Managing side effects

Saturday 1 February, 2014

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On this page: Fatigue | Appetite loss | Skin problems | Hair loss | Nausea | Diarrhoea | Mouth problems | Sexual intercourse and radiotherapy to the pelvic region | Fertility issues | Key points


Radiotherapy is an effective treatment for many cancers, but it can cause side effects. People react quite differently to radiotherapy, and some people may have no side effects. There are many factors that impact the type and severity of side effects, so it’s not unusual if your side effects are different to someone else having treatment.

Side effects vary depending on the part of the body being treated. Reactions can also change from one period of radiotherapy to the next. Before treatment begins, talk to your radiation oncologist about the possible side effects from the treatment.

During your course of treatment, tell your radiation oncologist, radiation therapist or nurse of any side effects you notice. These can usually be controlled with the right care and medicine.

Most side effects go away in time. Other less common side effects may be permanent, and some may not start until after treatment has finished.

If you have severe side effects, the doctor may change the treatment or prescribe a break in your course of treatment. However, this may not be possible if your doctor thinks pausing the treatment could affect how well it’s working. Check with your doctor.

Tip

Always ask your radiation oncologist before using any medicines, home remedies or creams to ease side effects. Some of these remedies can affect how radiotherapy works in your body.

Fatigue

During radiotherapy, your body uses a lot of energy dealing with the effects of radiation on normal cells. Tiredness usually builds up slowly during the course of treatment, particularly towards the end, and may last for a few months after treatment finishes.

Many people find that they cannot do as much, but others are able to continue their usual activities.

Tips
  • Do fewer things if you feel tired and spread out daily activities.
  • Rest or take naps during the day if you can.
  • Let family and friends help with shopping, child-care, housework and driving.
  • Take a few weeks off work during or after your radiotherapy, or reduce your hours. You may be able to work at home – discuss your situation with your employer.
  • Do light exercise, such as walking, and/or keep up with your normal exercise routine. Regular exercise may boost energy levels and make you feel less tired. Talk to your health care team about suitable activities for you.
  • Limit caffeinated drinks like tea, coffee and soft drinks. While they may boost your energy, caffeine can make you feel jittery and irritable. It can also cause insomnia and dehydration.
  • Avoid or limit alcohol.
  • Eat a healthy, well-balanced diet, and don’t skip meals.
  • Smoking reduces your energy. If you smoke, talk to your doctor or call Quitline 13 78 48 and ask about stopping.

Appetite loss

Good nutrition during radiotherapy treatment helps you remain as well as possible and get the most from your treatment. You may be advised to maintain adequate nutrition to complement how well the radiotherapy is working.

Some people lose interest in food during radiotherapy. This can depend on where on the body the radiotherapy is targeted.

Tips
  • Eat smaller amounts as often as possible.
  • Try to eat extra on days when you have an appetite.
  • Ask a dietitian for advice on the best eating plan during treatment and recovery.
  • If you don’t feel like eating solid foods, try enriching your drinks with powdered milk, yoghurt, eggs, honey, or weight-gain supplements. Sip water regularly to avoid becoming dehydrated.
  • If you’re advised to try a nutritional supplement, try using them alone or with other foods. Do not use any supplements or medicines without getting your treating doctor’s advice. Some supplements could interfere with treatment.
  • Sometimes cooking smells can put you off eating. It may help if someone else prepares your food, if possible, or you could consider heating precooked meals.
  • If you have radiotherapy to the head and neck area, chewing or swallowing might be difficult or painful. See below for tips.

Skin problems

Radiotherapy may make skin in the treatment area dry and itchy. Your skin may peel and look red, sunburnt or tanned. You may need dressings and creams to assist healing and make you more comfortable. Some of the radiation passes through your body and out the other side, so the skin in that part of your body may also be mildly affected. These reactions fade with time.

Tips
  • Follow skin care instructions as soon as treatment starts, even if you haven’t noticed any skin reactions.
  • Ask staff before using any soap, deodorant, perfume, talcum powder, creams, cosmetics, medicines or other products on the treatment area. If needed, you may be prescribed a moisturiser.
  • Wear loose soft clothing, such as cotton. Avoid tight-fitting clothes, belts or close-fitting collars over the treatment area.
  • Tell your doctor about changes to your skin, e.g. cracks or blisters, moist areas, rashes, infections or peeling.
  • Choose loose, old clothes that you can throw out if the dye or ink marks rub off on them.
  • Stay out of the sun and cover your skin before going outside. Talk to your doctor about using sunscreen – it’s not recommended on sensitive, inflamed or broken skin.
  • Let the dye outlines wear off gradually. Don’t scrub your skin to try to remove the marks.
  • Don’t use razors, hot-water bottles, heat packs, wheat bags or ice packs on the treatment area. Bathe or shower in lukewarm water – hot water can damage your sensitive skin. Pat skin dry with a soft towel.

Hair loss

If you have hair in the area being treated (e.g. scalp, face or body), you may lose some or all of it during radiotherapy. Your hair will usually grow back a few months after the treatment has finished. Sometimes hair loss is permanent.

