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What can I do to take care of myself during
therapy?
You need to take special care of yourself to protect your
health during radiation treatment. Your doctor or nurse will give you
advice about your treatment and the side effects you might have. Here
are some other tips:
- Be sure to
get plenty of rest. You may feel more
tired than normal. Try to get good, restful sleep at night. This
tiredness, often called fatigue, may last for several weeks after your
treatment ends. See the section "Dealing
with fatigue" for more
information.
- Take care of
the skin in the treatment area. If you
get external radiation therapy, the skin in the treatment area may
become more sensitive or look sunburned. Ask your doctor or nurse
before using any soaps, lotions, deodorants, medicines, perfumes,
cosmetics, talcum powder, or other substances on the treated area. Some
of these products may irritate sensitive skin. See the section "Dealing
with skin problems" for more information.
- Avoid wearing
tight clothes. This includes girdles,
pantyhose, or close-fitting collars over the treatment area. Instead,
wear loose, soft cotton clothing. Do not starch your clothes.
- Do not rub,
scrub, or use adhesive tape on treated
skin. If you skin must be covered or bandaged, use paper
tape or other
tape for sensitive skin. Try to put the tape outside the treatment
area, and do not put the tape in the same place each time.
- Do not put
heat or cold (such as a heating pad,
heat lamp, or ice pack) on the treatment area. Talk with
your doctor
first. Even hot water may hurt your skin, so use only lukewarm water
for washing the treated area.
- Protect the
treated area from the sun. Your skin
may be extra sensitive to sunlight. If possible, cover the treated skin
with dark-colored clothing before going outside. Ask your doctor if you
should use a lotion that contains a sunscreen. If so, use a sunscreen
product with a sun protection factor (SPF) of at least 15. Reapply the
sunscreen often, even after your skin has healed. Continue to give your
skin extra protection from sunlight for at least 1 year after radiation
therapy.
- Tell your
doctor about medicines you are taking
before treatment. Let your doctor know if you take any
medicines, even
things like aspirin, vitamins, or herbs.
Side effects can vary
Your doctor and nurse are the best people to talk to you about
your treatment, side effects, home care, and any other medical concerns
you may have. Tell them about any side effects you are having,
including skin changes, tiredness (fatigue), diarrhea, or trouble
eating. Be sure that you understand any home care instructions and know
who to contact if you have more questions.
Side effects vary from patient to patient and will depend on
the radiation dose and the part of your body treated. Some patients
have no side effects at all, while others have quite a few. There is no
way to know who might or might not have side effects. Your overall
health can sometimes affect how your body reacts to radiation treatment
and whether you have side effects.
Radiation therapy can cause early and late side effects. Early
side effects are those that happen during or shortly after treatment.
They usually are gone within a few weeks after treatment. Late side
effects are those that take months or years to develop. They are often
permanent.
The most common early side effects are:
- fatigue (feeling tired)
- skin changes
Other early side effects usually are related to the area being
treated, such as hair loss and mouth problems following radiation
treatment to the head.
Most side effects go away in time. In the meantime, there are
ways to reduce the discomfort they may cause. If you have bad side
effects, the doctor may stop your treatments for a while, change the
schedule, or change the type of treatment you are getting. Tell your
doctor, nurse, or radiation therapist about any side effects you notice
so they can help you manage them. The information here can serve as a
guide to handling some side effects, but it cannot replace talking with
your doctor or nurse about what is happening to you.
Dealing
with fatigue
Fatigue is the feeling of being tired physically, mentally,
and emotionally. It is very common with cancer and its treatment, and
often happens with radiation therapy. Managing fatigue is an important
part of care for you and your loved ones.
Fatigue means having less energy to do the things you normally
do or want to do. It can last a long time and can interfere with your
usual activities. It is different from the fatigue of everyday life,
which is usually short-term and relieved by rest. Cancer-related
fatigue is more severe and more distressing. Rest does not always
relieve it. Cancer-related fatigue can:
- differ from one day to the next in how bad it is
and how much it bothers you
- be overwhelming and make it hard for you to feel
well
- make it hard to be with your friends and family
- make you less able to keep up your normal
activities, including going to work
- make it hard to follow your cancer treatment plan
- last different lengths of time, which makes it hard
to guess how long you will have it
Only you know if you have fatigue and how bad it is. No lab
tests or x-rays can diagnose or describe your level of fatigue. The
best measure of fatigue comes from your own report to your doctor or
nurse. You can describe your level of fatigue as none, mild, moderate,
or severe. Or you can use a scale of 0 to 10, where a 0 means no
fatigue, and a 10 is the worst fatigue you could imagine. Either way
you choose, it is important to describe your fatigue to your cancer
team.
Most people begin to feel tired after a few weeks of radiation
therapy. Fatigue usually gets worse as your treatment goes on. Stress
due to your illness, daily trips for treatment, and the effects of
radiation on normal cells may also worsen fatigue.
