If you are undergoing cancer treatment that involves radiation therapy, you may find the whole process strange and daunting.
Radiation treatment is time-consuming and disruptive of your routines; it can drain your physical and emotional energy. Today, an adult in the U.S. has a 40% chance of being diagnosed with cancer at some point in their lifetime, according to the National Cancer Institute. About 60% of cancer patients receive some form of radiation treatment.
"To get through your course of radiation as smoothly as possible, and to receive the most benefit with the least amount of discomfort, you have to be quite careful about self-care," says Lorraine Portelance, M.D., a radiation oncologist with Sylvester Comprehensive Cancer Center. For decades, she has specialized in the care of patients with abdominal and pelvic cancers.
Dr. Portelance and a nurse on her team, Randi Steinhagen, R.N., offer advice to stay as comfortable as possible during radiation therapy.
A healthy lifestyle sets the stage for successful treatment
"The best predictor of how well a person will do during radiation is their general physical condition before they begin treatment," says Dr. Portelance. By eating right, moving often and resting enough, and maintaining good social ties, you will position yourself for superior physical and mental health whether or not you wind up in cancer treatment.
Rule #1: Consult your nurse or doctor
If you are receiving radiation therapy for cancer, the main thing to keep in mind is to consult your care team about problems or questions. "Don't ignore side effects, and talk about them with your doctor or a nurse. There may be adjustments that can be made to help you feel better," says Dr. Portelance.
"Day by day during your treatment, keep a running, detailed list of problems or issues you're having. Include notes about your level of pain from day to day, write down how many short- or long-acting pain pills you needed," says Dr. Portelance.
Bring this record to your treatment visits. "It will help your doctor make needed adjustments, based on good information, to provide you with nice pain relief all day," she says.
Be open to altering your diet
"Patients sometimes find that the treatment causes changes in their appetite. Radiation can also affect the body's ability to digest and absorb nutrients from food," says Dr. Portelance.
"The effects on appetite and digestion depend on where the radiation is aimed," says Ms. Steinhagen. If the radiation is targeted towards the lower abdomen, patients may experience loose stools, diarrhea, or cramping. Aimed somewhat higher on the abdomen, it may lead to bloating and nausea.
You may have to alter your eating habits even if you usually favor a healthy diet that's rich in salads and fresh fruits. "With radiation to the abdomen or pelvis, raw foods may not be agreeable. It may be better to eat cooked foods which are easier to digest," explains Ms. Steinhagen.
Eat attractive, nutrient-rich foods even if you don't feel hungry. Don't rely on your appetite. Instead, eat at set mealtimes.
Forego alcohol and tobacco
"Avoid drinking alcohol," says Steinhagen, "If the radiation is aimed at the head and neck, or the throat and stomach, drinking may be irritating and very uncomfortable." Also, avoid using tobacco products in any form, she advises.
Drink plenty of water
"When you stay well hydrated, you reduce the odds that you'll have to deal with side effects such as fatigue or weakness," says Dr. Portelance. "Even if you don't completely avoid them, they may not be as bad."
An easy, reliable way to make sure that you're drinking enough water is to check the color of your urine. It should be a light yellow or straw color. If it's dark or intense, increase your water intake. If your skin or lips often feel dry, you also need to drink more water.
Focus on oral and dental health
Radiation, especially aimed at the head and neck, can lead to some oral and dental side effects. "Patients sometimes have bleeding gums, mouth sores, and problems with their jaws. Fortunately, the oral and dental problems are usually temporary," says Ms. Steinhagen.
Your salivary glands may also produce less saliva, which can cause a condition called xerostomia or dry mouth.
"See your dentist before you start radiation. Tell them about your upcoming treatment and call them again if you have difficulties with eating or with your teeth, mouth, or jaws during radiation treatment," says Ms. Steinhagen.
Follow a routine for quality sleep
People often find radiation tiring, so you may need more sleep than you used to need. "If you're not in the habit of getting eight hours of sleep each night, you may want to start going to bed earlier and waking up later than you're used to," says Dr. Portelance.
Napping during the day can also support your body. "You may feel better if you take a few short naps or rest periods, maybe 10 to 15 minutes, at different times throughout the day," says Dr. Portelance. Avoid napping for more than an hour, though. Very long naps can disturb your nighttime sleep.
"Some of the medications that patients take during radiation can disrupt their sleep. These include steroids, which can make people antsy," says Dr. Portelance. Patients with brain cancer often take steroids to keep the brain from swelling. Oncologists sometimes prescribe steroids to patients to enhance the effects of pain control medications, too.
