Radiation Oncology

back to Patient Information

Managing of General 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.

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. This information 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.

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. Although treatment visits are time consuming, you can ask the radiation 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, 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.

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 some suggestions on how you can keep these areas dry.

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 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) 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 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 sun blocking 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.

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, your 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. See link Eating Hints, for information on 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.

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 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.

• 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 of the chance that it will worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head or neck. 
• 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.
• If you are able to eat only small amounts of food, you can increase the calories per serving by trying the following ideas:
• Add butter or margarine if you like the flavor.
• Mix canned cream soups with milk or half-and-half rather than water.
• Drink eggnogs, 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 having drinks enriched with powdered milk, yogurt honey, or prepared liquid supplements.

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. 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.