Radiotherapy is generally a safe and effective treatment for various cancers. However, since normal cells at or near the tumor site can be damaged when exposed to radiation, radiotherapy may cause adverse effects. Some people experience very few or no adverse effects after radiotherapy, while others have many. It is common for the side effects experienced by one person to be different from those experienced by another. For instance, a breast cancer patient undergoing radiotherapy may experience skin irritation while a patient being treated for mouth cancer may have soreness when swallowing. Nevertheless, most side effects are temporary and can be treated or managed with a few interventions by the oncologist or a member of the cancer treatment team.
Factors that influence the type and severity of adverse side effects of radiotherapy include:
- Part of the body or tissue being treated.
- Type of radiotherapy used.
- Radiation dose applied.
- Any other treatments the patient may be having.
- The patient’s general health.
How long will adverse effects last?
Depending on the treatment dose and schedule, radiotherapy side effects tend to begin during the second or third week of treatment. While some will be permanent, most of the adverse effects will go away a few months after treatment is completed. Adverse effects may continue for weeks or months after treatment because it takes a long time for healthy cells to repair and recover from radiation.
There are two general categories of side effects.
(a) Early (short-term) side effects: These are adverse effects that occur during or immediately after treatment. Typically, they are short-term, mild and highly treatable and will be gone a few weeks after treatment is completed. Depending on the site that receives treatment, the most common early side effects are fatigue, skin changes, hair loss and mouth problems.
(b) Late (long-term) side effects: These are adverse effects that appear several months or years after treatment. Late side effects occur because of changes caused in normal tissue by the radiation. Some of the side effects may be mild and will go away quickly, but some can be more serious and lasting. The risk of late adverse effects depend on the area treated and the radiation dose delivered, but careful planning and administration of radiation significantly minimizes long-term side effects. It is important to speak with your oncologist about the risk of having long-term side effects.
Here are ways of managing some of the most common short-term and long-term side effects of radiotherapy:
Feeling tired, exhausted or lacking energy for routine activities is a very common side effect of cancer radiotherapy. The body loses a lot of energy trying to cope with the effects of radiation on healthy cells. Likewise, fatigue is caused by the strain of traveling to and from treatments and appointments and the stress of being sick. Fatigue builds during the course of treatment, gets worse toward the end and continues long after treatment. It is therefore important to find ways to manage and cope with it.
So how should you deal with fatigue?
- Rest when you feel tired.
- Reduce the number of tasks per day and spread them out to have breaks between activities.
- Request family members and friends to help you with tasks such as driving and shopping.
- Take a break from work during or after treatment. Explain your situation to your employer.
- Engage in light exercise. Go out for walks and keep your normal routine.
- Eat a healthy and well-balanced diet. Do not skip meals.
- Reduce alcohol intake and stop smoking.
- Minimize caffeinated drinks such as tea, coffee and cola.
2. Skin problems
External beam radiotherapy can turn the skin in the treated area red, swollen, irritated, blistered, tanned or sunburned. A few weeks after treatment, the skin may become flaky, dry or itchy, and may even peel off. While these skin reactions disappear over time, it is important to inform your radiotherapy treatment team of these changes. The team will suggest ways of easing the discomfort, minimizing further irritation or preventing potential infection.
So how should you deal with skin problems?
- Avoid wearing tight, stiff or rough-textured clothes over the treatment area.
- Avoid rubbing, scratching, scrubbing or applying adhesive tape on the treated skin.
- Avoid applying heat or cold (like heat lamp, heating pad, razors or ice pack) on the treated skin.
- Avoid exposing the treated skin to the sun.
- Inform your treatment team of any skin changes such as blisters, cracks, rashes, moist areas, peeling or infection.
- Wash the treated skin with mild soap and lukewarm water. Avoid public swimming pools, saunas and spas.
- Follow the skin care instructions recommended by your treatment team. Inform them of any actions you may take that will affect the treated skin.
3. Mouth problems
When radiation is used to treat a cancer of the throat, neck, mouth or upper chest region, certain side effects may appear in the mouth and teeth. For example, treatment of mouth cancer may result in tooth decay, mouth sores and eating and swallowing difficulties. Radiation therapy may affect the salivary gland, decreasing saliva production and resulting in a dry mouth. Many weeks of radiotherapy also may make the mouth and throat sore and dry, with the voice becoming hoarse.
So how should you deal with mouth problems caused by radiotherapy?
- For dental problems, have a dental check-up.
- Avoid alcohol and tobacco because they worsen mouth dryness. Also avoid alcohol-containing mouthwashes, highly sugared drinks, spicy, salty or acidic foods, and hard and crunchy foods.
- Take regular sips of water and fluids that do not contain sugar.
- After speaking for a while, pause and sip a liquid. Carry a bottle of water.
- Try soaking or dipping food in whatever liquid you are drinking.
