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What are the potential side effects of radiation?

Not all patients experience side effects from radiation therapy. However, your radiation oncologist will carefully go over any side effects you could 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, and skin changes. 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.

You should inform your MRO care team if you are experiencing side effects. They can help you treat the problems and reduce the chance of them recurring.

Are side effects the same for everyone?

Side effects vary person by person. You may have none, a few mild ones, or more serious side effects depending on your treatment dose and which part of the body is being treated. Your general health also can affect how your body reacts to radiation therapy. Side effects are 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 minimal.

Most side effects go away with time. Your MRO care team 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. We encourage you 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. You can ask your MRO care team to schedule your treatments around your workday. However, treatment visits can be time consuming. While receiving treatment, you may decide to take a few weeks off work, or work a reduced schedule. MRO will happily provide any necessary paperwork to facilitate this. We encourage you 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, childcare, 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 MRO Care Team 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 therapy. This 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 MRO care team 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 radiation care team if you develop this condition, and they will 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 radiation care team. 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 even 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 a high neck, and use sunscreen. Ask your MRO care team about sunscreen lotions.

The majority of skin reactions to radiation therapy should go away a few weeks after treatment is finished. However, in some cases 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 radiation treatment to your hip, you will not lose hair from your head. Radiation treatment 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 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 radiation oncologist recommends. Chemotherapy can also affect hair loss.

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 it is used because of cancer treatment, and it 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 side effect may be related to your emotions and concerns about radiation treatment. Try to unwind before your treatment by reading a book, writing letters, or working on a crossword puzzle.

If you experience nausea, try not eating for several hours before your treatment, or limiting yourself to a bland snack of toast or crackers and apple juice. After radiation treatment, you may want to wait one to two hours before eating again. If the problem persists, ask your MRO care team 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 radiation 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 need to pay special attention to your diet.

Try to eat small meals often and enjoy a variety of foods. Your MRO radiation care team will 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 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. It includes recipes for the whole family, and highlights meals for people with special concerns, such as lactose intolerance.

If you have pain when you chew and swallow, your MRO care team may recommend a powdered or liquid diet supplement. Many of these products are available over the counter at the drugstore and come in a variety of flavors. They can be consumed alone, or combined with other foods, such as pureed fruit, or added to milkshakes. Ask your dietitian or pharmacist for more information.

Loss of appetite can result when changes occur in normal cells. Stress, and the radiation 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 radiation treatment.

Here are some suggestions to perk up your appetite and make the most of it when you feel like eating:

  • Eat when you are hungry, even if it’s not mealtime.
  • Eat several small meals during the day rather than three large ones.
  • Use soft lighting, upbeat music, or whatever helps you feel good while eating.
  • Vary your diet and try new recipes. If you enjoy company, have meals with family or friends, or turn on the radio or television.
  • Ask your MRO care team 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.
  • 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 don’t be shy about telling them what you’d 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.
  • 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 don’t feel like eating solid foods. If that’s the case for you, try to get the most from each glass by making drinks 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.

Here 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 or 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 MRO care team for special liquid medicines that can help you eat and swallow more easily.
  • Ask your MRO care team about liquid food supplements that can help you meet your energy needs.
  • If you are being treated for lung cancer, and you get your radiation oncologists approval, 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.

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 MRO care team or dentist can prescribe medicine for this discomfort and advise you on methods to relieve other mouth problems.

If you wear dentures you may notice they no longer fit. This can happen if radiation causes swelling in your gums. It is important not to let your dentures cause 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:

  • Sip cool drinks throughout the day. Water may be your best choice.
  • In the morning, fill a large cup with ice 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.
  • 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.

Dental care

Radiation treatment for head and neck cancer can increase your chances of getting cavities. Before starting your therapy, your MRO care team will assist you in arranging for a complete oral checkup to ensure treatments may safely begin. Your dentist will probably want to see you over the course of your radiation therapy to give you detailed instructions about caring for your mouth and teeth to reduce the risk of decay and help deal with possible soreness.

Next: Life beyond treatment

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