Side Effects

Radiotherapy for lymphomas produces undesired side effects. The types of side effects a patient experiences depends upon the dose of radiation, the area treated, and the patient's individual response. Doctors cannot predict the side effects a patient will suffer from as it differs in every person.

If a patient experiences side effects from radiation therapy, they should notify their oncologist immediately. In some cases, there are treatments for side effects that can ease or eliminate patient discomfort. However, if the side effects are too severe, the oncologist may decide to postpone or stop radiation therapy altogether.

Systemic Side Effects

Systemic side effects, also called generalized side effects, take a toll on the entire body. Fatigue and loss of appetite are the most common systemic side effects.

Fatigue

Fatigue is a general feeling of exhaustion. Patients are overly tired or feel weak. They have little or no energy to perform work or other daily tasks. Fatigue is common in lymphoma patients because they often receive radiation to large areas of the body.

Fatigue occurs because of the stress radiotherapy places on the body. While it is very successful at killing cancerous cells, it also weakens the immune system and destroys healthy cells. This undue stress contributes to a patient's need for extra sleep.

To combat fatigue, patients should get an adequate amount of sleep at night (at least 8 hours). Taking naps during the day may also help. Patients may find there are times of the day they are more active than others, and they should schedule priority activities for those “awake” times. They may want to work part-time or take a few weeks of vacation so they can rest when needed. A healthy diet and light exercise may also help combat fatigue. Getting the right nutrients and working your body can help induce sleep. The endorphins released during exercise may also help boost a patient's energy while they are awake.

Loss of Appetite

Radiation therapy can affect a patient's appetite and taste buds. Food may no longer be appealing, making it difficult for a patient to finish a meal. This is a tough side effect to deal with because a healthy appetite has been shown to help patients undergoing radiotherapy. Patients who take in the right nutrients generally fare better than those who don't eat.

If a patient has lost his or her appetite, the best thing to do is to try to get them to eat anyway. Try serving them several smaller meals per day rather than three large ones. If the patient suddenly craves a certain type of food, make sure they get it. Try making fruit smoothies or other shakes so that the patient doesn't have to chew the food. This might make eating easier.

Localized Side Effects

Localized side effects occur in a specific area of the body. Patients will only experience localized side effects in areas that are targeted by radiation therapy.

Irritated Skin

The skin is often affected by radiation because it covers the entire body. No matter where you receive radiation, it will have to pass through the skin. Skin can become irritated and red, as if sun burnt. It may also become dry and itchy. In this case, ask your doctor or nurse which lotions or creams are appropriate for use on your skin. Also ask about the use of soaps and deodorants, as some contain fragrances that will further irritate the skin. Be gentle when washing the skin and applying lotions, so as not to increase irritation.

Sore Throat

Radiation can irritate the lining of the throat, making it difficult to speak or swallow. A sore throat may also affect the patient's appetite. If the patient experiences pain, try serving smaller meals with soft foods. Smoothies and other pureed foods may also help. Ask the oncologist or nurse about food supplements if the patient is having problems eating; supplements can help improve patient health.

Inflammation of the Lungs

Radiation to the chest can affect the lungs by causing inflammation. This inflammation is called radiation pneumonitis, and it occurs in less than 1% of patients. The inflammation usually occurs 6 to 18 months after treatment has stopped. Symptoms include a dry cough, shortness of breath, and low-grade fever. Pneumonitis is usually not life threatening and can resolve itself. However, your doctor may prescribe some steroids to aid in the healing process.

Nausea and Vomiting

Radiation to the stomach can induce nausea and vomiting. The severity of these symptoms differs in every patient. Nausea can be triggered by the treatment itself, by certain smells, or by anxiety before the treatment. There are many ways to combat this symptom, though. Some patients are fine if they refrain from eating a few hours before and after treatment. Some take anti-nausea or anti-anxiety medicine. The more relaxed the patient is during a radiation treatment, the easier it will be to deal with nausea.

Diarrhea

Radiation to the intestines can result in loose stools and more frequent bowel movements. If this isn't stopped, it can lead to dehydration, weight loss, and fatigue. A low-residue diet including creamed soups, eggs, vegetables, potatoes, and cheese will help reduce the frequency of bowel movements. The doctor may prescribe medication to help as well.

Fertility

Radiation to the ovaries in women or the testes in men can reduce fertility. In women, this may mean early menopause; in men this may mean reduction of sperm count. It is possible for the radiation oncologist to shield the reproductive organs, but this is not always successful. The oncologist can also perform a procedure called oophoropexy, in which the ovaries are sutured to the uterus; the uterus can then shield the ovaries. However, this procedure may also result in reduced fertility.

Both sexes should consider birth control while undergoing radiotherapy, as a child conceived during this time can experience birth defects. Men may want to save sperm in a sperm bank and women may want to freeze their eggs prior to treatment if they want to have a biological child later in life. Infertility may be temporary or permanent, but if it is permanent, preserved reproductive cells may be a patient's only hope at having a biological child. For patients who suffer from infertility as a result of radiation, adoption and in vitro fertilization are other options.

Summary

There are many side effects a patient can suffer from as a result of radiotherapy. A patient should consult with their doctor before, during, and after treatment to cope with side effects.

Resources

• Radiation Therapy Effects - American Cancer Institute
• Guide: Radiation Therapy and You (NCI)

Photo from NCI Clinical Center