Management of side effects during radiotherapy 1. Fatigue: During radiotherapy, the body uses a lot of energy to heal itself. The stress of the disease, the daily commute to and from treatment, and the effects of radiation on normal cells all contribute to fatigue. Most people feel tired after a few weeks of radiation therapy and will feel more fatigued as the treatment continues. Weakness and fatigue will gradually disappear after radiation therapy is over. During radiotherapy, patients should do less. If you feel fatigued, then move less and rest more during your free time. Go to bed early at night and possibly rest during the day. You may ask family members and friends to help with household chores, shopping, childcare or driving. You can also ask your neighbors to help you buy some things when you go shopping. 2. Skin: The skin at the treatment site is sensitive and looks red and wrinkled. After a few weeks, the patient’s skin becomes dry due to radiation therapy. Patients should tell their doctors about these symptoms and they will make suggestions to eliminate your discomfort. Most skin reactions resolve a few weeks after radiation therapy is completed. In some cases, the skin treated with radiation therapy will be slightly darker than before. Patients should be careful with their skin and the following are some suggestions: (1) Use cold water and mild soap; let the water run over the skin that has received radiation therapy and do not rub it. (2) Clothing should not be worn too tightly over the area receiving treatment. (3) Do not rub or scratch sensitive areas. (4) Do not put hot or cold things, such as hot towels or ice packs, on the skin receiving radiation therapy, unless your doctor recommends it. (5) Do not rub medicated powders, skin creams, perfumes, deodorants, ointments, lotions, and home remedies on the area receiving radiation therapy while you are undergoing treatment and for a few weeks after your treatment has ended, unless authorized by your doctor. (Many skin products leave a layer on the skin, which may prevent radiation therapy or recovery). (6) Do not expose the area that received radiation therapy to sunlight during radiation therapy and for one year after radiation therapy is finished. If you want to stay in the sun for a few more minutes, wear protective clothing (such as wide-brimmed hats and long-sleeved shirts) as well as sunscreen. 3. Hair loss: Radiation therapy can cause hair loss (alopecia areata) at the treatment site. For example, if your hip is treated, your hair will not fall out. However, your head receives radiation therapy, which can cause some or all of the hair on your scalp to fall out. Many patients know that their hair will grow back once the treatment is over, but they still have a hard time adjusting to the hair loss. The amount of hair that grows back depends on the dose of radiation the patient receives and the form of radiation therapy used. For example, if the radiotherapy is meant to alleviate worry (reduce symptoms), your hair will grow back slowly; but if the radiotherapy is meant to cure the cancer, your hair won’t grow back, and this is an indication that you’ve achieved the results of the treatment. After hair loss your scalp becomes tender and you can cover your head. You should wear a hat or scarf to protect your head when you are in the sun. If you wear a wig, you should make sure that the inner layer of the wig does not irritate your scalp. 4. Blood: Radiation therapy does little to lower white blood cell counts or platelet counts. These blood cells help the body fight infection and prevent bleeding. If a patient’s blood tests show that radiation therapy has lowered the white blood cell count or platelet count, treatment will be put on hold for a week in order to increase the patient’s blood cell count. 5. Diet: Side effects also include dietary and digestive problems. During treatment, you may have no appetite at all. Even if you don’t feel hungry, it’s important to consume more protein and calories. Doctors have found that patients with a good appetite can cope better with cancer and its side effects. Solving short-term eating problems may be easier than you think. Here are guidelines and ways to help patients with eating problems. (1) If you have pain when chewing and swallowing food, your doctor may suggest powdered or liquid foods. These foods are available in stores and come in many flavors. They can be used with other foods. (2) The following suggestions will help increase your appetite when you have a loss of appetite and make you eat as much as possible. ① Eat when you are hungry, even if it is not time to eat. ② Eat small, frequent meals. ③ If you like to eat with people, then you eat with family or friends, or you can turn on the radio or TV. ④ In some cases, patients are not allowed to drink alcohol, this is because alcohol can aggravate the side effects of treatment. This is especially important when you are having radiation therapy for brain or neck cancer. ⑤ If you find it troublesome to cook, make a few extra servings and put them in the refrigerator. ⑥ Keep some healthy snacks close by so that you can eat them whenever you want. ⑦ If you have someone to cook for you, just tell them what you want to eat. ⑧ If you live alone, you can order take-out. You can ask the hospital, doctor or nurse about food choices. (3) If you can only eat a very small amount of food, you can increase your energy intake by: ① Adding butter or margarine to your food. ② Drinking milk instead of water. ③ Drinking something like milk between meals. ④ Adding some seasoning or cream to vegetables. Some people find that when they don’t want to eat solid food, they can still eat plenty of liquid food. If this is true for you, you add powdered milk, yogurt, honey or liquid supplements to your drinks. 6. Emotions: Many patients feel depressed, scared, angry, defeated, lonely or helpless. You may also feel tired as a result of radiation therapy, which can ruin your mood. You can talk to your doctor or local cancer society about these problems and find opportunities to work through them with people who care about you.