Taking Care of Yourself During Treatment

The following guidelines will help protect your skin during radiation therapy:

• If your skin is marked with a dye, do not wash the marks off. They are necessary for accurate treatment from one visit to the next.
• Keep the skin dry in the area being treated.
• You may rinse the treatment area with plain water. Using a soft cloth, pat dry.
• Do not use soap in the treatment area.
• Do not massage or rub the treated area vigorously.
• Do not apply ointments, creams, lotions, talcum powders, alcohol, deodorants, anti-perspirants, perfumes, make-up or after-shave lotions in the treatment area unless prescribed by your physician. These products may intensify a skin reaction.
• Mild shampoos may be used.
• You may use aquaphor, a soothing gel.  Ask your doctor if it must be cleaned off before treatment.)
• Do not apply hot packs, heating pads, water bottles, saunas or sun lamps to the skin being treated.
• Avoid cold. Do not expose the skin to ice bags or air conditioning vents.
• Avoid exposing the treatment area to direct sunshine.
• Do not put any dressings or tape of any kind on the treatment area unless prescribed by your doctor in the Radiation Oncology Department. If you have an open sore in your treatment area, your nurse will help you cover it with a dressing for protection. Do not use adhesive tape. Paper tape is recommended.
• If shaving is necessary in the treatment area, use only an electric razor with no skin preparation.
• Prevent rubbing of clothes or dressings on the skin as much as possible. Avoid harsh fabrics in the treatment area. Wear clothing with high cotton content; it allows the skin to breathe. If you are receiving radiation in the pelvic area, do not wear pantyhose.
• Use gentle detergents to wash clothing that come in contact with the treatment area.
• After the entire treatment is finished, a mild hand cream containing lanolin or 100 percent pure aloe vera gel may be used to relieve dryness and irritation. Do not use scented or medicated lotions. Cornstarch may also be used to relieve itching. Skin feel should begin to improve about two weeks after the final treatment.
• Your doctor will advise you about skin care and, if necessary, will prescribe special ointments and creams or other medications.

• Chemotherapy – Mouth Care (PDF) »
• Radiation Treatment – Mouth Care (PDF) »

The importance of maintaining good nutrition is a vital part of medical care for individuals with cancer.  Nutrients are the basic ingredients that cells, tissues and organs in the body require to reproduce, maintain and repair themselves.  The body requires nutrients – protein, carbohydrates, fats, vitamins, minerals, trace minerals and water on a regular basis and in proper amounts to function effectively.  Your physician or nurse may recommend that you meet with a dietitian while you are receiving radiation therapy or before you start your treatment.

Dietitians on staff at the Department of Radiation Oncology are registered members of the American Dietetic Association and licensed in the state of Missouri.  They specialize in the medical nutrition therapy for patients diagnosed with cancer.  A registered dietitian can assist you with the following:

• General nutrition counseling
• Assessment of individual nutritional needs
• Suggestions for coping with side effects of cancer treatment
• Use of nutritional supplements
• Prevention of weight loss
• Healthy weight management
• Information on the role of diet and nutrition in reducing cancer risk

If you would like to meet with a dietitian, please notify your physician, nurse, or therapist.

Barnes-Jewish Hospital at Washington University Medical Center Radiation Oncology Department is completely opposed to smoking. Patients receiving head and neck radiation will find cigarette smoke especially irritating. Talk to the physician or nurse if you are having trouble giving up cigarettes.

Need help quitting smoking? Learn more about “Take Control of Your Life,” the six-session smoking cessation program at the Cancer Information Center, located on the first floor of the Center for Advanced Medicine.

Nausea

If you have nausea, try to eat small, frequent meals of bland, dry foods. You should drink liquids about an hour before or an hour after you eat. If possible, you should try to avoid cooking areas when you are nauseated. Your radiation oncologist will prescribe anti-nausea medication if necessary.

Diarrhea

A common side effect of radiation therapy to the abdomen is diarrhea. You may need need to decrease the amount of fiber in your diet. Your nurse will give you information about diet to help you minimize problems with diarrhea.

Avoid raw fruits and vegetables, stimulants such as coffee or tea, raw seeds, gassy or greasy foods, and milk products.

