Managing side effects of radiotherapy

Friday 1 January, 2016

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On this page: How long will side effects last? | Fatigue | Skin problems | Appetite loss | Nausea | Bladder and bowel problems | Hair loss | Infertility | Sexuality and intimacy issues | Mouth problems | Key points


Radiotherapy is an effective treatment for many cancers, but it can cause side effects because it also damages healthy cells at or near the treatment area. Some people experience many side effects, while others have very few or none. It’s not unusual if the side effects you experience are different from someone else having the same type of radiotherapy.

Many factors can impact the type and severity of side effects, including:

  • the type of radiotherapy
  • the part of the body being treated
  • the dose
  • any other treatments you might be having
  • your general health.

It is important to maintain your general health during treatment. People with diabetes in particular should ensure the condition is well managed – see your general practitioner before treatment starts.

Side effects can change from one period of radiotherapy to the next and may build up over time. During treatment, tell your radiation oncologist, radiation therapist or nurse about any side effects, as they can usually be controlled with the right care and medicine.

Always ask your radiation oncologist before using any medicines, home remedies or creams to ease side effects, as some may affect the way radiotherapy treatment works or make side effects worse.

How long will side effects last?

Most side effects go away in time. Some may be permanent, and others may not start until after treatment has finished (see Late effects of treatment, below). If you have severe side effects, the radiation oncologist may change the treatment or prescribe a break. However, pausing treatment may not be possible if the doctor thinks this could affect how well the treatment is working.

The information below lists ways to manage side effects. For more information about radiotherapy side effects, refer to the section about the type of cancer you have. Call 13 11 20 and ask for a free copy.

Late effects of treatment

Some side effects may not occur until many months or even years after treatment has finished. These are called late effects.

Late effects may be mild and may not have a major impact on your daily life, or they may be more significant. Some may go away or improve on their own, while others can be treated and managed.

Any late effects you experience will depend on the area of the body treated, and may include bladder and bowel changes and changes in sexual function.

You can read about ways to manage late effects on this page.. Talk to your doctor if you experience side effects that are not described here.

Fatigue

Feeling exhausted and lacking energy for day-to-day activities is a common side effect of radiotherapy. During treatment, your body uses a lot of energy dealing with the effects of radiation on normal cells. Fatigue can also be caused by travelling to treatment and appointments. It usually builds up slowly during the course of treatment, particularly towards the end, and may last for some weeks after treatment finishes.

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

Skin problems

External radiotherapy may make skin in the treatment area dry and itchy. Your skin may peel and look red, sunburnt or tanned, and it may feel painful. These reactions fade with time. You may need dressings and creams to assist healing, avoid infection and make you more comfortable.

Appetite loss

Some people lose interest in food during radiotherapy. This can depend on the part of the body being treated. For more information about appetite loss and nutrition, see Nutrition and Cancer.

Nausea

If you have radiotherapy to your stomach, pelvic region or head, you may feel like vomiting (nauseous) during the session. This will usually improve shortly afterwards, but some people feel queasy for a few hours. Your radiation oncologist may prescribe medicine to take before each session to prevent nausea. For more information about managing nausea, talk to your doctor or nurse, or call Cancer Council 13 11 20.

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

Bladder and bowel problems

Radiotherapy to the stomach, lower abdomen or pelvic area can irritate the bladder and bowel.

Bladder changes include needing to pass urine more often or in a hurry. Some people may leak urine, for example, when they cough or sneeze. For ways to manage continence issues, talk to your doctor or call the National Continence Helpline on 1800 33 00 66.

Radiation may also irritate the lining of the bowel or stomach, causing diarrhoea. Symptoms include frequent loose bowel movements, abdominal cramps, minor bleeding and feeling an urgency to go to the toilet. To reduce the effects of radiation on the bowel during treatment, the radiation therapists may advise you to fill your bladder before each session. This will expand your bladder and push your bowel higher up into the abdomen, away from the radiation.

Hair loss

If you have hair in the area being treated, you may lose some or all of it during radiotherapy. The hair will usually grow back a few months after treatment has finished, but sometimes hair loss is permanent.

Generally, 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 from one side of the head to the other.

