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.

• Eat a balanced, nutritious diet. Depending on the area of the body that will get radiation (for example, the abdomen or pelvic area), your doctor or nurse may suggest changes in your diet. You can get more information in our booklet, Nutrition for the Person with Cancer During Treatment: A Guide for Patients and Families.

• 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:

• Add butter or olive oil.

• 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