Coping With Radiation Side Effects

by Jane Ashley

Many newly diagnosed cancer patients are surprised to learn that radiation will be part of their treatment. When most people think about cancer treatment, they automatically think of chemotherapy.

External Beam Radiation National Cancer Institute

Yet over half of all cancer patients will receive radiation as part of their treatment regimen. Radiation therapy is considered an essential part of curative treatment for brain, breast, cervical, head and neck, lung, prostate and sarcomas. Radiation is also used for eye, lymphomas, thyroid cancers and vulva cancers too. Radiation is sometimes combined with chemo to increase the effectiveness of treatment in both rectal and anal cancer.

What causes radiation dermatitis?

When the radiation is delivered via an external beam, there is a potential for radiation dermatitis (burns to the skin). The radiation not only damages the cancer cells, but the radiation may also damage our skin as the radiation beams travel through our skin to the target.
With daily radiation, the skin is damaged more quickly than it can repair itself … resulting in radiation burns, blisters and weeping skin. In other words, the skin peels off before it can grow back causing sores and/or ulcers. The damage usually doesn’t develop until later in treatment or four to six weeks after treatment ends. Areas, where there are skin folds (such as beneath the breast, the groin area or neck), are particularly vulnerable to skin damage.

Be proactive – don’t wait.

Your radiology oncology team will provide you with helpful hints and tips before you begin treatment. Be sure to follow their recommendations – they’ve been working with patients and radiation burns for a long time and know their stuff. Helpful advice includes:

Loose Fitting Clothes

Wear loose-fitting clothing.
• Avoid itchy fabrics, like wool or no-iron shirts or blouses (the no-iron finish can be irritating)
• Ask before using perfumes, lotions or deodorants.
• Use warm water instead of hot water for showering.

When you begin, you will probably be advised to use a high-quality moisturizer like Aquaphor (also available as a spray), Biafene or Eucerin after every treatment and at bedtime. Wash the affected area with a mild soap, such as Dove or Neutrogena and tepid water to help prevent infection. Use your fingertips, not a washcloth, loofah or brush.

Products and tips that help.

Virtually every patient will develop skin problem. Breast cancer patients’ problems are totally different from anal, cervical and rectal cancer patients. Head and neck cancer patients experience a completely different set of symptoms. Not all of these hints will be specific for your situation, but they’ll give you some guidance toward finding relief. Your goal is to be able to have your radiation without a break.

Calendula ointment . Calendula is made from the marigold flower and is a powerful anti-inflammatory. A large study demonstrated its ability to help heal and/or lower radiation damage to the skin.
Silver sulfadiazine cream . Silvadene, the brand name, works by preventing the growth of bacteria that could infect a skin wound. It can be used for moist desquamation to prevent infection.
• Low-dose topical corticosteroids. These over-the-counter ointments help tame the itching that radiation sometimes causes.
Hyaluronic acid . This is an anionic, nonsulfated glycosaminoglycan can help reduce the severity of skin reactions.
Hydrocolloid and hydrogel dressings . These specialized dressings are more appropriate than gauze for weepy areas that are slow to heal.
The tips below are mostly behavior related things that we can incorporate into our daily life while undergoing radiation therapy.
• Avoid sun exposure. Wear cover-ups or long sleeved shirted. Stay under an umbrella. Avoid getting sunburned.
• Avoid chlorine. Chlorine is drying and will burn and sting any raw skin you have.
• Blowing air cools down the burn. Many people find that a hand-held fan or their hair dryer set on cool brings temporary relief to the radiated area.
• Avoid extremely hot or cold water on the radiated area. This includes the use of hot water bottles or ice packs.
• No pain patches. Never use a pain patch on skin that has received radiation.

Did you know that radiation therapy can cause fatigue and hair loss?

Everyone is different. Some people breeze through radiation without a hint of fatigue. But other patients experience fatigue.
Fatigue from radiation is due to damage of healthy cells. A further cause is that most radiation is scheduled for 5 days a week – those daily trips to and from radiation exacerbate the fatigue you are already experiencing. Be sure to tell your healthcare team if your fatigue interferes with daily activities, you experience confusion or can’t focus, or you are unable to get out of bed for 24 hours.

Hair loss sometimes occurs in the immediate area of the where the radiation beam is targeted. So you might lose a patch of hair on your head if you’re having brain radiation. Head and neck patients might lose a strip of hair. Pelvic radiation patients may lose their pubic hair. This hair loss is temporary – it will regrow in the months after radiation ends.

Specialized tips for specific types of radiation.

Some patients experience very specific side effects related to the unique locations of their cancers.
As if radiation dermatitis is not enough to cope with, head and neck cancer patients have some other issues to deal with too. These tips are especially for head and neck cancer patients.

Swallowing. Many treatment centers have a “swallowing” specialist to help you with special exercises to keep your swallowing muscles strong.
• Eating. You’ll probably get a list of foods that are high in protein but easy to swallow. Many treatment centers have a dietitian who’ll meet with you.
• Changes in your mouth and throat. Radiation can cause sore and ulcers in your mouth and throat too. Moisturizing your mouth and throat by drinking water, broth and Gatorade will help.
These tips are for patients who have pelvic radiation (anal, cervical and rectal cancer) – both urination and bowel movements can be painful.
• Before urination. Always apply Aquaphor or some other barrier ointment. Urine is acidic and will sting and burn any raw area that it touches. Use a baby wipe or wet wipe instead of dry toilet paper.
• Diet. Many patients experience diarrhea. Eat a low fiber, low-fat diet. Drink more fluids to avoid dehydration. Eat bananas and potatoes (without the skin) to replace potassium you may have lost. Avoid hot, spicy foods. Your medical team may also tell you what to take for severe diarrhea.
• Relieving discomfort. A warm sitz or tub bath often helps relieve the discomfort.
• Sexual changes. Be sure to ask your medical team about sexual activity. Women may experience vaginal dryness and vaginal stenosis (shortening of the vagina). Men may experience erection problems, which may or may not be permanent.

The Bottom Line …

Radiation therapy is often used in cancer treatment. Many people find that it is easier than chemotherapy. Others suffer more adverse reactions. Your radiology team always wants you to share your side effects with them so that they can minimize your discomfort.

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