation therapy department to try to schedule treatments with your workday in mind. While receiving treatment, you may decide to take a few weeks off work, or work a reduced schedule; our clinics will happily provide any necessary paperwork to facilitate this. You are encouraged to speak frankly with your employer about your care and your needs. You may be able to do some work at home. If your job requires lifting or heavy physical activity, you may need to change your activities until you have regained your strength.
Whether you are working or not, it is a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors can help by picking up groceries for you when they do their own shopping. To conserve your energy, you could ask someone to drive you to and from your treatment visits.
Your doctor may suggest you limit activities that might irritate the area being treated. In most cases, you can have sexual relations. But because radiation therapy may cause fatigue, your desire for physical intimacy may lessen. For most patients, these feelings are temporary.
What Causes Fatigue?
During radiation therapy, the body uses significant energy healing itself. Illness-related stress, daily trips to the clinic for treatment, and the effects of radiation on normal cells all contribute to fatigue. Most people begin to feel tired after two to three weeks of radiation therapy. Gradually, this weakness or weariness should dissipate after your treatment is finished.
Help yourself during radiation therapy by not trying to do too much. If you feel tired, limit your activities. Use 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.
How Are Skin Problems Treated?
Over the course of your radiation treatments, your skin in the treatment area may become red, irritated, sunburned, tanned, or dry. Your doctor or nurse will have advice on how to relieve any itching or discomfort.
In some cases, particularly in areas where there are skin folds, you may experience a “moist reaction.” This is when the skin becomes especially wet and sore. It is 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.
Be very gentle with your skin, and avoid irritating areas being treated. When you wash, use only lukewarm water and mild soap. Try to avoid tight clothing over the area. Try not to rub or scratch any sensitive spots. Also, avoid putting anything that is very hot or very cold, such as heating pads or ice packs, on your treated skin.
Avoid any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you are being treated and for several weeks afterwards, unless approved by your doctor or nurse. Many skin products leave a coating on the skin that may interfere with your therapy or healing.
Avoid long sun exposures to the area being treated for at least one year after your treatment is complete. If you expect to be in the sun for more than a few minutes, wear protective clothing, such as a hat with a broad brim and a shirt with high neck, and use sunscreen. Ask your doctor or nurse about sunscreen 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, but only in the treated area. For example, if you receive treatment to your hip, you will not lose hair from your head. Radiation to your head, however, may cause you to lose some or all of the hair on your scalp.
Many patients find that their hair grows back once the treatments are finished. But accepting hair loss, 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. Chemotherapy can also affect hair loss and regrowth.
You may want to cover your head with a hat, turban, or scarf, especially while out in the sun. If you prefer a wig or toupee, be sure the lining does not irritate your scalp.
A hairpiece is tax deductible if used because of cancer treatment and may be covered in part by your health insurance. If you plan to buy a wig, it is a good idea to select it early in your treatment so you can match the color and style to your own hair.
How Do I Manage Nausea?
Some patients report feeling queasy for a few hours after radiation therapy. This type of side effect may be related to your emotions and concerns about treatment. Try to unwind before having treatment by reading a book, writing letters, or working on a crossword puzzle.
If you have this problem, try not eating for several hours before your treatment time. You may be able to handle your treatment better on an empty stomach. Or try a bland snack of toast or crackers and apple juice.
After treatment, you may want to wait one to two hours before eating again. If the problem persists, ask your doctor to prescribe a medicine to prevent nausea.
Here are some tips to help an unsettled stomach:
- Stick to any special diet that your doctor or dietician gives you.
- Eat small meals.
- Eat often, and try to eat and drink slowly.
- Avoid foods that are fried or 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.
What if I Experience Eating Problems During Treatment?
Some side effects from radiation therapy can cause problems with eating and digesting food. You may lose your appetite or have pain when you chew or swallow. Because proper nutrition can help your damaged tissue repair itself, you will want to pay special attention to your diet.
One idea is to eat small meals often and to eat a variety of foods. Your doctor or nurse can tell you whether your treatment calls for a special diet. If you are losing weight, a dietitian can offer ideas to help you build and maintain your weight.
There are a number of diet guides available to help with your short-term eating problems. Eating Hints, a booklet published by NCI, offers excellent advice on how to maximize calories and protein without eating larger quantities, and tips to help you enjoy eating. Recipes are for the whole family and are marked for people with special concerns, such as lactose intolerance.
If you have pain when you chew and swallow, your doctor may advise a powdered or liquid diet supplement. Many of these products, available at the drugstore without prescription, come in a variety of flavors. Tasty when used alone, they can also be combined with other foods, such as pureed fruit, or added to milkshakes. Some come with their own recipe booklets. Ask your dietitian or pharmacist for more information.
Loss of appetite can result when changes occur in normal cells. Stress, and the treatments themselves, may cause you to lose your appetite. Even if you are not very hungry, it is 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.
This list suggests ways to perk up your appetite when it is 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, 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 throat or chest region.
- When you feel up to it, make some simple meals in batches and freeze them for later.
- Keep healthy snacks close by for nibbling.
- If other people offer to cook for you, let them. And do not be shy about telling them what you would like.
- 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.
- If you can only eat small amounts, increase your calories per serving by adding butter or oil to your meal. Or rather than water, try mixing milk or half-and-half into canned creamed soup.
- Add more calories by drinking milkshakes, eggnog, 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 do not 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.
Tips on Food Preparation and Eating
If you are having radiation therapy to the throat or 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 also 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 soften them.
- 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 make eating and swallowing easier by reducing swallowing discomfort.
- 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.
In addition, you can find many helpful suggestions in the NCI booklet Eating Hints.
How Do I Handle Mouth or Throat Problems?
Soreness in your mouth or throat is common with treatments to the head and neck region and may appear in the second or third week of external radiation therapy. It will likely end a month or so after treatment ends.
During this time, you may have trouble swallowing because of a dry mouth. Your doctor or dentist can prescribe medicine for mouth discomfort and advise you on methods to relieve other mouth problems.
If you wear dentures, you may notice they no longer fit. This may happen if radiation causes swelling in your gums. It is important not to let your dentures cause gum sores that may become infected. You may need to stop wearing your dentures until radiation therapy is over.
Your salivary glands may produce less saliva than usual, making your mouth feel dry. Here are some tips for dry mouth:
- It is helpful to sip cool drinks throughout the day. Water may be 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.
- Many radiation therapy patients say that drinking carbonated beverages helps relieve dry mouth.
- Sugar-free candy or gum may also help.
- Avoid tobacco and alcoholic drinks. They dry and irritate mouth tissues.
- 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.
Radiation treatment for head and neck cancer can increase your chances of getting cavities. Mouth care will be a very important part of your treatment.
Before starting radiation therapy, our clinics will assist you in notifying your dentist and arranging for a complete dental/oral checkup. Your radiation oncologist will consult with your dentist to ensure radiation treatments may safely begin.
Your dentist will probably 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 soreness of your mouth.
You may be asked to clean teeth and gums thoroughly with a soft toothbrush after meals and at least once more each day.