Radiation Therapy: Daily Life and Side Effects

Before treatment starts you have a planning session, called simulation. Marks or small permanent dots go on the skin, so you are positioned the same way each time. If the treatment area is the head or neck, a mold or fitted mesh mask may be made. Most external beam courses run once a day, Monday to Friday. The number of weeks depends on the cancer and the goal. NCI notes that most visits last 30 minutes to an hour. The beam itself is on for only one to five minutes. External beam radiation does not make you radioactive. You can safely be around children and pregnant people.

The routine is repetitive and undramatic, and that surprises many people. You feel nothing during the treatment itself. People often say the logistics, the parking and the daily travel are harder than the sessions.

Fatigue is the most common effect. NCI reports that more than 80 percent of people having chemotherapy or radiation get it. Sleep and rest do not relieve it, and it can follow very little activity. With radiation it usually rises after treatment starts. It peaks around the midpoint, then levels off until the course ends. NCI suggests choosing the activities that matter most and doing them when your energy is best. Staying active, such as walking, may help you feel better.

The treated skin can turn red or darker. It can go dry, itchy, flaky or peeling. In some areas it can blister or weep. It behaves like a sunburn that keeps being reapplied. The usual advice runs like this:

• Wear loose clothing in soft fabrics.
• Use lukewarm water and mild soap.
• Do not rub or scrub.
• Keep adhesive tape off treated skin.
• Avoid heat or ice packs unless your team approves.
• Check with your team before using any skin product, including creams, powders or deodorants.

Ask whether any products should be avoided before a session. Protect treated skin from the sun with dark clothing or SPF 30 or higher sunscreen, as ACS advises.

Early effects arise during or soon after treatment. NCI says healthy cells usually recover within a few months. Some people still feel worse for a time around the end of treatment. Ask your team what to expect for your plan, and tell them if symptoms get worse so they can be managed.

Effects are mostly limited to the part of the body being treated. Head and neck radiation can bring mouth and throat soreness, dry mouth, taste changes and trouble swallowing. It can also cause tooth decay, jaw stiffness and thyroid changes. Chest treatment can cause sore throat, nausea and shortness of breath. Heart and lung effects can occur. The abdomen can bring nausea, vomiting, diarrhea and cramps. The pelvis can bring bowel and bladder problems, rectal bleeding, and fertility or sexual changes. Breast radiation can cause skin irritation, soreness and swelling.

Early effects arise during or soon after treatment. Late effects can appear months or years later. Their risk depends on the dose and the area treated. Ask which late effects apply to your treated area, and what follow-up is advised. This is easy to leave unaddressed once the daily visits stop.

Tell your radiation team at any daily visit about new or worsening symptoms. You do not need to wait for a scheduled review.

• Call 911 or go to an emergency department if you have trouble breathing, or your throat closes up so much that swallowing is not possible. This matters most during head, neck or chest treatment. Do not drive yourself.
• Call 911 or go to an emergency department if your temperature reaches 100.4 degrees Fahrenheit (38 degrees Celsius) or higher while you are also on chemotherapy, or if any fever comes with shaking chills, confusion or fast breathing. The CDC states that a fever during chemotherapy is a medical emergency, because an infection can become life-threatening within hours when white cells are low.
• Call your care team the same day if your temperature reaches that level on radiation alone. Call too if treated skin breaks open, blisters or weeps, if pain is beating your current medicine, or if you cannot drink enough to stay hydrated. During head and neck treatment, call if your mouth is so sore that you are skipping meals.
• Call your care team within a day or two if pelvic or abdominal treatment brings several more loose stools a day than usual, blood in stool or urine, or pain on passing urine.

• NCI - External Beam Radiation Therapy
• NCI - Fatigue and Cancer Treatment
• American Cancer Society - Radiation Therapy Effects on Different Parts of the Body
• CDC - Fever during cancer treatment