Radiation Therapy Head and Neck

Side Effects

Most patients develop side effects from radiation therapy. They begin about 2 weeks after treatment starts. They may get worse during treatment, but will slowly get better after treatment is finished. The type and how severe they are depend on many factors. These include the dose of radiation, the number of treatments, and your overall health. Side effects may be worse if you are also getting chemotherapy.
Below are the most common side effects of radiation therapy to the head and neck. You may have all, some, or none of these. Your nurse will discuss the ones you are most likely to have. Please report any problems to your doctor or nurse.

Changes to the mouth and throat

You will notice changes in your mouth and throat that may include:

• Mouth sores
• Mouth pain
• Throat sores
• Throat pain
• Pain with swallowing
• Difficulty swallowing
• Thickened saliva with dry mouth
• Changes in taste

To help relieve these symptoms, follow the suggestions below:

• Brush your teeth after eating and at bedtime with the toothpaste your doctor prescribed for you or with a mild toothpaste that contains fluoride (e.g., Bioténe^®). Use a soft-bristle toothbrush. If your mouth becomes too sore for this, use a supersoft or baby’s toothbrush.
• If you have dentures, a bridge, or a dental prosthesis, remove and clean it each time you clean your mouth. Leave it out while you sleep. If your mouth becomes irritated, keep it out of your mouth as much as you can.
• If you currently floss your teeth, continue to floss once a day at bedtime. If you have not flossed in the past, do not begin during your treatment.
• Rinse your mouth with solution every 4 to 6 hours or more often for comfort. Swish and gargle well for 15 to 30 seconds and then spit it out. Use any of the following solutions below:
  • One quart (4 cups) of water mixed with 1 teaspoon of salt and 1 teaspoon of baking soda
  • One quart of water mixed with 1 teaspoon of salt 
  • One quart of water mixed with 1 teaspoon of baking soda
  • Water
  • A mouthwash with no alcohol or sugar, e.g., Bioténe^®, Dentek^™
• Use a lip moisturizer (e.g., Aquaphor^®) after you care for your mouth. Do not apply it 4 hours before your treatment^.
• If you are experiencing dry mouth, try the suggestions below:
  • Try using mouth moisturizers to help relieve the dryness.
  • Take frequent sips of water or other liquids (e.g., coconut water, almond milk, Gatorade^®, broth) throughout the day. You may find it helpful to carry a bottle of water.
  • Use an aerosol pump spray bottle to moisten your mouth throughout the day.
  •  Use a humidifier at home, especially at night. Avoid using air conditioners. Be sure to change the water in the humidifier and clean it as directed.
• If you start having pain or difficulty swallowing, tell your doctor or nurse. They can prescribe medication to make you more comfortable.
• As side effects develop, your doctor may ask you to be seen daily by your nurse. He or she will inspect the inside of your mouth each day and will spray your mouth, if needed.

Changes inside the nose

You may notice changes inside your nose. These may include:

• Dryness
• Stuffiness
• Occasional minor nosebleeds

To help relieve these symptoms, keep the inside of your nose moist. You can do this with:

• Saline nose spray
• A humidifier

Ear pain

You may develop pain in your ear from the swelling caused by radiation. Tell your doctor or nurse if you develop ear pain. The pain may be a sign of infection. To take care of your ears:

• Do not use Q-tips^®.
• Do not try to clean or clear out your ear.

Voice changes

You may develop hoarseness during your treatment from the swelling caused by radiation. To help relieve these symptoms:

• Rest your voice as much as you can.
• Do not whisper. This can cause strain on your vocal cords.
• Use a humidifier.
• Gargle with one of the solutions mentioned on page 10.

Skin reactions

During radiation therapy, your skin in the area being treated will change. After 2 or 3 weeks, your skin will become pink or tanned. As treatment goes on, it may become bright red or very dark. It may also feel dry and itchy and look flaky. You may notice a rash, especially in any area where you have had previous sun exposure. Although this may be a side effect of treatment, a rash could be a sign of an infection. If you develop a rash at any time during your treatment, tell your doctor or nurse.
Sometimes the skin in sensitive areas, such as behind the ear and near the collarbone, may blister, open, and peel. If this happens, tell your doctor or nurse. Your nurse will apply special dressings or creams and teach you how to care for your skin.
The skin reactions sometimes become more severe during the week after treatment is completed. If this happens, call your doctor or nurse. These symptoms will gradually decrease about 3 or 4 weeks after you finish your treatment.
Below are guidelines to care for your skin during treatment. Continue to follow them until the skin reaction resolves. These refer to the skin only in the area being treated.

