While radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. The side effects that may occur are described in the following pages. It is important to remember that no person will have more than a few of them, and for many people they may be mild.

Years ago, in the 1950s and 60s, radiotherapy often caused very severe side effects, especially skin burns and scarring. There have been huge improvements in the machines that give the treatment, and severe side effects are now very rare.

As radiotherapy affects people in different ways, it is difficult to predict exactly how you will react to your treatment. Before you start, the staff will discuss with you any likely side effects of the particular treatment you are having. They can also give tips on how to deal with them and how they can be treated. Being aware of side effects in advance can help you to cope with any problems that occur.

Most side effects of radiotherapy disappear gradually once the course of treatment is over. However, for some people, they may continue for a few weeks.

You may feel very tired during your radiotherapy. This can often be made worse by having to travel to your treatment each day. Listen to your body, and if necessary, allow yourself extra time to rest, perhaps by taking a nap in the afternoons. It may help if you spread chores out over the week, sit down to do them, wherever possible, and accept any offers of help. Tiredness can be a problem for some months after your treatment has finished.

As always during treatment of any kind, it is important to maintain a healthy diet and drink plenty of fluids. At times you probably won't feel like eating, or you may find that your eating habits change. It may be easier to have small snacks throughout the day rather than large meals. It is not unusual to lose a little weight during radiotherapy, but if you are having any problems with eating it is important to tell the radiotherapy staff. They can arrange for you to talk to the dietitian at the hospital. Our section on eating well also gives useful advice on eating.

Some people develop a skin reaction while having external radiotherapy. If this effects you, it will normally happen after 3–4 weeks. People with pale skin may find that the skin in the treatment area becomes red and sore or itchy. People with darker skin may find that their skin becomes darker and can have a blue or black tinge. The amount of the reaction depends on the area being treated and the individual's skin.

Some people have no skin problems at all. Your radiographers will be looking for these reactions, but you should also let them know as soon as you notice any soreness or change in skin colour.

It’s important not to use any creams or dressings unless they have been prescribed or recommended by your specialist or the radiographer.

Occasionally, if your skin gets very sore, your treatment may have to be delayed for a short time to allow the area to recover.

Staff at the radiotherapy department will be able to give you advice on how to look after your skin in the area being treated. Care of the skin will vary according to the part of the body that is being treated and the dose of radiotherapy that the skin is receiving.

You may be advised to use only tepid water and plain soaps, without any perfume, to wash the area; and not to soak too long in the bath. You can dry your skin by patting it gently with a soft towel, but you shouldn’t rub the area as this may make it sore.

Perfumed soaps, talcum powder, deodorants and perfumes may also make your skin sore and should not be used. The staff at the hospital may suggest that you gently apply plain moisturisers, such as E45 cream or aqueous cream, to the area. After your treatment, plain soap and plain moisturisers are often recommended. Aloe vera cream can sometimes help the skin to heal. Always check with the radiotherapy staff before applying anything to your skin.

It is very important that any marks put on your skin to show the treatment area are not removed. If the marks do fade or disappear, do not try to replace them yourself but let the radiotherapy staff know.

Men who are having radiotherapy to the head and neck may be advised not to shave the area, or to use an electric razor rather than wet-shaving.

These restrictions apply only to the treatment area, and the rest of your skin can be treated normally. Your skin may peel after the redness has faded, but it will gradually heal. Changes in the skin usually settle down two to four weeks after the treatment has finished, but the area may stay slightly darker than the surrounding skin.

Your skin in the treated area is very sensitive and needs protecting from the sun or cold winds. If you are having radiotherapy to the head or neck, try wearing a hat or a silk or cotton scarf when you go outside.

For at least the first year after your radiotherapy, it is very important to cover the treated area if you go out in strong sunshine. Wear clothing made of cotton or natural fibres, which have a closer weave and offer more protection against the sun. Even after this time, the area of treated skin will be more delicate than normal, so extra care should be taken. Use a sun-cream (of at least factor 15) and cover the area with a hat or close-weave clothing. It is important to remember that you can burn even through clothing if you are out in hot sun for a long time.

You can swim as soon as any skin reaction has settled down, usually within a month of finishing treatment. However, if you are swimming out of doors, do not stay in the water too long, and remember to use a waterproof sun-cream.

Loose-fitting clothes, preferably in natural fibres rather than man-made materials, are more comfortable and less irritating to the skin. If you are having radiotherapy to your neck, avoid tight collars and ties.

Shoulder straps and bra straps can also cause irritation if they rub against treated skin. If your breast area is being treated, you may be more comfortable not wearing a bra or wearing a cropped top or vest.

Radiotherapy to some parts of the body may affect the bone marrow, which produces the different types of blood cells. If the doctors think this might happen to you, you will have regular blood tests during your treatment to check your blood counts (the number of cells in your blood). If your blood counts are low, you may feel tired and 'run down'. If your blood count becomes very low (which is unlikely), it may be necessary to have a short rest from treatment so that your blood cell levels can return to normal. You may also need to have a blood transfusion.

It is very important to let your doctors know if you feel very unwell, or if your temperature goes above 38ºC (100.4ºF), or if you start feeling cold and shaky.

Stopping smoking during and after radiotherapy is very worthwhile. Research has shown that it may make the radiotherapy more effective as well as reducing the side effects. It will also improve your general health and reduce your risk of developing other cancers.

Stopping smoking or even cutting down at such a stressful time can be very difficult, but do your best. If you want help or advice you can talk to your specialist, GP or a specialist nurse, who will be able to suggest ways of stopping. Organisations such as QUIT also offer advice and valuable support.

Complementary therapies can help to improve your quality of life and wellbeing and can sometimes help to reduce the side effects of radiotherapy. Many people find that complementary therapies or practices can help them to feel stronger and more confident in dealing with radiotherapy. These therapies can be used alongside conventional treatments and medicines.

Some complementary therapies, such as meditation or visualisation can be done by the person with cancer themselves and can reduce anxiety. Other therapies such as gentle massage can be carried out by relatives or carers and can help them to support the person with cancer.

Physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical. Touching someone gently can express how much you care about them.

Some hospitals offer complementary therapies alongside conventional care. These may include:

• aromatherapy
• art therapy
• colour and sound therapy
• massage
• reflexology
• relaxation, visualisation or guided imagery techniques
• acupuncture.

Relaxation

Deep relaxation is a skill which can be learned. It can be used to:

• release muscle tension
• relieve stress
• reduce tiredness and pain
• improve sleep and peace of mind
• regain control of emotions.

Relaxation is not simply 'taking it easy', but involves making time to reflect on problems or anxieties and, hopefully, develop a positive mental outlook.

There are several different relaxation techniques which can be self-taught from books or tapes. You can get these from your local library, bookshop and some chemists. Therapists and groups throughout the country also teach particular relaxation methods.