In general, you will only lose hair in the treated area. However, when tumours on the face are treated, hair on the back of the head may be lost due to small amounts of radiation passing through the head and out the other side.

Tips
  • Wear a wig, toupee, hat, scarf or turban. Do whatever feels comfortable and gives you the most confidence.
  • If you plan to wear a wig, choose it early in your therapy so you can match it to the colour and style of your own hair. Cancer Council nurses, your doctor or nurse may be able to help you find a wig.
  • Protect your head against sunburn and the cold if you plan to leave it bare.
  • Expect the hair that grows back to be different, perhaps thinner or curly where it was once straight. After a large dose of radiotherapy, the new growth may be patchy for a while.
  • Ask your hairdresser to make your remaining hair look as good as possible. Your hairdresser may be able to try a new style. In time, your hair will probably return to its normal condition.
  • See information about our upcoming Look Good...Feel Better workshops. This program teaches techniques to help restore appearance and self-image during treatment.

Nausea

If you have radiotherapy to your stomach region, you may get an upset stomach. This problem will usually get better when your treatment session is over. However, some people feel queasy for a few hours after external radiotherapy.

For more information, talk to your doctor or nurse or call Cancer Council on 13 11 20 for information on eating well.

Tips
  • Have a bland snack, such as toast and apple juice, before treatment.
  • Sip on water and other fluids throughout the day to prevent dehydration.
  • Nibble dry biscuits.
  • Ask your doctor if a prescription for anti-nausea medication would help you.
  • Take anti-nausea medication before, during or after treatment, as prescribed by your doctor.
  • Tell your doctor if medicine doesn’t help – it may take some time to find medication that works for you.
  • Contact your doctor if you still feel nauseated after a few days, or are vomiting for more than 24 hours.

"At first I couldn’t think about eating without thinking about throwing up. Drinking ginger beer helped control the nausea." - Simon

Diarrhoea

If you have radiotherapy to your stomach, lower abdomen or pelvis, you may get diarrhoea. This can occur because the radiation irritates the lining of the bowel or stomach. Symptoms include frequent loose, watery bowel movements, abdominal cramps, and feeling an urgency to go to the toilet. It often begins in the third or fourth week of treatment, and continues for about 3–4 weeks.

If you are having pelvic treatment, the therapists may advise you to fill your bladder before each treatment session. This expands your bladder and pushes your bowels higher up into the abdomen, away from the radiation. Make sure you follow these instructions to minimise any reactions.

Tips
  • Check with your treatment team before taking any home remedies. You may be prescribed medication to relieve diarrhoea.
  • Avoid high-fibre and spicy foods, e.g. wholegrains, nuts, legumes, and hot curries.
  • Drink lots of clear liquids as soon as diarrhoea starts, or when you feel it is going to start, to avoid dehydration. Try apple juice, peach nectar, weak tea and clear broth.
  • If you feel ill, eat or drink as well as you can so your body gets the energy and nutrients it needs.
  • Slowly reintroduce fresh fruits and vegetables and wholegrain breads and pasta after the diarrhoea has cleared up.
  • Contact your doctor immediately if you have blood in your faeces or if you have more than 5–6 bowel movements in 24 hours.

Mouth problems

Radiotherapy is often used to treat cancer in the mouth, throat, neck or upper chest region. Depending on the area treated, radiotherapy may affect your mouth and teeth. This can make eating and swallowing difficult, and affect your sense of taste.

Dental problems

Radiotherapy to the mouth may increase the chance of tooth decay or other problems in the long term. Future dental work can be more difficult due to problems with healing. You will need to have regular, ongoing dental check-ups after treatment is finished.

If you’re seeing a dental specialist, ask if they can liaise with your usual dentist about any work you need carried out before treatment. They can also give you detailed instructions about caring for your mouth and teeth, to help prevent tooth decay and to deal with problems such as mouth sores.

Side effects

After several weeks of treatment, your mouth or throat may become dry and sore, and your voice may become hoarse. This will gradually improve after treatment is completed, but may take several weeks or even months.

You may also have thick phlegm in your throat, or a lump-like feeling that makes it hard to swallow.

Food may also taste different. Recovery of normal taste can sometimes take a long time after treatment is completed.

Tips 
  • If possible, have a dental check-up before treatment begins with a dentist who specialises in radiotherapy’s effect on the teeth.
  • Go to the website www.health.gov.au/dental to see if you are eligible to receive dental services under Medicare.
  • Keep your mouth wet by sucking on ice chips and sipping cool drinks. Carry a water bottle with you.
  • Avoid tobacco and alcohol, which will dry your mouth out even more.
  • Try to have more liquids or soft food if chewing and swallowing are painful.
  • If your sense of taste changes during radiotherapy, try different ways of preparing food. For example, add lemon juice to meat and vegetables, marinate foods or add spices.
  • If eating is uncomfortable or difficult, talk to your doctor. If you are in pain, you can ask for pain-relief medication, which may help you eat well and feel better.
  • Ask your doctor or nurse for information about artificial saliva to moisten your mouth.
  • Rinse your mouth regularly using a non-alcoholic mouthwash recommended by your doctor or dentist. Some people rinse their mouth with saltwater. This is a natural disinfectant. You can make this mouthwash at home by dissolving ¼ teaspoon of salt into 1 cup of warm water.
  • Talk to a dietitian, who can suggest nourishing foods that will not hurt your mouth.
  • Ask for a referral to a speech pathologist if you have difficulty swallowing.
  • If you lose too much weight, you may need extra feeding through a tube that goes into your stomach. Your doctor can discuss this with you.

