Side Effects of Radiation Treatment

As with any cancer therapy, radiation has some side effects that relate directly to the area being treated. Side effects of chemotherapy such as nausea and hair loss tend to be common knowledge in today's society due to personal/familial experiences or scenes in movies. Thanks to this spotlight, many people undergoing radiation treatment for the first time are usually taken back by the spectrum and/or intensity of its side effects.

Side effects of radiation therapy are characterized as acute or chronic. Acute side effects are those experienced during the course of radiation treatment and for several months after treatment is completed. Chronic side effects can occur months or even years after completing treatment.

The intensity of the side effects depends on the tissues and size of area being treated, the total dose and daily dose of radiation, the method of delivery and the sensitivity of individual patients.

Two people receiving the same dose of radiation in the same area might experience vastly different side effect intensities depending on their sensitivity to the radiation itself, current effects of other anti-cancer therapies including chemotherapeutical agents or past treatment with chemotherapeutical agents or radiation (ONS 2006).

Side effect profiles can be further divided into general and site-specific. The main difference between these two categories is that site-specific side effects occur in the treatment field, whereas general side effects occur throughout the body.

Skin Reactions:

Most patients receiving radiation will experience side effects in the skin because the skin serves as a protective barrier for the body's organs. The epidermis, or outermost layer of the skin, is more frequently affected by radiation than the inner dermis because of the rapid cell division.

Skin changes are categorized based on the degree of skin injury (Itano & Taoka 2005). More common types of skin reactions include erythema, hyperpigmentation, dry desquamation and moist desquamation.

Erythema is a generalized reddening of the skin in the treatment field. It may develop after 5-10 treatments and is characterized by itchy, red, raised vesicles. Erythema results from an increase in capillary blood flow that progresses from opening of the vessels to congestion (Itano & Taoka, 2005).

Hyperpigmentation is darkening of the skin due to the radiation. Unlike a tan or burn received from the radiation of the sun, the hyperpigmentation of radiation treatments might be permanent.

Dry desquamation presents as scaly, flaky skin, which causes itching, peeling, and shedding. This occurs in response to radiation damage to the basal cells of the epidermis (Itano & Taoka, 2005).

Moist desquamation is characterized by reddened, weeping skin that is warm and tight to the touch. Skin with moist desquamation has a shiny appearance and produces a clear to cloudy drainage with random areas of crust or scab formation. This occurs in response to complete destruction of the epidermis (Itano & Taoka, 2005).

Often, erythema occurs before moist desquamation and looks like a second-degree burn, is painful, and can become infected (Sitton, 1997). Sometimes, short treatment breaks are offered along with adjustment in the treatment field, if possible, to avoid further complications.

Managing Skin Changes:

General interventions to minimize or prevent reactions to radiation include washing the skin in the treatment field with mild, moisturizing soap while avoiding exposure to irritants such as perfumes, deodorants, lotions, cold, heat and sun. Loose-fitting clothing will help to avoid friction rubs (ONS, 2006).

If you suffer from erythema or dry desquamation, apply moisturizers that contain no fragrances or other irritants. Your physician can prescribe a gentle lotion or you can buy Aquaphor Healing Ointment from a drug store (consult your physician first). If the skin is itchy your physician can prescribe a hydrocortisone cream.

If you suffer from moist desquamation, apply comfort or occlusive transparent, hydrocolloid, or hydrogel wafer dressings, and use silva impregnated gauze or hydrogel if infection is suspected. Providing a break from treatment will also help (Wickline, 2004).

Fatigue

Fatigue is a commonly experienced side effect of radiation treatment. It is difficult to manage and may be attributed to the effect of combined treatment, the physiological process of cancer, or individual lifestyle. General feelings that patients describe include malaise, decreased energy, inability to perform activities of daily living, and exhaustion (Sitton, 1997).

Mechanisms that cause radiation-related fatigue are not well defined by researchers. It could be that more energy is required by the body to repair tissue and cell damage and to eliminate the dead tumor's toxic byproducts (Sitton, 1997). It's also been observed that patients receiving larger doses of radiation to a larger field will experience more fatigue than patients receiving lower doses of radiation on a smaller field (Sitton, 1997), although this could tie into the first theory.

