Frequently Asked Questions

Chemotherapy involves medications given by injections or pills for cancer. This type of treatment is circulated throughout the entire body and is generally prescribed by a medical oncologist. Radiation therapy or radiotherapy is produced by a linear accelerator or another radiation source, and is prescribed by a radiation oncologist. The radiotherapy beams are focused on a very specific area of the body, and thus the effects are highly localized.

Most radiation therapy treatments are daily, five days per week, for a specified period of one to eight weeks, depending on the disease and the course that your physician prescribes.

Radiation therapists, who are under the direction of your radiation oncologist, will be taking all the time necessary to ensure that you are accurately positioned for your treatment. The actual time when the radiation is "on" is generally only about a minute or two for each treatment field. Most of the time, patients are in and out of the department in less than 40 minutes. The staff attempts to arrange the schedules to ensure that appointments are kept on time, but on some days, there may be delays because of unforeseen circumstances or emergencies.

Through years of research and experience, there are ranges of doses that are recommended for each specific type of cancer. Your case will be thoroughly reviewed by the radiation oncologist, and a customized dose and treatment field will be prescribed based on the cancer diagnosis, the cell type, and the location and stage of the disease.

Many patients continue with most of their normal activities during treatment — working, golfing, gardening, etc. Depending on the area being treated, however, there may be side effects including fatigue, nausea, "sun-burned" skin, or diarrhea. Your physician can discuss the likely side effects and prescribe medication for some conditions.  Making certain that you are taking care of your body’s needs is very important. Maintaining your weight and getting adequate fluids and rest are important goals to consider.

Almost all patients are able to drive while receiving radiotherapy treatment. However, with some types of cancer, driving may NOT be recommended due to fatigue or strong pain medication. Your physician will be able to address your specific case.

Good nutrition is important during your radiation treatments, and taking a multivitamin at this time is acceptable. Your physician will, however, need to be aware of all medication and/or herbal products that you are currently taking, including large doses of any one vitamin. In some cases, mega-vitamins may be harmful.

There is usually no pain associated with the radiation treatments. It is very much like having an X-ray taken. Sometimes a sunburn effect may cause the area to be tender.

If you miss an appointment during your prescribed treatment, it will extend your treatment course by a day. We strongly recommend that you attempt to make all appointments as prescribed by your radiation oncologist. Keep in mind that the treatments are generally given Monday through Friday. Weekend treatments are given in emergency cases.

In general, you will be scheduled to see your doctor and your nurse once a week during your treatments. Sometimes, you will see a physician other than your regular doctor. You will also be monitored daily by the radiation therapists who actually deliver the radiation treatments. In addition, all departments are staffed with nursing personnel who can manage your needs and answer health questions relating to your treatments. Your physician is always available if needed, and covering staff are available 24-hours a day, seven days a week. Your nurse is available Monday through Friday from 8 a.m. to 5 p.m.

The most common early side effects of radiation therapy are fatigue and skin changes. They can result from radiation to any treatment site. Other side effects are related to treatment of specific areas. For example, temporary or permanent hair loss may be a side effect of radiation treatment to the head. Appetite can be altered if treatment affects the mouth, stomach or intestine.

Fortunately, most side effects will go away in time. In the meantime, there are ways to reduce discomfort. If you have a side effect that is significant, the doctor may prescribe a change in your treatments or even give you a temporary break.

The side effects of radiation treatment vary from patient to patient. You may have no side effects or only a few mild ones through your course of treatment. Some people do experience serious side effects, however. The side effects that you are likely to have depend primarily on the radiation dose and the part of your body that is treated. Your general health also can affect how your body reacts to radiation therapy and whether you have side effects. Before beginning your treatment, your doctor and nurse will discuss the side effects you might experience, how long they might last, and how serious they might be.

Fatigue, feeling tired and lacking energy, is the most common symptom reported by cancer patients. The exact cause is not always known. It may be due to the disease itself or to treatment. It may also result from lowered blood counts, lack of sleep, pain and poor appetite.

Most people begin to feel tired after a week or two of radiation therapy. During radiation therapy, the body uses a lot of energy for healing. You also may be tired because of stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells. Feelings of weakness or weariness will go away gradually after your treatment has been completed.

You can help yourself during radiation therapy by not trying to do too much. If you do feel tired, limit your activities and use your leisure time in a restful way. Save your energy for doing the things that you feel are most important. Do not feel that you have to do everything you normally do. Try to get more sleep at night, and plan your day so that you have time to rest if you need it. Several short naps or breaks may be more helpful than a long rest period.

If you have a full-time job, you may want to try to continue to work your normal schedule. However, some patients prefer to take time off while they’re receiving radiation therapy; others work a reduced number of hours or arrange for a late afternoon nap.

Whether you’re going to work or not, it’s often a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors may be able to help by picking up groceries for you when they do their own shopping. It is important to keep your spirits up and not become overly depressed.

As a general rule, the area that is being treated with radiation should NOT be exposed to much direct sunlight for up to a year after treatment.  Sunscreen is highly advisable for these regions. Sunscreen should not be applied on treated area while undergoing treatment.

