Cancer Care

SELF CARE - Pathways To Success In Radiation Therapy

• Preparing for Treatment
• What the Patient Can Do While On Treatment
• Self Care While On Treatment
• Nutrition
• Treatment of Head and Neck
• Treatment of Brain
• Treatment of Chest Area
• Treatment to the Prostate and Pelvic Areas
• Special Instructions Upon Finishing Treatments

Preparing for Treatment

Treatment Schedule:- After the first planning appointment, the patient will be given a regular appointment scheduled for the same time each day. The number of treatments prescribed during your planning session is only an estimate and may change as treatment progresses.
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What The Patient Can Do While On Treatment

Most people are able to drive themselves to and from their appointments, there is no medical reason related to the patients treatment which will prevent him from driving.
Tell your radiation oncologist all the medications you are taking, including prescription medications, cold remedies, herbs, laxatives, and any other over the counter medications. Most likely, the patient will be able to continue on routine medications during treatment without experiencing ill effects. However we recommend discontinuing with all herbal medication as it may interfere with your treatments.
The patient is encouraged to continue working and normal activities as long as the patient has the energy and feels well.
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Self Care While On Treatment

The normal reaction of the skin in the treated area is a tanned, reddened, or sunburned appearance. This reaction will lessen and eventually and the skin color will return to its natural color once treatment has been completed. It is very important to take care of your skin while on treatment, and the following is recommended:
Should the skin become extremely red, break or begin draining in the treated area, the patient should contact his radiation oncologist.

• Wash skin with cool water. Do not use soap in the treatment area. Pat the skin dry with a non-abrasive towel, do not rub the skin dry.
• Perfumes, cosmetics, ointments, heating pads, and hot water should be avoided around the treated area.
• Clothing such as tight collars, tight jeans, bra straps should be avoided around the treated areas. Soft cottons, loose fitting clothing should be worn to avoid rubbing the skin in an abrasive way.
• Sun block should be worn on the treated areas at all times while outdoors. 100% Aloe vera gel should be used to moisturize the skin. Only lotions prescribed by the radiation oncologist should be used in the treatment area. Check with your physician before using any lotion as some contain irritating ingredients.
• While on treatment only electric razors should be used to avoid skin cuts.
• Swimming in chlorinated or salt water should be avoided.
• Showers are recommended in place of bathing.
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Nutrition

In order for the patients body to repair while receiving radiation, it is very important to eat healthy food and at points high caloric food to maintain your weight. Even if overweight, maintaining the same weight is important because the calories provide the cells energy necessary to fight the cancer. Even if a loss of appetite is experienced, the following guidelines should be followed:
• Walk briskly for twenty to thirty minutes before a meal to increase hunger.
• If extremely tired, rest for fifteen minutes before eating.
• Eat smaller meals more frequently.
• Eat whenever hungry, even if it is not mealtime.
• Dine with family or friends
• Stock up on convenience foods that are easy to make and vary your meals.
• Try eating high protein/high caloric foods such as eggs, milkshakes, meats of all kinds, oatmeal, ice cream. Nutritional supplements such as Prosure,Ensure, Sustecal or Boost can also be added to the diet.
• “Meals on Wheels” can be arranged for delivery of meals directly to the patients home. The radiation oncology social worker at the office can provide information to assist you with this process.
• Often a patient might find his appetite to be healthiest in the morning. If so, eat a full, nutritious and substantial breakfast.
• Spicy, hot or acidic foods should be avoided, such as hot coffee or tea, or acidic foods like orange juice and tomato sauce can injure the lining on the mouth and throat. Rough or course foods such as raw vegetables, whole grain cereals, crackers, and nuts should be avoided as well.
• Drink as much water as possible. Use a straw to drink liquids, then tilt your head back to make swallowing easier.
• Suck on ice cubes or ice chips to keep salivary glands stimulated and mouth moist.
• If you need more specialized help, please ask the medical doctor to refer you to an oncology nutritionist.
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TREATMENT PROCEDURES FOR SPECIFIC BODY AREAS

