Managing Side Effects from Radiation Therapy

While radiation therapy itself does not hurt, there can be short-term side effects to contend with, which can affect your hair, skin, sleep, appetite and emotions, too. Side effects vary from patient to patient. Depending on how your body responds to therapy, you may have no issues or experience some mild discomforts. Yet, some people may have more serious side effects—it depends mostly on the treatment dose and the part of your body that is being treated.

Your general health also can affect how your body reacts to radiation therapy, including whether you have side effects and what kind. Before beginning your treatment, discuss with your radiation oncologist the short- and long-term side effects that might arise. Read on for answers to questions patients often ask our doctors about what to expect during treatment:

“Not necessarily,” says Yale Medicine radiation oncologist Lynn Wilson, MD, who is the chair of Therapeutic Radiology and a professor of therapeutic radiology at Yale School of Medicine. “It will depend on what side effects you experience—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. However, your desire for physical intimacy may be lower because radiation therapy may cause you to feel more tired than usual.

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,” says Dr. Wilson.

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. Although treatment visits are time consuming, you can ask your doctor's office or the radiation therapy department to help by scheduling 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 have a frank conversation with your employer about your needs and wishes during this time. You may be able to agree on a part-time schedule, or 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.

You may notice that your skin in the treatment area begins to look reddened, irritated, sunburned or tanned. After a few weeks your skin may become very dry. 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. You might find it helpful to seek care from an onco-dermatologist, a doctor who specializes in caring for skin problems cancer patients encounter.

Be very gentle with the skin in the treatment area. Avoid irritating treated skin, which can compromise the stratum corneum (the skin’s outermost layer, which serves as a barrier to the outside world). When you wash, use only lukewarm water and mild soap. Don't wear tight clothing over the treatment area. It's important not to rub, scrub 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. Don't use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you're being treated or for several weeks afterward (unless approved by your doctor or nurse). That’s because many skin products can leave a coating on the skin that can interfere with radiation therapy or healing.

Avoid exposing the area to the sun during treatment and for at least one year after your treatment is completed. Be vigilant about sun protection, and wear sunscreen every day. Also opt wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves).

If your skin does react, 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, due to changes in the melanocytes where skin pigment (melanin) is produced in the irradiated area.

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 have a very fine texture.

Your scalp may be tender after the hair is lost, so you may want to cover your head with a hat, turban, or scarf. 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 partially covered 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 more easily match the color and style to your own hair.

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, your treatment might be delayed for about a week to allow your blood counts to increase.

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 so that your body can heal. 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.

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 they can be 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 even 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 that you make every effort 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. For ideas on how to increase your appetite during treatment, click here.

What side effects occur with radiation therapy to the head and neck area? Some people who are having radiation to the head and neck have 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 your sense 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. You also may notice that your jaw feels stiff and that you cannot open your mouth as wide as before your treatment. Jaw exercises 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 your 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.

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 swallowing to be difficult or painful. 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 will help you deal with them.

If you are receiving radiation therapy after a lumpectomy or mastectomy, it's a good idea to go without 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 four to six 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 the therapy. These long-term side effects may continue for a year or longer after treatment. The redness of the skin will fade, and you may notice that your skin is slightly darker, just as when a sunburn fades to a suntan. 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 you may notice that your breast is 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. You may have some breast tenderness or a feeling of tightness while the implants are in your breast. 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.

If you are having radiation treatment to the stomach or some portion of the abdomen, you may experience 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.

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 medication 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.

Nearly all patients who receive treatment for cancer feel some degree of emotional upset. "It's not unusual to feel depressed, afraid, angry, frustrated, alone or helpless," says Dr. Wilson. "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 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.

For more information about the radiation oncology services Yale Medicine doctors provide, click here.