Comprehensive Cancer Care Services

Services | Radiation Therapy| Side Effects and Management

Although patients do not feel anything during a radiation treatment, the effects of radiation gradually build up over time. Patients who develop side effects from radiation, typically do so after the first 3 weeks of treatment and these side effects may increase until after the completion of therapy.

The vast majority of patients are able to complete radiation therapy without significant difficulty. When sid e effects of radiation therapy develop, they are limited to the areas that are receiving radiation. The chance of experiencing side effects, however, is highly variable. A dose that causes some discomfort in one patient may cause no side effects in other patients. We will closely monitor your progress and provide management as indicated.

Side effects are usually temporary and resolve shortly after the radiation is completed. Your Radiation Oncologist will discuss the likelihood of side effects with you during your consultation and during your weekly physician visits.

The most common side effects of radiation are:

• Skin reaction
• Fatigue

1. Skin Reaction – A common side effect of radiation therapy that may be experienced is skin irritation in the area of the body that is being treated. The skin reaction can range from mild redness and dryness (similar to a sunburn) to peeling of the skin (desquamation) in some patients. The majority of skin reactions to radiation therapy go away a few weeks after treatment is completed. In some cases, the treated skin will remain slightly darker or lighter than it was before, and it may continue to be more sensitive to sun exposure.

It is important to notify your nurse or physician when your skin becomes irritated, because redness and dryness can eventually progress to peeling in the area. They can suggest measures to relieve your discomfort and possibly minimize further irritation. There are effective topical medications for treatment of radiation induced skin irritation, as well as a number of precautions that may minimize skin irritation during radiation therapy, such as:

• Keep the treated area dry and free from irritation. Cornstarch, gently patted on with a powder puff, will keep the skin dry.
• Wash the skin in the treatment area only with mild soaps.
• Use a mild shampoo, such as baby shampoo, if the head is being treated.
• When using a towel, pat the area dry instead of rubbing.
• If you must shave in the treated area, use an electric razor to prevent cuts.
• Avoid using shaving lotions or scented creams.
• Limit use of perfumes, deodorants, or makeup in the treated area.
• Avoid using heating pads or ice packs on the skin in the treated area.
• Wear loose-fitting clothing that does not rub on the skin in the treated area.
• Avoid harsh fabrics over the treatment area, such as wool, corduroy, or starched cloth. Lightweight cotton is recommended.
• Avoid sun exposure in the treated area. 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 shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunscreen lotions of SPF 15 or higher.
• Check with your nurse or physician regarding the use of creams or lotions. Usually, samples of safe topical medications are available in the radiation clinic.
• Unless necessary, do not use adhesive tape, including band aids and paper tape on the treated area.
• Do not swim in salt water, lakes, pools, or ponds until your skin has completely healed from the radiation treatments.
• Always report any discomforts or concerns to your doctor, nurse, or radiation therapist.

2. Fatigue – A feeling of tiredness, weariness, weakness, exhaustion, or a profound lack of energy. Fatigue is one of the most common side effects of radiation therapy. Patients are not restricted from normal activity during radiation therapy; however, they should balance normal activity with periods of rest. Fatigue is typically more severe 2-4 hours after treatment. The feeling of fatigue should wear off several weeks after the completion of radiation therapy. The following suggestions may help you manage fatigue resulting from radiation therapy:

• Limit your activities, if possible.
• Exercise each day to maintain your strength.
• Prepare meals ahead of time and freeze them.
• Use convenience foods that are ready to eat.
• Accept offers of help from friends and relatives
• Drink three quarts of fluid each day to avoid the build-up of cellular waste products.
• Increase rest by getting more sleep at night and taking naps during the day.
• Try to eat even when you are tired. Sometimes a little food will increase energy.

Side effects that may occur with Radiation to the Head, Neck, Mouth or Throat

• Mucositis (sore mouth or throat)
• Xerostomia (dry mouth)
• Changed sense of taste and/or smell
• Hypothyroidism

3. Mucositis (Sore Mouth or Throat) – When you have a sore mouth or gums take special care of your teeth, as they are a primary site for infection and pain. Keep your mouth clean. Use a soft bristle toothbrush; rinse your mouth before and after meals with plain water or a mild mouth rinse (made with one quart water, one-half to one teaspoon salt, and one teaspoon baking soda); and floss regularly. Avoid commercial mouthwashes and alcoholic or acidic beverages because they can dry and further irritate your mouth. Many patients find a WaterPik type device helpful for maintaining oral hygiene.