You may notice that your skin in the treatment area is red or irritated. It may look as if it is sunburned, or tanned. After a few weeks, your skin may be very dry from the therapy. Ask your doctor or nurse for advice on how to relieve itching or discomfort. Do not use any skin creams that you have not discussed with your treatment team.

With some kinds of radiation therapy, treated skin may develop a "moist reaction," especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It’s important to notify your doctor or nurse if your skin develops a moist reaction. They can give you suggestions on how to care for these areas and prevent them from becoming infected.

During radiation therapy, you will need to be very gentle with the skin in the treatment area. The following suggestions may be helpful:

• Avoid irritating treated skin.
• When you wash, use only lukewarm water and mild soap, and pat dry.
• Do not wear tight clothing over the area.
• Do not rub, scrub, or scratch the skin in the treatment area.
• Avoid putting anything that is hot or cold, such as heating pads or ice packs, on your treated skin.
• Ask your doctor or nurse to recommend skin care products that will not cause skin irritation. Do not use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you’re being treated and for several weeks afterward unless approved by your doctor or nurse.
• Do not apply any skin lotions within four hours of a treatment.
• Avoid exposing the radiated area to the sun during treatment.  If you expect to be in the sun for more than a few minutes, you will need to be very careful.  Wear protective clothing, such as a hat with a broad brim and a shirt with long sleeves, and use a sunscreen.  Ask your doctor or nurse about using sun blocking lotions.  After your treatment is over, ask your doctor or nurse how long you should continue to take extra precautions in the sun.

The majority of skin reactions to radiation therapy are mild and go away a few weeks after treatment is completed. In some cases, though, the treated skin will remain slightly darker that it was before and it may continue to be more sensitive to sun exposure.

Radiation therapy can cause hair loss, also known as alopecia, but only in the area being treated. For example, if you are receiving treatment to your hip, you will not lose the hair from your head. Radiation on your head may cause you to lose some or all of the hair on your scalp. Many patients find that their hair grows back again after treatments are finished. The amount of hair that grows back will depend on how much and what kind of radiation you receive. You may notice that your hair has a slightly different texture or color when it grows back. Other types of cancer treatment, such as chemotherapy, also can affect how your hair grows back.

Although your scalp may be tender after the hair is lost, it’s a good idea to cover your head with a hat, turban, or scarf. You should wear a protective cap or scarf when you’re in the sun or outdoors in cold weather. We can help arrange for wigs or hairpieces for those desiring this.

In some cases, radiation therapy can cause low levels of white blood cells and platelets. These blood cells normally help your body fight infection and prevent bleeding. If large areas of active bone marrow are treated, your red blood cell count may be low as well. If your blood tests show these side effects, your doctor may wait until your blood counts increase to continue treatments. Your doctor may check your blood counts regularly and change your treatment schedule if it is necessary.

Sometimes radiation treatment causes a loss of appetite and interferes with eating, digesting, and absorbing food. Try to eat enough to help damaged tissues rebuild themselves. It is not unusual to lose one or two pounds a week during radiation therapy, though we will try hard to help you maintain your weight. You will be weighed weekly to monitor your progress.

It is important to eat a reasonable diet. You may find it helpful to eat small meals often and to try to eat a variety of different foods. Your doctor or nurse can tell you whether you should eat a special diet, and a dietitian will have some ideas that will help you maintain your weight.

The list below suggest ways to perk up your appetite when it’s poor and to make the most of it when you do feel like eating.

• Eat when you are hungry, even if it is not mealtime.
• Eat several small meals during the day rather than three large ones.
• Use soft lighting, quiet music, brightly colored table settings or whatever helps you feel good while eating.
• Vary your diet and try new recipes. If you enjoy company while eating, try to have meals with family or friends. It may be helpful to have a radio or television on while you eat.
• Ask your doctor or nurse whether you can have a glass of wine or beer with your meal to increase your appetite. Keep in mind that, in some cases, alcohol may not be allowed because it could worsen the side effects of treatment. This may be especially true if you are receiving radiation therapy for cancer of the head, neck, or upper chest area including the esophagus.
• Keep simple meals in the freezer to use when you feel hungry.
• If other people offer to cook for you, let them. Don’t be shy about telling them what you’d like to eat.
• Keep healthy snacks close by for nibbling when you get the urge.
• If you live alone, you might want to arrange for "Meals on Wheels" to bring food to you. Ask your doctor, nurse, social worker, or local social service agencies about "Meals on Wheels." This service is available in most large communities.
• If you are able to eat only small amounts of food, you can increase the calories per serving by:
  • Adding butter or margarine.
  • Mixing canned cream soups with milk or half-and-half rather than water.
  • Drinking eggnog, milkshakes or prepared liquid supplements such as "Boost" between meals.
  • Adding cream sauce or melted cheese to your favorite vegetables.

Nearly all patients being treated for cancer report feeling emotionally upset at different times during their radiotherapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Radiotherapy may affect your emotions indirectly through fatigue or changes in hormone balance, but the treatment itself is not a direct cause of mental distress.

You may find that it’s helpful to talk about your feelings with a close friend, family member, chaplain, nurse, social worker, or psychologist with whom you feel at ease. You may want to ask your doctor or nurse about meditation or relaxation exercises that might help you unwind and feel calmer. We have a social worker available to help you work through some of these issues, as well as support groups.