Keep your skin clean

• Bathe or shower daily using warm water and a mild, unscented soap. Examples of soaps you can use include Neutrogena^®, Dove^®, baby soap, Basis^®, and Cetaphil^®. Rinse your skin well and pat it dry with a soft towel.
• When washing, be gentle with your skin in the area being treated. Do not use a washcloth or a scrubbing cloth or brush.
• Do not use alcohol or alcohol pads on the skin in the area being treated.

Moisturize your skin often

• If you are likely to get a skin reaction, your nurse will recommend that you start using a moisturizer. You should start using it the first day of your treatment to minimize the reaction. If you are not likely to develop a skin reaction, you will not need a moisturizer unless your skin becomes dry or itchy. Your nurse will give you instructions. If you are not sure whether you should use a moisturizer, please ask your nurse.
• There are many moisturizers you can use. Some can be purchased over the counter and some require a prescription. There is no evidence that any one moisturizer is better than another. Over-the-counter moisturizers you can use include Aquaphor^®, Eucerin^®, or calendula.
• You can also use Miaderm, 
• If you don’t like the feel of the moisturizer your doctor or nurse recommends, let them know. He or she can select another product for you to try.
• Apply the moisturizer at least 2 times a day.
  •  If your radiation treatment is in the morning, apply it:
    • After your treatment
    • Before you go to bed
  • If your radiation treatment is in the afternoon, apply it:
    • In the morning before your treatment
    • Before you go to bed

Avoid irritating your skin in the treatment area

• Wear loose-fitting, cotton clothing over the treated area.
• Use only the moisturizers, creams, or lotions that are recommended by your doctor or nurse.
• Do not use any of the following in the area being treated:
  • Makeup
  • Perfumes
  • Powders
  • Aftershave
• You can use nonaluminum-based deodorant on intact skin in the area being treated. Stop using it if your skin becomes irritated. Examples of these deodorants include Toms of Maine^® and crystal deodorants.
• Avoid shaving the treated skin. If you must shave, use only an electric razor.
• Do not put any tape on the treated skin.
• Do not let your treated skin come into contact with extremly hot or cold temperatures. This includes hot tubs, water bottles, heating pads, and ice packs.
• Do not apply any patches to the treated area, including pain patches.
• If your skin is itchy, do not scratch it. Ask your nurse for recommendation on how to relieve the itching.
• If you have no skin reactions, you can swim in a chlorinated pool. However, be sure to rinse off the chlorine right after getting out of the pool.
  • Avoid tanning or burning your skin during and after you are finished with treatment. If you are going to be in the sun, use a PABA-free sunblock with an SPF of 30 or higher. Also, wear loose-fitting clothing that covers you as much as possible.
  • If you have any silver-containing bandages, remove them and clean the area before treatment.

Hair loss

You may lose some or all of the hair on your face, neck, or scalp in the area being treated. The hair will usually grow back 2 to 4 months after treatment is completed.

Difficulty with eating and drinking

Radiation to the head and neck can cause pain in your throat, dry mouth, thick saliva, or pain with swallowing. Because of this, you may not be able to eat enough food to maintain your weight and energy level. In addition, if you have a mask to position you for treatment, it may not fit correctly if your weight changes. You also may not be able to drink enough liquid to stay well hydrated. The recommendations below will help you get enough food and liquids.

Get adequate nutrition during your treatment

• Eat a well-balanced diet high in calories and protein. Eating well will help you maintain your weight and feel better during treatment. Your dietitian will work with you to help you select the best foods and liquids.
• If you want more information about eating during treatment, ask your nurse or dietitian for the following resources:
  • Eating Well During and After Your Cancer Treatment:  www.mskcc.org/cancer-care/patient-education/resources/eating-well-during-and-after-your-treatment
    
  • Eating Guide for Mechanical Soft and Puréed Diets: www.mskcc.org/cancer-care/patient-education/resources/eating-guide-pureed-and-mechanical-soft-diets
    
• You may take a daily multivitamin if you want. It should not exceed the recommended daily amount. Do not take any other vitamins or nutritional or herbal supplements unless your doctor approves them.
  