Tips for managing radiotherapy side effects
Fatigue
  • Listen to your body. If you feel tired, rest.
  • Try to do fewer things and spread out your daily activities.
  • Ask family and friends for help, e.g. with shopping, housework and driving.
  • Take a few weeks off work during or after treatment, reduce your hours or work from home. Discuss your situation with your employer.
  • Do some light exercise, such as walking, or keep up with your normal routine if possible. Regular exercise may boost energy levels and make you feel less tired. Talk to your treatment team about suitable activities for you.
  • Limit caffeinated drinks, such as cola, coffee and tea. While they may boost your energy, caffeine can make you feel jittery and irritable, and cause insomnia and dehydration.
  • Limit your alcohol intake.
  • Eat a healthy, well-balanced diet, and don’t skip meals.
  • Smoking reduces your energy. If you smoke, talk to your doctor or call the Quitline on 13 7848 for support.
Skin problems
  • Follow skin care instructions from your treatment team as soon as treatment starts, even before you notice any skin changes. You may be prescribed a special moisturiser if required.
  • Wear loose, soft clothing made from cotton. Avoid tight-fitting clothes, belts or collars over the treatment area.
  • Tell your treatment team about skin changes, e.g. cracks or blisters, moist areas, rashes, infections or peeling.
  • Cover your skin before going outside and stay out of the sun when you can, as the treatment area will be more sensitive to sun damage.
  • Avoid using public swimming pools, spas and saunas that contain chlorine, which can dry out skin.
  • Let skin markings wear off gradually. Don’t scrub your skin to remove them.
  • Avoid using razors, hot water bottles, heat packs, wheat bags or icepacks on the treatment area. Bathe or shower in lukewarm water, as hot or very cold water can damage sensitive skin. Pat skin dry with a soft towel.
Appetite loss
  • Eat smaller amounts as often as possible rather than a few large meals.
  • 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.
  • Do not use nutritional supplements or medicines without your doctor’s advice, as some could interfere with treatment.
  • Cooking smells may put you off eating. It may help if someone else prepares your food, or you could consider reheating precooked meals.
  • If you have radiotherapy to the head and neck area, chewing or swallowing may be difficult or painful, and your sense of taste may change. See below for ways to manage these effects.
Nausea
  • Have a bland snack, such as toast and apple juice, before each session. You may find that ginger or peppermint flavoured food and drinks help to reduce nausea.
  • Sip on water and other fluids throughout the day to prevent dehydration.
  • Eat dry biscuits.
  • Some people find that anti-nausea medicine helps. Ask your doctor for a prescription, and tell them if the prescribed medicine doesn’t help – it may take some time to find one that works for you.
  • Contact your doctor if the symptoms of nausea don’t improve after a few days, or if you have been vomiting for more than 24 hours.
Hair loss from the head
  • Wear a wig, toupee, hat, scarf or turban, or leave your head bare. Do whatever feels comfortable and gives you the most confidence.
  • If you plan to wear a wig, choose it before treatment starts so you can match your own colour and style. Call Cancer Council 13 11 20 for information about wig services.
  • If you leave your head bare, wear a hat, beanie or scarf to protect your head against sunburn and the cold.
  • Talk to your hairdresser or barber about how to style your new hair. The hair that grows back may be thinner, or curly where it was once straight, and the new growth may be patchy for a while.
  • Contact Look Good Feel Better. This program teaches techniques to help restore appearance and improve self-confidence during treatment. For details, visit lgfb.org.au or call 1800 650 960.
Diarrhoea
  • Check with your treatment team before taking any home remedies. You may be prescribed medicine to relieve diarrhoea, and taking them together may cause unwanted effects.
  • Avoid high-fibre and spicy foods, e.g. wholegrains, nuts, legumes and curries.
  • Drink lots of clear liquids when you first notice symptoms of diarrhoea to avoid dehydration. Try apple juice, peach nectar, weak tea and clear broth.
  • Eat or drink as well as you can so your body gets the energy and nutrients it needs.
  • Slowly reintroduce fresh fruits, vegetables, and wholegrain breads and pasta after the diarrhoea has stopped.
  • Contact your doctor immediately if you have blood in your bowel motions or if you have more than 5–6 bowel movements in 24 hours.

Infertility

Having radiotherapy near your reproductive organs or to the abdomen could affect your ability to have children (fertility). Radiotherapy to the brain can affect the pituitary gland, which controls the hormones the body needs to produce eggs and sperm.

Effects on women

Treatment to the pelvic area or abdomen can cause periods to become irregular or stop for a short time. For some women, periods stop permanently, leading to menopause and infertility. If you wish to have children in the future, talk to your doctor before treatment starts about ways to preserve your fertility, such as storing eggs or embryos.

Effects on men

Radiotherapy to the pelvic area and testicles may temporarily reduce sperm production. You may feel the sensations of orgasm, but ejaculate little or no semen. This is called a dry orgasm. Semen production often returns to normal after a few months. For some men, the effect is permanent and causes infertility. If you want to father a child, you may wish to store sperm before treatment starts so your partner can conceive through artificial insemination in the future. Discuss this with your doctor.

Many people experience a sense of loss when they learn they may no longer be able to have children. If you have a partner, talk to them about your feelings. Talking to a counsellor may also help. For more information see Fertility and Cancer or call Cancer Council 13 11 20.

Sexuality and intimacy issues

Radiotherapy can make you feel too tired or sick to want to be intimate. Some people may feel less sexually attractive to their partner because of changes to their body. Talking to your partner or a counsellor about your concerns may help.

Radiotherapy to the pelvic region

This can make sexual intercourse uncomfortable. You may notice a change in your sexual desire (libido). These changes are common and may only be short term.

Effects on women

Radiotherapy to the pelvic area usually affects the ovaries. This will cause women to stop having their periods, which is called menopause. The symptoms of menopause include hot flushes, dry skin and vaginal dryness.