The cause of cancer-related fatigue is not always clear. But
if the cause of fatigue is known, treatment will be directed at the
cause. For example, if anemia (low red blood cell counts) is thought to
be causing fatigue, the anemia can be treated. In some patients,
treatment may include correcting fluid and mineral imbalances in the
blood. Increased physical activity, treating sleep problems, and good
nutrition all seem to improve fatigue. Education and counseling are
part of the treatment; they can help people learn how to conserve
energy, reduce stress, and use distraction to focus on things other
than the fatigue.
By understanding fatigue, you can cope with it better and
reduce your distress. Often, a family member can help you talk to your
health care team about your fatigue and how it affects you.
Fatigue will usually go away over time after your treatment is
finished. Until then, there are some things that you can do to help you
deal with it:
- Make a list of your regular activities in order of
how important they are to you. Try to do the important ones first, when
you have the most energy.
- Ask for help from loved ones and friends.
- Place things that you use often within easy reach.
- Use methods to reduce stress, such as deep
breathing, visual imagery, meditation, prayer, talking with others,
reading, listening to music, painting, or any other activity that gives
you pleasure.
- Keep a journal of how you feel each day. Take it
with you when you see your doctor.
- Balance rest and activities. Avoid too much bed
rest, which can make you feel weak. Schedule activities so that you
have time for plenty of rest. Most people find that a few short rest
periods are better than one long one.
- Discuss physical activity with your doctor before
you start any exercise program.
- Unless you are given other instructions, eat a
healthy diet that includes protein (meat, milk, eggs, and beans), and
drink plenty of water each day.
Let your doctor or nurse know about your fatigue and talk with
them if:
- Your fatigue does not get better, keeps coming
back, or gets worse.
- You are more tired than usual during or after an
activity.
- You are feeling tired and it is not related to
something you've done.
- You become confused or cannot focus your thoughts.
- You cannot get out of bed for more than 24 hours.
- Your fatigue disrupts your social life or daily
routine.
If you need to take time off from work, talk to your employer.
You may also have some rights that will help you keep your job. Call us
or visit our Web site to get more information on fatigue,
as well as
information on the Americans
with Disabilities Act and the Family
and Medical Leave Act. Some of these laws can help
people with cancer.
Dealing
with skin problems
Your skin in the treatment area may look red, irritated,
swollen, blistered, sunburned, or tanned. After a few weeks, your skin
may become dry, flaky, itchy, or peel. It is important to let your
doctor or nurse know about any skin changes. They can suggest ways to
ease the discomfort and maybe lessen further irritation.
Most skin reactions go away a few weeks after treatment ends.
In some cases, though, the treated skin will stay darker than it was
before. You need to be gentle with your skin. Here are some ways to do
this:
- Use only lukewarm water and mild soap. Just let
water run over the treated area. Do not rub. Also be careful not to rub
away the ink marks needed for your radiation therapy.
- Do not wear tight clothing over the treatment area.
- Try not to rub, scrub, or scratch any sensitive
spots.
- Do not put anything that is hot or cold, such as
heating pads or ice packs, on your treated skin, unless your doctor
tells you to do so.
- Do not use a pre-shave or after-shave lotion or
hair-removal products. Use an electric shaver if you must shave the
area, but first check with your doctor or nurse.
- Ask your doctor or nurse before using any powders,
creams, perfumes, deodorants, body oils, ointments, lotions, or home
remedies in the treatment area while you are being treated and for
several weeks afterward. Many skin products can leave a coating on the
skin that can cause irritation, and may even change the dose of
radiation that enters the body.
- Avoid exposing the area to the sun during treatment
and for at least 1 year after your treatment is completed. Do not use
tanning beds.
- 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.
What can I do about hair loss?
Radiation therapy can cause hair loss (alopecia), but only
in
the area being treated. For example, if you get treatment to your hip,
you will not lose hair from your head. But radiation to your head may
cause you to lose some or all of the hair on your head.
Most patients find that their hair grows back after the
treatments are finished, but dealing with hair loss can be hard. When
it does grow back, your hair may be thinner or a different texture than
it was before. Ask your doctor or nurse if you have questions or
concerns about hair loss.
If you do lose your hair, your scalp may be tender and you may
want to cover your head. You should wear a hat or scarf to protect your
head when you are in the sun. If you prefer to wear a hairpiece or wig,
be sure the lining does not irritate your scalp. Your local American
Cancer Society office may be able to help you get wigs or hats. You may
also want to check to see if head coverings are a tax-deductible
expense or if they are covered by your health insurance.
Will my blood counts be affected?
Radiation therapy can cause low white blood cell counts
or low
levels of platelets,
but this is rare. These blood cells help your body
fight infection and prevent bleeding. If your blood tests show this
side effect, treatment might be delayed for about a week to allow your
blood counts to return to normal. This side effect is more likely to
happen if you are also getting chemotherapy.