Sexual intercourse and radiotherapy to the pelvic region

Radiotherapy to the pelvic area can make sexual intercourse uncomfortable. You may notice a change in your sexual desire (libido). This is common and may only be short term. Radiotherapy can make you feel too tired or nauseated to want to be intimate. Some people may also feel less sexually attractive to their partner because of changes to their body. Talking to your partner about your concerns may help.

Effects on women

Radiotherapy may cause the vagina to feel dry, itchy or burning. Treatment may also make vaginal tissue shrink and stiffen, making sex painful. Your doctor or nurse may suggest you use vaginal lubricant or an instrument to expand the vagina (dilator), or to have regular intercourse. Vaginal changes are usually not permanent, but for some women, they are longer lasting or permanent. Talk to your health care team for information and support.

Some women stop having their periods during treatment and may experience menopause. The signs of menopause include hot flushes, dry skin and vaginal dryness.

Effects on men

Men may have problems getting and maintaining erections, and ejaculation may be painful for a few weeks after treatment.

Using contraception

Your doctor may talk to you about using contraception during or after radiotherapy. See also Fertility issues.

During treatment

Although radiotherapy can affect fertility, it is still possible for a woman to become pregnant while having treatment. A man receiving radiotherapy could still make his partner pregnant. Women having radiotherapy or whose partners are having radiotherapy are usually advised not to become pregnant.

In a woman, radiotherapy to the pelvic area may affect either her eggs (ova) before conception or her unborn child. Radiotherapy to an area close to a man’s testicles may cause him to produce abnormal sperm.

If pregnancy is possible, you and your partner will be strongly advised to use contraception or abstain from sex during radiotherapy. If you or your partner becomes pregnant, talk to your doctor as soon as possible.

After treatment

It may be recommended you use a barrier method of contraception (such as a condom or a female condom) for a certain period of time. This is to prevent the risk of infection if you have any sores that are healing.

Talk to your doctor for more information about using contraception. Your health care team can also give you advice if you are planning on starting a family after cancer treatment.

Fertility issues

Having radiotherapy near your reproductive organs could affect your ability to have children naturally (fertility).

Effects on women

Radiotherapy to the pelvic area can cause periods to become irregular or stop for a short time. For some women their periods stop permanently (menopause). Talk to your doctor about ways to relieve the symptoms of menopause.

Effects on men

Radiotherapy to an area that includes the testicles may reduce sperm production temporarily. You may feel the sensations of orgasm, but ejaculate little or no semen. This is called a dry orgasm. Usually, semen production returns to normal after a few months, but for some men, infertility is permanent.

If you want to father a child, you may wish to have sperm stored before your treatment starts. This may allow your partner to conceive through artificial insemination later. Discuss this with your doctor.

For more information about these issues, call Cancer Council on 13 11 20 for a free copy of Sexuality, Intimacy and Cancer.

Tip

Speak to your doctor about the effects on fertility before you start radiotherapy treatment.

Key points

  • The side effects you have depend on the type and dose of radiotherapy you receive, and the part of your body being treated.
  • Talk to your health care team about any of the symptoms you experience – they may suggest ways to manage them.
  • Fatigue is a common problem. Try to plan activities around your energy levels, and talk to family and friends about ways they can help you.
  • If your skin is red or sore, avoid using perfumes or talcum powder. Keep the skin moisturised by using only the creams recommended by your nurse. Protect your skin when going out in the sun.
  • Some people find the marks on their skin rub off on clothing. Wear loose, old clothes during treatment. Soft cotton fabrics are best. • People may lose hair in the area where they have radiotherapy.
  • Radiotherapy can affect your appetite. This will depend on where you have radiotherapy.
  • Nausea and diarrhoea can occur if you have treatment to the stomach or pelvic area. Follow instructions given by your treatment team, and drink lots of fluids each day to prevent dehydration. Prescription medication can also help.
  • Visit a dentist before treatment begins and let them know you will be having radiotherapy.
  • Sexuality issues following treatment are common. Your fertility may also be affected. It’s advised that you don’t get pregnant while having radiotherapy. You will need to use birth control or avoid having sexual intercourse.

Reviewed by: Dr Mohan Arianayagam, FRACS (Urol), Urologic Oncologist, Nepean Hospital, Penrith, NSW; Donna Clifford, Urology Nurse Practitioner Candidate, Royal Adelaide Hospital, SA and David Connah, Cancer Council Connect Consumer Volunteer.

Updated: 01 Feb, 2014