• If you are getting chemotherapy at the same time as your radiation therapy, you may need to have a feeding tube placed before beginning treatment. This will ensure you are able to take in enough liquids and nutrients once your side effects begin and it becomes difficult to swallow. You may need to have a feeding tube placed during or after your treatment if you are losing too much weight.
  

Adjust what you eat and drink based on your side effects

• If you have pain or soreness in your mouth or throat or are having difficulty swallowing:
  • Eat soft, moist, bland foods taken in small bites and chewed well.
  • Use sauces and gravies to soften foods.
  • Avoid substances that may irritate your mouth and throat such as:
    • Very hot foods and liquids
    • Dry, hard, and coarse foods (e.g., chips, pretzels, crackers, and raw vegetables)
    • Spices (e.g., pepper, chili, horseradish, hot sauce, curry)
    • Acidic or citrus foods and juices (e.g., orange, grapefruit, lemon, lime, pineapple, tomato)
    • Alcohol
    • Tobacco
  • Try changing the texture of your foods by blending or puréeing them.
  • Take liquid nutrition supplements. There are many products available and they come in a variety of flavors. Speak with your doctor, nurse, or dietitian about how to select a product.
• If your mouth is dry:
  • Rinse your mouth before eating.
  • Use gravies and sauces to prepare your food.
  • Drink liquids while eating dry foods such as rice or bread.
• If you have a loss of appetite:
  • Eat small, frequent meals throughout the day. If you never seem to feel hungry, set up a schedule to ensure that you eat regularly.
  • Be selective about what you eat. Choose foods and drinks that are high in calories and protein.
  • Eat your meals in a calm place and take your time. Eat with family or friends whenever possible.
  • Bring snacks and drinks with you when you come for treatment. You can have them while you are waiting or while you are coming to and from the department each day.
  • Take liquid nutritional supplements if you are not eating enough food. There are many products available and they come in a variety of flavors. Speak with your doctor, nurse, or dietitian about which product is best for you.
• If you have nausea:
  • Tell your doctor or nurse. Medication can be prescribed to relieve this.
  • Select foods that are usually well tolerated, including:
    • Foods at room temperature or cooler
    • Liquids that are cooled or chilled
    • Dry, starchy foods such as toast, soda crackers, melba toast, dry cereal, pretzels, and angel food cake
    • Yogurt, sherbet, and clear liquids (e.g., apple juice, Jell-O^®, ginger ale)
    • Cold chicken or turkey, baked or broiled, with the skin removed
    • Soft fruits and vegetables
  • Avoid foods and liquids that may increase nausea. These include:
    • Hot foods with strong odors
    • Spicy, fatty, greasy, and fried foods
    • Very sweet foods
    • Acidic or citrus foods and juices (e.g., orange, grapefruit, pineapple, tomato)
    • Alcohol

Fatigue

Most people develop fatigue (i.e., lack of energy, sleepiness, weakness, and not being able to concentrate) after 2 or 3 weeks of treatment. This will gradually go away after your treatment is done, but can last for several months. There are a lot of reasons people develop fatigue during treatment, including:

• The effects of radiation on the body
• Traveling to and from treatment
• Not having enough restful sleep at night
• Not eating enough protein and calories
• Having pain or other symptoms
• Feeling anxious or depressed

Some people find that their fatigue is worse at certain times of the day. Below are suggestions to help you manage your fatigue.

• If you are working and are feeling well, continue to do so. However, working less may help increase your energy.
• Plan your daily activities. Pick those things that are necessary and most important to you and do them when you have the most energy.
• Plan time to rest or take short naps during the day, especially when you feel more tired. You may also find it helpful to go to sleep earlier at night and get up later in the morning.
• Ask family and friends to help you with shopping, cooking, and cleaning.
• Some people have more energy when they exercise. If your doctor approves, try light exercise such as walking.
• Eat foods that are high in protein and calories.
•  Some people have symptoms such as pain, nausea, diarrhea, difficulty sleeping, or feeling depressed or anxious. These can all increase your fatigue. Ask your doctor or nurse for help with any other symptoms you may have.

If you are getting chemotherapy at the same time as radiation therapy, you will feel very fatigued during the last few weeks of treatment. This, combined with the other side effects you will have, will cause you to feel very weak. During the last 2 weeks of treatment, you may need to have someone come with you each day for your treatment.