The location of the radiation can also play a part in fatigue. For example patients receiving whole brain radiation are expected to experience more fatigue than patients receiving radiation in other areas (ONS, 2006)

Additional factors may contribute to fatigue including chemotherapy, surgery, medications such as anti-nausea and narcotic pain medications, pain, anemia, nutritional status, respiratory issues, poor sleep patterns, travel distance to and from the treatment center, the duration of the treatments, and perhaps pressure to maintain a normal lifestyle.

Fatigue will hit everyone differently and every patient must take steps to manage fatigue on his or her own. Patients and caregivers might be alarmed at the amount of time the patient spends sleeping and think that he or she is getting sicker, but it's important to point out that fatigue is an expected side effect of radiation treatment and is not an indication of tumor progression or some new ailment.

Relieving and Managing Fatigue

Maintaining a high-calorie and high-protein diet with adequate fluid intake is one way to prevent excessive fatigue. Your nutritionist can help set up a proper dietary plan for you. If you don't already have a nutritionist in your team, you can ask your physician for a referral.

Catching certain ailments early, such as infections or anemia is important because as these get worse, so can the fatigue.

Though you probably feel the worst you have in your life, it's important to balance rest with some form of exercise. Your doctor or nurse can suggest a light customized routine to help combat fatigue.

While swimming is considered an excellent form of therapy and exercise, use caution if you are experiencing even the smallest amount of skin reactions. If you swim in a pool, the chemicals in the water (specifically chlorine or bromine) can cause more damage to your irritated skin. Poor pH levels in the pool can cause irritation as well.

Swimming in fresh water is not recommended because bacteria could get into broken skin and cause an infection.

Having a great support system is important as well for times when you are too tired to take care of chores around the house. If you don't have anyone around you can see if your insurance will pay for help.

Probably the best news is that your treatment schedule can be set for times when you are least tired.

Some Site-Specific Side Effects

The degree of reaction to site-specific side effects is individual, with some patients experiencing extreme debilitation and others only minor effects. (ONS, 2006) Again this depends on the site, dosage, previous modalities of cancer treatment and the patient's individual sensitivity.

Regarding the central nervous system, the most common side effects that may occur during radiation treatment to the brain include swelling of the brain, hair loss, fatigue and neurological changes (Itano & Taoka, 2005).

When radiation is applied to the head and neck area, the common side effects include stomatitis and mucositis, which is an inflammation of the oral mucous membranes, dry mouth caused by the radiation's effects on the salivary glands resulting in decreased saliva output, taste changes caused by the radiation's effect on the taste buds and esophagitis or inflammation and ulceration of the esophagus that causes pain and the inability to swallow (Itano & Taoka, 2005).

Breast radiation side effects include breast tenderness, shrinkage of the breast tissue, fatigue, skin reactions and a condition called lymphedema or the collection of fluid in the tissues due to a disruption of the lymph node's ability to circulate lymph fluid (Itano & Taoka, 2005).

No matter what you experience, always keep your radiation oncology team members informed. Don't be afraid to bring up the tiniest nuisance. Small irritations might not be relevant for a healthy individual, but a slight irritation in a cancer patient can avalanche into bigger problems quickly.

By reporting your side effects as soon as possible, your doctor may be able to help lessen the symptoms before they get worse or generally improve your quality of life during treatment. This knowledge could also potentially benefit others undergoing similar treatments.

Sources:

The Cancer Basics Course (2006). Oncology Nursing Society (ONS).
Joanne Itano & Karen N. Taoka (2005). Core Curriculum for Oncology Nursing; 4^th edition. Missouri: Saunders.
E Sitton (1997). Managing Side Effects of Skin Changes and Fatigue. In: Nursing Care in Radiation oncology, 2nd edition. Philadelphia: Saunders.
Wickline, M.M. (2004). Prevention and Ttreatment of Acute Radiation Dermatitis: Oncology Nursing Forums.