Will I have eating problems?
Radiation to the head and neck or parts of the digestive
system may cause eating and digestion problems. You may lose interest
in food during your treatment. Even if you are not hungry, you should
try to eat protein and high-calorie foods. Doctors have found that
patients who eat well can better handle their cancer treatments and
side effects.
Coping with short-term diet problems may be easier than you
expect. There are a number of guides and recipe booklets for patients
who need help with eating problems. You can get a copy of our free
booklet, Nutrition for the Person with
Cancer: A Guide for Patients and
Families, by calling our toll-free number, or
you can read it on
cancer.org.
The list below suggests things you can do when you don't feel
like eating, and how to make the most of it when you do feel like
eating.
- Eat when you are hungry, even if it is not
mealtime.
- Eat 5 or 6 small meals during the day rather than 2
or 3 large ones.
- Vary your diet and try new recipes.
- If you enjoy company while eating, try to eat with
family or friends, or turn on the radio or television.
- Keep healthful snacks close by for nibbling when
you get the urge.
- If other people offer to cook for you, let them. Do
not be shy about telling them what you would like to eat.
- If you live alone, you might want to arrange for
programs like Meals on Wheels to bring food to you. Ask your doctor,
nurse, or local American Cancer Society office about Meals on Wheels in
your area.
- If you drink alcohol, ask your doctor if you should
avoid alcohol during your treatment. Find out if it will interact with
any medicines you are taking.
If you are able to eat only small amounts of food, you can
increase the calories per serving by trying the following:
- Mix canned cream soups with milk or half-and-half
rather than water.
- Drink milkshakes, instant breakfast mixes, or
liquid supplements (in cans or bottles) 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 do not feel like eating solid foods. If this is the case for
you, try to get the most from each glassful by making drinks enriched
with powdered milk, yogurt, honey, or liquid nutrition drinks.
Talk to your health care team about any eating problems you
may be having. They can help you find ways to feel better and get the
nutrients your body needs.
How will I feel emotionally?
Many patients feel tired due to the radiation therapy and this
can affect emotions. You also might feel depressed, afraid, angry,
frustrated, alone, or helpless.
Attending a support group of other people with cancer may help
you. Ask your doctor or call the American Cancer Society for more
information about ways to meet with others who share your problems and
concerns.
Will side effects limit my activity?
Side effects might limit your ability to do things. But what
you can do will depend on how you feel. Some patients are able to go to
work or enjoy leisure activities while they have radiation therapy.
Others find they need more rest than usual and cannot do as much. Your
doctor may suggest you limit activities that might irritate the area
being treated.
Are there long-term side effects I should be
concerned about?
During and right after radiation therapy, it may be hard to
think ahead to what may happen many years in the future. But depending
on the type of treatment and the location of the cancer, there may be
long-term side effects from your radiation treatment. (Some of these
are described in more detail in the next section.) Even though
long-term problems are less common than short-term side effects, they
should still be taken into account when making decisions about
radiation therapy.
Damage to your body
Radiation can damage normal cells, and sometimes this damage
can have long-term effects. For example, radiation to the chest area
may affect the lungs or heart. In some people this may cause scarring,
which can affect a person’s ability to do things. Radiation
to the abdomen (belly) or pelvis can lead to bladder, bowel, or sexual
problems in some people. Radiation in certain areas can also lead to
fluid build-up and swelling in parts of the body, a condition known as
lymphedema.
Risk of another cancer
Another thing some people worry about is a possible increased
risk of getting a second cancer some time in the future. This increase
in risk is small but real.
The link between radiation and cancer was noted many years ago
in studies of atomic bomb survivors, workers exposed to radiation on
their jobs, and patients treated with radiation therapy. Young women,
for example, who had gotten whole body radiation for the treatment of
Hodgkin disease were found to be at increased risk for breast cancer
and other cancers later in life. (This treatment is no longer common.)
And some cases of leukemia are also related to radiation exposure. The
leukemia usually develops within a few years of exposure. The risk
peaks about 5 to 9 years after the radiation exposure and then slowly
declines. Other types of cancer after radiation exposure take much
longer to develop. Most do not happen until at least 10 years after
radiation exposure, and some are diagnosed 15 or more years later.
What does this mean to me?
Radiation therapy techniques have steadily improved over the
last few decades. Treatments now target the cancers more precisely, and
more is known about choosing the best radiation doses. More precise
radiation means less damage to nearby, healthy tissues. These advances
are also expected to reduce the number of second cancers that result
from radiation therapy. The overall risk of second cancers is low and
must be weighed against the benefits gained with radiation treatments.
Talk to your doctor before you start radiation treatment to
make sure you are aware of the possible long-term effects. This can
help you make an informed treatment decision and help you know what
symptoms you may need to watch out for after treatment.
Last Medical Review: 12/23/2008
Last Revised: 12/23/2008
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