It is important that you drink 2 to 3 quarts of fluids every day when you have diarrhea to keep you from getting dehydrated. Jello, colas and Gatorade are good choices.

Check with your radiation oncologist or nurse before using any over-the-counter medications. You may require a prescription medication to help control diarrhea.

Other bowel and bladder discomfort

Occasionally, patients will feel burning, itching, pain or other discomfort during a bowel movement. Please report any discomfort to a member of your treatment team. Medications can be ordered to help lessen these symptoms.

Do not apply creams or lotions to the irradiated area. A member of your treatment team can advise you about skin care.

Radiation therapy to the abdomen can cause some discomfort to the bladder. You may notice that you need to urinate more often, feel a burning during urination, or feel a pressure or urgency to urinate. If you have any of these symptoms, you will need to drink 2 to 3 quarts of fluid each day.

Please tell your radiation oncologist or nurse if you develop any of these symptoms.

Sexual activity

During your course of treatment, you may notice changes in your sexual desire or performance. These changes vary greatly from one person to another. We encourage you to discuss your concerns with your radiation oncologist or nurse.

Hair loss

Hair loss is a side effect of radiation therapy to the brain. Your hair will begin to thin and fall out after the first week or two of treatment. New hair growth should be visible three to six months after radiation treatments end. If the dose of radiation is high, however, hair loss will be permanent.

To protect your scalp from the sun or cold, you should wear a hat, scarf or wig when outside.

If you wish to purchase a wig, you should do so before treatment. It will be easier to match your own hair color and preferred style. Some health insurance policies will cover the cost of a wig. Your doctor can also give you a prescription for the wig. The Cancer Information Center also has wigs available. You should wear your wig only on special occasions. It is better for your skin if you expose it to air when you are not outside.

Check with the nurse about the use of a mild soap or shampoo for your hair. Do not dye your hair or get a permanent at this time.

After you lose your hair, use warm water only on your scalp. Pat the area dry with a soft towel.

When rising your scalp, do not wash the marks off. If the marks do come off, do not attempt to redraw them.

Medications

While you are having treatments, your physician may prescribe a steroid (Decadron, Cortisone, Prednisone, etc.). This medication reduces the swelling and inflammation caused by the tumor. While you are taking the steroids, you might have an increased appetite, increased thirst, increased need to urinate, fluid retention, leg cramps and mood changes. If you have these or any other side effects, please tell someone on the radiation oncology treatment team. If you are unable to take this medication for any reason, tell your radiation oncologist, nurse, or a member of your treatment team.

Steroids should always be taken with food or an antacid like Maalox. This will help decrease stomach upset.

During your course of treatment, your physician may direct you to slowly decrease the steroids. Do not decrease this medication on your own.

Skin reactions

Follow the skin care guidelines found on the Skin Care instruction sheet. If your skin becomes red, dry and scaly or if it blisters and peels, a member of your treatment team can tell you how to care for the irritated skin. Please do not use your own remedies.

• Do not shave in the treated area throughout your therapy. After your treatments end, do not start to shave again until all skin reactions have completely disappeared. Treated skin may be sensitive for many years. It may may be best to use an electric razor.
• A white cotton T-shirt is less irritating to your skin than a bra. If you are uncomfortable without a bra, check with your nurse about the type of bra to wear.
• Do not use any deodorants on the treated side without first discussing with your doctor or nurse. If you perspire heavily, check with your physician about using baking soda under your arms or under your breasts.
• Do not swim during your treatment period unless you have the approval of your radiation oncologist. The chlorine in swimming pools is drying to the skin. Also, the small ink marks used to outline the treatment area on your skin may wash off.
• Do not allow your skin to be exposed to direct sunlight within the treatment area either during or after your treatments. If you plan to be in the sun, discuss skin care with your radiation oncologist or nurse.
• Around the last week of treatment, the treated skin may become moist or start to peel. A member of your treatment team will give you specific instructions for how to care for this type of reaction.