Report sleep problems to your doctor or nurse. They will help you find a solution.
Be truthful about your pain level
"Sometimes patients want to be brave, or they fear dependence, so they don't want to take pain medication. But if the pain keeps them awake at night, they can become exhausted," says Ms. Steinhagen.
Research has shown that cancer patients don't really have to worry about becoming addicted to pain medicines. "A lot of studies have shown that most patients with cancer don't' have trouble being weaned off of opioids. Dependency is more of a problem with people who have long-term, chronic pain," says Dr. Portelance.
Continue taking regular prescriptions
Also, tell your care team about natural remedies you use. They need to know the names and the amounts of prescription and over-the-counter drugs that you regularly take. Either bring the bottles with you so the information can be entered into your chart, or write down the names and amounts you take.
"Some natural products can interfere with the treatments, so it's important to let your care team know about them," says Dr. Portelance. Acai, for instance, can reduce the good effects of both radiation therapy and chemotherapy.
Exercise to an extent you find manageable
"Patients who have the strength to fit in about 20 minutes of movement during radiation therapy tend to tolerate treatment better and to feel more energetic," she says.
Good options include a daily walk, yoga, or some other low-impact exercise. Putting on some of your favorite music and dancing will lift your spirits too. And exercising during the day will help you sleep deeply at night.
Baby your skin
"Radiation therapy can irritate your skin," says Dr. Portelance. "If you notice any problems with your skin, pruritus [itchiness], blistering, redness, or burning, speak to your nurse or doctor. They will prescribe an ointment or cream to relieve the problem.
Generally, pay close attention to skincare during your treatment. The key steps? Treat your skin gently, use only mild and safe products on it, and shield it from extreme temperatures and from sunlight, which is, after all, another kind of radiation (ultraviolet).
Follow these skincare tips throughout radiation therapy and until your skin feels normal again:
- "Forget about using very hot water or scrubbing with a washcloth, sponge, or loofah when you're washing any treated area," says Ms. Steinhagen. Instead, gently wash those parts of your body using either warm water alone or warm water and a gentle cleanser, using only your hands. Ask your care team to recommend the proper cleansers.
- Likewise, avoid using hot water bottles, heating pads, or ice packs on treated areas.
- Moisturize daily, using only those moisturizers that your care team recommends.
- "Don't try to scrub away any lines or markings that were made on your skin to help target the radiation. Just ignore them," Ms. Steinhagen says.
- Avoid shaving treated areas of skin.
- Skip antiperspirants and talcum powder, which can increase the amount of radiation you receive. You may be able to use deodorants, but they can be irritating. Again, ask your care team.
- Avoid putting anything sticky, such as bandages or nicotine patches, on the treated skin.
- Wear loose, soft, comfortable clothing over treated areas.
- "Do try and spend some time outdoors every day, if you can," says Dr. Portelance, saying that time outside is a proven mood booster. "But remember that intense cold can be hard on your skin," she says. In frigid weather, bundle up and limit your time outdoors, and in hot sunny conditions, wear a hat and tightly woven clothing to protect your skin from the sun. Also, lather exposed areas of skin with a sunscreen recommended by your care team.
- "Keep in mind that once you've had radiation treatment, you're at a greater risk for developing sunburn cancer in that area," warns Dr. Portelance. Ask your care team if you will need to have regular skin checks in the future.
Tap into your support networks
If friends or relatives ask how they can help during your treatment, ask them for some specific kind of service. "Maybe they can help by driving you to your appointments or keeping your children after school," says Dr. Portelance. She reminds patients it's not a sign of weakness to ask for help; it's a sign of competency and strength.
You may also be able to speak with a social worker at the hospital or treatment center where you undergo radiation to tap into sources of practical support.
Consider a lighter workload
You may be able to continue working during radiation treatment, though you may need to reduce your work hours somewhat. "Patients who are undergoing radiation alone, as opposed to having radiation along with chemotherapy, tend to have fewer side effects and an easier time working," says Dr. Portelance.
Carefully follow COVID precautions
If you're in cancer treatment, you surely don't want to increase your risk of catching COVID-19 as well. "Wear your mask to your appointments and whenever you're around people outside the house," says Dr. Portelance. Also, practice social distancing and wash your hands often.
For most patients, radiation therapy goes on for four or five days a week, for about five to seven weeks. "Many patients sail through radiation therapy," says Dr. Portelance, "The ones who do best are the people who make time for self-care and who ask the nurses or me for help with their questions or problems."