Patients with mucositis should also select foods that will not irritate an already tender mouth, for example:

• Choose soft foods that are easy to chew and swallow.
• Avoid foods that irritate the mouth such as citrus fruits and foods that are spicy, salty, rough, coarse, or dry.
• Cook foods until they are soft and tender.
• Cut foods into small pieces.
• Mix food with butter, thin gravies or sauces to make it easier to swallow.
• Puree food in a blender or food processor.
• Use a straw to drink liquids.
• Eat foods cold or at room temperature, as hot food can irritate a tender mouth.
• Do not smoke, chew tobacco or drink alcohol because this can irritate mouth sores
• Ask your doctor or nurse about medicines to help treat mouth sores and control pain while eating.

4. Xerostomia (Dry Mouth) – Radiation therapy that is delivered to the head and neck area may also result in xerostomia. Xerostomia is a chronic dry-mouth condition, which is caused by damage to the salivary glands as a result of radiation therapy. Xerostomia can impair a your ability to speak, chew, swallow, and taste. Coping with a dry mouth can be difficult, but the following tips may help.

• Try consuming sweet or tart foods or beverages, such as lemonade, to help your mouth produce saliva. (Avoid these, however, when experiencing a sore mouth or throat.)
• Suck on sugar-free, or regular hard candy, frozen grapes, ice chips or popsicles or chew sugar-free gum; this may also help to produce more saliva.
• Eat soft and pureed foods that are easier to swallow.
• Take small bites of food and chew completely.
• Eat foods with sauces, gravies, and salad dressings to make them moist and easier to swallow.
• Keep lips moist with lip salves
• Use a cool mist humidifier to moisten room air, especially at night.
• Drink 8 to 12 cups of liquid a day and take a water bottle with you when you leave home. Sip water every few minutes to make swallowing and talking easier.
• If the dry mouth problem is severe, ask your radiation oncologist or dentist about products that coat and protect the mouth and throat.

Change in Sense of Taste and/or Smell

Your sense of taste or smell may change during treatment. These senses may be affected by chemotherapy, radiation and/or the cancer itself. Dental problems can also affect these senses and it is important to practice good dental hygiene.

Meat and other foods high in protein may begin to have a bitter or metallic taste, while many other foods will have less taste in general. For most people, changes to your taste and smell will go away when the treatment is completed. However, there is no foolproof way to prevent these changes to taste and smell because each person is affected differently by illness and treatments.

Following is a list of helpful suggestions that may help in making food more appealing to your senses:

• Fish, chicken, peanut butter, dairy products, eggs, dried beans, and beef jerky are sources of protein that may taste better than red meats.
• Cold sources of protein such as cheeses, lunch meats, egg or meat salads may be better tolerated if cooked foods have an unsavory smell.
• Enhance the flavor of meat by marinating it in sweet fruit juices, Italian dressings or by using small amounts of flavorful seasonings such as basil, oregano or rosemary.
• If foods taste too sweet, try tart foods such as lemons, oranges, or dill pickles (unless your mouth or throat is too sore). Adding coffee to milkshakes to reduce the sweet taste. Bar bitters which are non-alcoholic may be used to cut the sweet taste of nutritional supplements such as Ensure, Boost, Scandishake, etc.
• Use plastic utensils and non-metal cookware if foods taste metallic.
• Food supplements are usually better cold and if smell is a problem drink with a straw.

5. Hypothyroidism - Hypothyroidism (abnormally low levels of thyroid hormone) is occasional late complications of radiation therapy in patients where the radiation field includes the neck. This may occur in up to one-third of patients receiving radiation therapy. Often patients who have received radiation therapy will be tested if they develop signs and symptoms of hypothyroidism.

Less Common Side Effects of Radiation Therapy

6. Alopecia (Hair Loss) – Alopecia only occurs on the head if it is the area of treatment. It may be temporary or permanent based on the dose of radiation given. Hair thinning usually begins to occur after two to three weeks of treatment. Hair re-growth takes three to six months. New hair may be a different color or consistency.

Measures which may be of help in the matter are:

• Use mild shampoo one to two times a week to gently wash hair.
• Protect the scalp from the wind, cold, and sun by wearing a head covering.
• Apply a sunscreen with a SPF 15 or more on the face and scalp and wear a head covering to shade the area when necessary to be in the sun for an extended period.
• Use a soft bristle brush to reduce stress on hair shaft.
• Avoid hair dyes, permanents, and heat to area.
• Assistance from community organizations such as The American Cancer Society (www.cancer.org) which promotes