Trouble swallowing

• Eat soft, moist foods that are cut into small pieces. Sauces and gravies can improve the taste of food and help you swallow it. Try to limit yourself to foods and drinks that are bland and mild in temperature. Your nurse can give you information about diet to help you if you have trouble swallowing. You may need to see a dietician to help you decide what to eat. Your nurse will help you make an appointment.
• Eat many small meals a day instead of a few large ones. Take small bites and chew your food well.
• Avoid alcoholic beverages and smoking.
• Check with your radiation oncologist about the use of antacids or other medications before meals. They may be helpful if you have trouble swallowing or have a burning sensation when you eat.
• If you have trouble swallowing pills or capsules, ask your radiation oncologist or nurse for help. Check with your physician or nurse before you try to crush pills or open capsules.
• Some medications are time-released and need to be taken in their original form.
• Try to drink eight to ten glasses of liquid a day. You may find that using a straw makes swallowing easier. your radiation oncologist or nurse.
• Around the last week of treatment, the treated skin may become moist or start to peel. A member of your treatment team will give you specific instructions on how to care for this type of reaction.

Skin reactions

Please follow the skin care guidelines listed on the Skin Care instruction sheet.

Trouble swallowing

• Eat soft, moist foods that are cut into small pieces. Sauces and gravies can improve the taste of food and help you swallow it. Try to limit yourself to foods and drinks that are bland and mild in temperature. Your nurse can give you information about diet to help you if you are having trouble swallowing. You may need to see a dietitian to help you decide what to eat. Your nurse will help you make an appointment.
• Eat many small meals a day instead of a few large ones. Take small bites and chew your food well.
• Avoid alcoholic beverages.
• Check with your radiation oncologist about using antacids or other medications before meals. They may be helpful if you have trouble swallowing or have a burning sensation when you eat.
• If you have trouble swallowing pills or capsules, ask the radiation oncologist or nurse for help with this problem. Check with your physician or nurse before you try to crush or open capsules. Some medications are time-released and need to be take in their original form.
• Try to drink 8 to 10 glasses of liquid a day. You may find that using a straw makes swallowing easier.

Dry or sore throat

• If swallowing becomes painful or if your mouth becomes sore, please tell a member of your treatment team. Medications are available to help ease this discomfort.
• You might find using a humidifier or vaporizer helpful. Use it in your main living area during the day or in your bedroom at night.
• Do not smoke cigarettes, cigars or a pipe.
• Do not chew tobacco. These products can cause severe irritation to sensitive tissue in the mouth and throat.

Persistent cough

Patients treated to the chest may have a cough, increased bronchial secretions and some difficulty swallowing. This should clear a few weeks after you finish your course of treatment.

Your physician or nurse will tell you how and when to use a cough suppressant. If you have a lot of phlegm, be sure to drink enough liquids to keep it thin. This will make phlegm easier to cough up.

If you have a persistent cough accompanied by shortness of breath, chest discomfort, night sweats or fever, please let your physician or nurse know at once.

If you are having radiation therapy to the head and neck area, you may experience a dry mouth. If so, follow these instructions during your treatment and after you finish treatment until your normal salivary function returns. These suggestions will help you stay as comfortable as possible by stimulating your appetite and preventing oral infections.

You may be told to use fluoride to prevent cavities. If so, please note that you must follow these oral instructions along with your fluoride treatments.

You will be referred to a special dentist and will be seen before your treatment begins. Please follow the dentist’s instructions closely.

Brushing teeth

Brush after each meal. You may want to brush before you eat. This will help stimulate your taste and appetite. Continue to brush unless it becomes too painful or causes bleeding. If this occurs, check with your nurse or physician.

• Use an ultra-soft toothbrush. You may soften your brush more by rinsing it in warm water.
• Do not use commercial toothpaste or mouthwash. Use baking soda or a product your nurse or physician recommends.
• Brush your teeth in the direction they grow: down on the top teeth, and up on the bottom teeth.

Rinsing your mouth

Rinse and cleanse your mouth every 2 hours throughout the day, especially before and after you eat. This will help your appetite.

Do not use a commercial mouthwash. Instead, rinse with:

• 1 teaspoon salt
• 1 teaspoon baking soda
• Dissolve in 1 quart of regular tap water (room temperature). Then rinse again with a large glass of warm, not hot, water.