Skin Care

Miaderm-L with 4% Lidocaine HCI 4 fluid oz.

 

FDA approved and non prescriptive. For the pain associated with radiation treatment

 

One of the most uncomfortable side effects of radiation therapy is the skin reaction in the area being treated. Similar to a sunburn the skin may react with a mild to moderate pink color, or redness accompanied by itching, burning, soreness, and peeling. The effects of radiation on the skin are the most common side effects of radiation treatment, with up to 95% of patients experiencing an adverse skin reaction. One of the most significant problems associated with radiation dermatitis (burns) is that it can force interruptions in treatment, which have been proven to increase the risk of the cancer recurring.


Miaderm Radiation Relief lotion is a water-based lotion formulated with ingredients that are supported by scientific studies. The key ingredients of calendula, hyaluronate (hyaluronic acid), and aloe vera have been clinically proven to be effective in phase III prospective randomized trials published in peer reviewed scientific journals. The sole purpose of Miaderm is to help decrease the skin effects through preventative care. Thus that patients experience in being treated with radiation therapy.

Miaderm-L with 4% Lidocaine HCI is ideal for radiation patients who may have started their treatments before beginning to apply Miaderm radiation relief lotion. Primarily, Miaderm-L is designed for those patients whose skin breakdown is sufficient to cause discomfort requiring relief. Additionally Miaderm-L can be used if moist desquamation; if it is in small patches, though should not be used on confluent moist desquamation  Even in instances where continued treatment is acceptable and indicated, discomfort can cause patients to interrupt their own treatment. Offering additional relief, Miaderm-L provides additional help in the prevention of treatment breaks. Our company manufactures only Miaderm and Miaderm-L and is solely focused on improving the quality and efficacy of radiation therapy by soothing and protecting the skin.  

• Recommended for use one week prior to the start of treatment 3 x daily during treatment and for two weeks after treatment ends.
• Water-based (proven more effective than petroleum based
products)
• Non-steroidal and non-irritating
• Alcohol and nut oil-free
• Contains marine collagen
• Useful beyond treatment as a moisturizer and for the relief of burns, sunburn and itchiness
• Safe and effective anywhere on the body and for all
skin types
• Made in the U.S.A. in an FDA-approved lab
 

 

Oral Care

MuGard (Prescribed only)

 A rinse for oral mucositis has been shown to offer significantly better symptom improvement than placebo in a randomized controlled trial. The mucoadhesive hydrogel (MuGard, Access Pharmaceuticals) coats the oral cavity and mucous membranes, and was approved by the US Food and Drug Administration (FDA) in 2006.

MuGard is used for:

Treating sores and ulcers in the mouth caused by various conditions (eg, radiation, chemotherapy, canker sores, surgery, poorly fitting dentures).
MuGard is a mucoadhesive. It works by forming a protective coating over the inside of the mouth.

Do NOT use MuGard if:

• you are allergic to any ingredient in MuGard

Contact your doctor or health care provider right away if any of these apply to you.

Before using MuGard:

Some medical conditions may interact with MuGard. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances

Some MEDICINES MAY INTERACT with MuGard. However, no specific interactions with MuGard are known at this time.
Ask your health care provider if MuGard may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use MuGard:

Use MuGard as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Use a measuring device marked for medicine dosing. Your doctor will tell you how much of MuGard to use. Ask your pharmacist for help if you are unsure of how to measure your dose.
• Gently pour the prescribed amount of medicine into the mouth. Rinse the entire mouth for 1 minute or longer, if possible.
• If rinsing is not possible or is too painful, spread MuGard throughout the mouth by gently rotating your head.
• Be sure that all parts of the mouth have been covered by MuGard.
• Check with your doctor to see if you should spit MuGard out or swallow it after rinsing.
• Do not eat or drink for at least 1 hour after you use MuGard.
• If you miss a dose of MuGard, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use MuGard.

Important safety information:

• Do not dilute MuGard before using it.
• It is important to practice good oral hygiene as directed by your doctor or dentist while you are using MuGard. Talk with your doctor or dentist if you have questions about good oral hygiene.
• Use MuGard with caution in the ELDERLY; safety and effectiveness in the elderly have not been confirmed.
• MuGard should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using MuGard while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you use MuGard, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of MuGard:

All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no COMMON side effects have been reported with MuGard. Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.