Treatment to the vagina may cause the area to feel dry or itchy, or you may feel a burning sensation. Vaginal tissue may shrink and stiffen, making sex painful. Your doctor or nurse may suggest you use a vaginal lubricant or an instrument to expand the vagina (dilator), or they may recommend you have regular intercourse. Vaginal changes are usually not permanent, but for some women they can be. Discuss any concerns with your treatment team.

Effects on men

Men may have problems getting and maintaining erections, and ejaculation may be painful for a few weeks after treatment. Talk to your doctor if these effects are ongoing and causing you distress. They can suggest ways to manage them, such as prescription medicine.

Using contraception

Your doctor may talk to you about using contraception during or after radiotherapy.

During treatment

Although radiotherapy can affect fertility, it is still possible for a woman to become pregnant (unless the reproductive organs have been removed during surgery). A man having radiotherapy could get his partner pregnant.

Radiotherapy to the pelvic area may affect a woman’s eggs (ova), and treatment to areas near the testicles may lead to the production of abnormal sperm. If pregnancy is possible, you will be advised to use contraception or avoid sexual intercourse during radiotherapy. Talk to your doctor as soon as possible if pregnancy occurs.

After treatment

Your doctor may recommend 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 on or near your genitals.

Your treatment team can give you information about having children after treatment.

For more information see Sexuality, Intimacy and Cancer or call Cancer Council 13 11 20.

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.

Treatment to the mouth may increase the chance of tooth decay or other problems in the future. You will need to have a dental check-up before treatment starts and regular check-ups after treatment has finished.

If you’re seeing a dental specialist, such as an orthodontist, ask if they can liaise with your usual dentist about any work you need to have before radiotherapy treatment starts. Your dentist can give you detailed instructions about caring for your mouth and teeth to help prevent tooth decay and deal with side effects such as mouth sores.

Common mouth problems

After several weeks of treatment, your mouth or throat may become dry and sore, and your voice may become hoarse. These effects will gradually improve after treatment finishes, but it may take several weeks or even months. In some cases, the effects may improve but not completely disappear.

You may 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 many months after treatment has finished.

Tips for managing mouth problems
  • If possible, have a dental check-up before treatment begins with a dentist who specialises in the effect radiotherapy has on teeth.
  • Keep your mouth wet by sucking on ice chips and sipping cool drinks. Carry a bottle of water with you.
  • Ask your doctor, nurse or pharmacist for information about artificial saliva to moisten your mouth.
  • Avoid tobacco and alcohol, as they will worsen mouth dryness.
  • If chewing and swallowing are painful, try to consume more liquids or soft food.
  • Talk to a dietitian, who can suggest nourishing foods that will not hurt your mouth.
  • If you have difficulty swallowing, ask your doctor for a referral to a speech pathologist.
  • To manage taste changes, try different ways of preparing food. For example, add lemon juice to meat and vegetables, marinate foods or add spices.
  • Talk to your doctor if eating is uncomfortable or difficult. If you are in pain, ask for pain relief medicine, which may help you eat well and feel better.
  • 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 a saltwater mouthwash at home by dissolving 1⁄4 teaspoon of salt into 1 cup of warm water. Rinse your mouth with plain water afterwards.
  • For more information see taste and smell changes during cancer treatment.

Key points

  • The side effects you experience will depend on the type and dose of radiotherapy, the part of the body being treated, your general health and other treatments you might be having.
  • Your health care team can suggest ways to prevent and manage side effects.
  • Some effects occur months or years after treatment finishes. These are called late effects.
  • Fatigue is common during radiotherapy. 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, keep the skin moisturised by using creams recommended by your nurse. Protect your skin when you go out in the sun, as the treatment area will be more sensitive to sun damage.
  • Wear loose, soft clothing, and avoid tight-fitting clothes around the treatment area.
  • A dietitian can advise you on the best eating plan during treatment and recovery.
  • You may experience nausea and diarrhoea if you have treatment to the abdomen or pelvic area. Drink lots of fluids to prevent dehydration. Prescription medicine may help.
  • Treatment may affect your fertility. If you would like to have children in the future, talk to your doctor before treatment starts.
  • You will be advised to avoid pregnancy during treatment. You will need to use contraception or avoid having sexual intercourse.
  • See your doctor if radiotherapy to the head area causes difficulty swallowing.

Reviewed by: A/Prof Martin Borg, Radiation Oncologist, Adelaide Radiotherapy Centre, SA; Dr Daniel Badger, Medical Physicist, The Queen Elizabeth Hospital, SA; Jason Bonifacio, Centre Leader, St Vincent’s Hospital, Darlinghurst, Waratah Private Hospital, Hurstville, Radiation Oncology Associates & Genesis CancerCare, NSW; Melissa Cadzow, Consumer; Kim Fotheringham, Radiation Oncology Nurse, W.P. Holman Clinic, Launceston General Hospital, TAS; Kath Lockier, Consumer; Dr Kathy Pope, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Simoene Smith, 13 11 20 Consultant, Cancer Council NSW.

Updated: 01 Jan, 2016