Mouth injury

Be careful not to injure the lining of your mouth. Avoid:

• tobacco
• alcohol
• very hot or cold food or drinks
• very spicy foods
• citrus fruits (and their juices) such as oranges, lemons, limes, grapefruits, pineapples and tomatoes
• hard and coarse foods such as pretzels, raw vegetables, potato chips, crackers, and hard bread or toast.

Taste changes

Food may not taste the same to you during therapy. It may seem either very salty or quite tasteless. Please do not get discouraged. Try a variety of foods. Things that you usually do not like may taste good to you now. It is very important that you continue to eat and avoid losing weight.

Eating problems

• Eat many small meals a day instead of a few large ones. Take small bites and chew your food well. Soft, moist foods work best.
• If swallowing food is difficult or if you begin to lose weight, you may need to use one of the high-calorie food supplements available. The radiation oncology nurse will give you samples of different supplements to try.
• You may need to see a dietitian. The nurse will help you make an appointment.

Thickened saliva and dry mouth

• In addition to the mouth care suggested above, you might find using a humidifier or vaporizer helpful. Use it in your main living area during the day or in your bedroom at night.
• Drink plenty of fluids. It is especially important that you try to drink fluids with caloric and nutritional value, rather than water. Your radiation therapy team can suggest drinks to try.
• Try sucking on sugarless hard candy or gum, but avoid mentholated candies.
• Do not apply creams or lotions to your lips. A member of your treatment team can advise you about caring for your dry lips.

Trouble swallowing

• Eat soft, moist foods that are cut into small pieces. Sauces and gravies can improve the taste of food and help you swallow it. Try to limit yourself to foods and drinks that are bland and mild in temperature. Your nurse can give you information about diet to help you if you have trouble swallowing. You may need to see a dietitian to help you decide what to eat. Your nurse will help you make an appointment.
• Eat many small meals a day instead of a few large ones. Take small bites and chew your food well.
• Avoid alcoholic beverages.
• Check with your radiation oncologist about using antacids or other medications before meals. They may be helpful if you have trouble swallowing or have a burning sensation when you eat.
• If you have trouble swallowing pills or capsules, ask your radiation oncologist or nurse for help. Check with your physician or nurse before you try to crush pills or open capsules. Some medications are time-released and need to be taken in their original form.
• Try to drink eight to ten glasses of liquid a day. You might find that using a straw makes swallowing easier.

Hoarseness

Don’t be worried if your voice becomes hoarse. This is an expected side effect. Try to speak in a soft tone and only when necessary. Using your voice will irritate your vocal cords further. For most patients, hoarseness is not permanent and usually clears up soon after treatment has ended.

Smoking Cessation

Please avoid smoking during and after your course of irradiation.

Need help quitting smoking? Learn more about “Take Control of Your Life,” the six-session smoking cessation program at the Cancer Information Center, located on the first floor of the Center for Advanced Medicine.

Skin reactions

Please follow the skin care guidelines listed on the Skin Care instruction sheet.

Diarrhea

A common side effect of radiation therapy to the pelvis is frequent loose stools or diarrhea.  You may need to decrease the  amount of fiber in your diet.  Your nurse will give you information about diet to help you minimize problems with diarrhea.

• Avoid raw fruits and vegetables, stimulants  such as coffee or tea, raw seeds, gassy or greasy foods, and milk products.
• It is important that you drink 2 to 3 quarts of fluids every day when you have diarrhea to keep you from getting dehydrated.  Jello, colas and Gatorade are good choices.
• Check with your radiation oncologist or nurse before using any over-the-counter medications.  You may require a prescription medication to help control diarrhea.

Other bowel and bladder discomfort

Occasionally, patients will feel burning, itching, pain, or other discomfort during a bowel movement.  Please report any discomfort to a member of your treatment team. The physician can prescribe a special diet or medication to reduce this.

Please tell your radiation oncologist or nurse if you develop any of these symptoms.

Sexual activity

During your course of treatment, you may notice changes in your sexual desire or performance.  These changes vary greatly from one person to another.  We encourage you to discuss your concerns with your radiation oncologist or nurse.