- Consume soft or liquid foods when chewing and swallowing becomes difficult.
- Speak with a dietitian about nutritious foods that will not hurt your mouth.
- Use viscous Lidocaine (or other analgesic) before meals.
- Talk to your doctor when eating and swallowing is difficult or uncomfortable. Ask for pain-relieving medicine if you are in pain.
4. Appetite loss
Some people lose interest in food after or during radiotherapy. This will depend on the part of the body exposed to radiation. To deal with appetite loss:
- Try eating small amounts of food as often as you can.
- Try eating extra food on days when you have some appetite.
- Seek the advice of a dietitian on how to plan for your meals during and after treatment.
- Try enriching solid foods with powdered milk, eggs, yoghurt or honey.
- Seek your doctor’s advice before using any medicines or nutritional supplements.
- Ask someone to help you cook if cooking smells are putting you off.
5. Bladder and bowel problems
Radiation therapy to the abdominal area, pelvic area or stomach can irritate the bowel and bladder, resulting in adverse effects. Changes in the bladder may result in incontinence such as urine leakage when you cough or sneeze. Irritation of the stomach or bowel may cause constipation, nausea, vomiting or diarrhea. You also may experience frequent loose bowel movements, minor bleeding, abdominal cramps and a feeling of urgency when you go to the toilet.
Ways of dealing with bladder and abdominal problems include:
- Drink plenty of water, juices and hot beverages to prevent constipation and replace fluids lost through diarrhea.
- Drink small amounts of fluids and eat small quantities of food throughout the day instead of 3 large meals.
- Avoid high fiber diet until symptoms resolve. Soluble fiber or foods rich in pectin such as apples, oatmeal, bananas, applesauce and pears are recommended.
- Ask your doctor for anti-nausea medicines and contact your doctor if nausea symptoms fail to improve for a few days or if you continue vomiting for more than 24 hours.
- If you are experiencing bloating or gas, limit drinks and foods causing gas.
- Avoid alcoholic beverages, milk, milk products and foods high in fat.
- Ask your doctor about stool softeners or laxatives.
- Go for walks and exercise regularly, keeping to exercises that your condition can allow.
6. Hair loss
If the area being treated has hair, some or all of them may be lost during radiation therapy. Some hair will grow back in the area a few months after treatment, but hair loss may be permanent in some areas. Usually, patients lose hair from the treated area, but treating tumors of the face may lead to loss of hair on the back of the head as small quantities of radiation will cross from one side of the head to the other.
So how should you deal with hair loss?
- Wear a hat, wig, scarf, toupee or turban. You also can leave your head bare. Just do what makes you feel comfortable and confident.
- If you intend to leave your head bare, use a scarf, beanie or hat to protect it from cold and sunburn.
- The hair growing back on your head may be thinner, curlier and more patchy than before. So speak with a barber or hairdresser to find the right style for your new hair.
7. Sexuality, intimacy and infertility
Radiotherapy on the pelvic area, abdomen or near reproductive organs may affect sexual desire, make sexual intercourse uncomfortable, cause irregular periods or early menopause in women, damage testicles, reduce sperm production or cause erectile dysfunction in men, damage ovaries or cause dryness of vagina, and cause infertility. Radiation therapy to the brain may affect the pituitary gland and reduce the secretion of hormones controlling the production of sperm and ova (eggs), while the fatigue associated with undergoing radiotherapy may make sexual intercourse less attractive. Most of these changes are temporary and short-term. Make sure to discuss them with your treatment team.
To cope with sexuality, intimacy and infertility issues:
- Speak with your partner about your feelings.
- See a relationship counselor for advice.
- Ask a doctor for a vaginal lubricant or dilator if the vaginal tissue has stiffened or the area is itchy and dry after radiotherapy.
- Use your doctor’s recommended barrier method of contraception to prevent genital sores shortly after radiotherapy.
- Speak with your doctor about erectile dysfunction or infertility. You will be given options for dealing with these issues.
Radioprotective drugs for minimizing side effects
Radioprotective drugs are given before radiotherapy to help protect normal tissues near the treated tumor from effects of exposure to radiation. Most commonly, the drug Amifostine is used for this purpose, but there are other drugs still under study. While not all doctors agree on using these drugs because of their side effects, there is agreement that they are invaluable in certain situations. For example, using Amifostine prior to radiotherapy for head and neck cancer significantly reduces adverse effects on the mouth and surrounding tissues. Your doctor will discuss with you whether to use a Radioprotective drug or not.
Can the side effects limit your activity level?
Radiotherapy side effects may reduce your ability to do certain things. Your activity level after treatment will depend on the actual side effects and your overall feeling. Some patients will go back to work and start enjoying leisure activities while undergoing radiotherapy, but others will find it necessary to have more rest. Speak to your treatment and care team about what you can and cannot do during and after radiotherapy.