Understanding Radiation Therapy

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Common side effects of radiation therapy


Fatigue (fuh-teeg) is feeling tired physically, mentally, and emotionally. It’s very common with cancer and its treatment, and often happens with radiation therapy. Managing fatigue is an important part of care.

Fatigue means having less energy to do the things you normally do or want to do. It can last a long time and can get in the way of your usual activities. It’s different from the fatigue of everyday life, and it may not get better with rest. Cancer-related fatigue is worse, and it’s more distressing. 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 good
  • Make it hard to be with your friends and family
  • Make you less able to keep up your normal activities, including things like taking care of your home and 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’s 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 treatment goes on. Stress due to your illness and daily trips for treatment may make fatigue worse.

The cause of cancer-related fatigue is not always clear. But if the cause is known, your doctor often can treat it. For example, if anemia ([uh-nee-me-uh] 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. Increasing physical activity, treating sleep problems, and eating well might all improve fatigue, too. Education and counseling are often part of the treatment; they can help you learn how to save 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 treatment ends. Until then, here are some things that you can do to help you deal with it:

  • Make a list of the things you need to do 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.
  • Try to reduce stress. Things like deep breathing, visual imagery, meditation, prayer, talking with others, reading, listening to music, painting, or any other activity that gives you pleasure may help you feel less stressed out.
  • Keep a journal of how you feel each day. Take it with you when you see your doctor.
  • Balance rest and activities. Try not to spend too much time in bed, 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.
  • Talk to your doctor about whether you should exercise, and what types of physical activities may be best for you.
  • 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 be sure to 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’s not related to something you’ve done.
  • You become confused or can’t focus your thoughts.
  • You can’t 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. Visit our website to get more information on fatigue, or call us for a free copy of Fatigue in People With Cancer. We also have the Americans With Disabilities Act: Information for People Facing Cancer and the Family and Medical Leave Act (FMLA). Some of these laws can help people with cancer.

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 it may peel. It’s important to let your doctor or nurse know about any skin changes. They can suggest ways to ease the discomfort, maybe lessen further irritation, and try to prevent infection.

Most skin reactions slowly go away after treatment ends. In some cases, though, the treated skin will stay darker and might be more sensitive than it was before. You need to be gentle with your skin. Here are some ways to do this:

  • Do not wear tight, rough-textured, or stiff clothes over the treatment area. This includes anything tight or elastic that squeezes the area. Instead, wear loose clothing made from soft, smooth fabrics. Do not starch your clothes.
  • Do not rub, scrub, scratch, or use adhesive tape on treated skin. If your 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 or UV-protective clothing before going outside. Ask your doctor if you should use sunscreen. If so, use one with a sun protection factor (SPF) of at least 30. Reapply the sunscreen often. Continue to give your skin extra protection from sunlight, even after radiation therapy ends.
  • 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 until it’s done.
  • 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 anything on the skin in the treatment area. This includes powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies 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.

Hair loss

Radiation therapy can cause hair loss (the medical word for this is alopecia [al-o-PEE-shuh]). But hair is only lost in the area being treated. For instance, radiation to your head may cause you to lose some or all of the hair on your head (even eyebrows and lashes), but if you get treatment to your hip, you will not lose the hair on your head.

Most people find that their hair grows back after treatment ends, but it can be hard to deal with hair loss. 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. 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 tax deductible or if they are covered by your health insurance.

Blood count changes

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 changes in your counts, treatment might be delayed for a week or so to allow your blood counts to return to normal. This side effect is more likely if you are also getting chemotherapy.

See our document called Understanding Your Lab Test Results to learn more about blood cells and what changes in the numbers of these cells means.

Eating problems

Radiation to the head and neck or parts of the digestive system (like the stomach or intestines) might cause eating and digestion problems. You may lose interest in food during treatment. But even if you’re not hungry, try to eat protein and some 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 people who need help with eating problems. See our document called Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families for advice on managing eating problems and some easy recipes to try.

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’re hungry, even if it’s 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 healthy snacks close by for nibbling when you get the urge.
  • If other people offer to cook for you, let them. Don’t be shy about telling them what you would like to eat.
  • If you live alone, you might want to arrange for a program like Meals on Wheels to bring food to you. Ask your doctor, nurse, or local American Cancer Society office about programs in your area.

If you’re 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 milk shakes, 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 don’t 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, juice, or liquid nutrition drinks.

Talk to your health care team if you have any eating problems. 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 during radiation therapy, and this can affect emotions. You also might feel depressed, afraid, angry, frustrated, alone, or helpless.

We have a lot of information that can help you understand and manage the emotional changes that often come with cancer and cancer treatment. Coping With Cancer in Everyday Life, Distress in People With Cancer, and Anxiety, Fear, and Depression are a few examples. These can be read online, or you can call us to have free copies sent to you.

Getting involved with a support group and meeting other people with cancer may help you. Ask your doctor or call the American Cancer Society for more information about ways to connect with others who share your problems and concerns.

Will side effects limit my activity?

Side effects might limit your ability to do some things. But what you can do will depend on how you feel. Talk to your doctor about this. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and can’t do as much. Your doctor may suggest you limit activities that might irritate the area being treated.

Last Medical Review: 05/02/2014
Last Revised: 05/02/2014