Sometimes there are no side effects experienced by the patient; however, depending on the region of the body being treated, side effects may occur gradually or not appear until several days or even weeks after treatment.
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Treatment Of The Head And Neck

Prior to treatment on this part of the body special care should be given to the mouth. Preventative mouth care should be followed. Your radiation oncologist and dentist can order pain medication for sores in your mouth and inform you of the proper foods to eat to avoid irritating the sores. Preventing an infection and dental cavities is extremely important during this time as well. Keeping your mouth as clean as possible is essential during this time. The following list should be followed:
• Four times a day, the teeth should be cleaned with a soft bristled brush, including after all meals.
• Floss twice a day or use a Water Pik to clean between teeth.
• Use a fluoride toothpaste without grains to avoid irritation. (Ask your radiation oncologist or nurse for samples)
• Rinse your mouth well with water at least six times a days.
• Fluoride rinse, gel or tablets should be used on a daily basis. Depending on your needs your dentist will give you instructions for one of fluoride treatments. Upon conclusion of radiation treatments, fluoride should be continued.

Some of the following reactions may occur while receiving radiation to the head and neck areas.
• Sore throat, dry mouth
• Loss of taste
• Difficulty with swallowing
• Small sores in mouth
• Skin reddening similar to a mild sunburn
• Temporary loss of hair; rare occurrence of permanent hair loss in side burn area

Other Instructions:
• Do not smoke tobacco or drink alcoholic beverages. Both will cause irritation to your mouth and throat.
• Adding a humidifier or vaporizer in your bedroom or main living area will add moisture the air and help heal a soar throat.
• Thirty minutes prior to eating, applying xylocaine will decrease localized soreness and inflammation. Obtain doctor approval before beginning.
• If experiencing a persistent cough with phlegm, make sure you are drinking enough fluids to keep the phlegm thin so coughing it out is easier. A nurse will advise you on the use of a cough medicine preparation also.
• If you are taking medicines in pill form and have difficulty swallowing, the pills can be crushed and added to ice cream or other soft foods, such as apple sauce.
• If radiation therapy is being applied to your head use a shampoo such as baby shampoo or Neutragena. Do not wash off the purple marks, if they come off, do not attempt to redraw them. After the first two weeks of treatment, only water may be used. Never use a hair dryer.
• If shaving, only an electric razor may be used. After treatments are finished and the skin has healed a blade razor may be used. Exposing the head, face and neck to fresh air is important; however, avoid dramatic temperature changes, direct sun light, or heat from a sun lamp. Wearing a wig while on treatment except on special occasions for two to three hours is not recommended. Approximately one month after treatment has ended, you may wear a wig as desired.
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Treatment To The Brain

Side effects such as headaches and fatigue may occur as a result of radiation treatment. By using mild pain medicines often the side effects will diminish; however, it may require Decadron, a steroid medication to be prescribed. If you are taking Decadron, do not stop the medication abruptly prior to or during treatment. If you are having any problems, let your radiation oncologist know. Hair loss can be expected with this area of radiation treatment, but it is usually temporary.
• During the latter weeks of your treatment you may feel unusually tired. We recommend pacing your activities and plan for rest periods to avoid becoming overtired.
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Treatment To The Chest Area

Radiation to this area may cause the following side effects:
• Upset stomach or heartburn, possibly accompanying loss of appetite.
• Reddening of the skin over the chest.
• Feeling of a lump in the throat, and difficulty swallowing.
• Increased coughing.

If slight nausea or upset stomach is experienced, try smaller, more frequent meals of bland foods. If you are experiencing difficulty with swallowing, drink high protein liquids, such as milk shakes, eggnog, and eat soft foods. Your physician may also prescribe an anti-nausea medication. Also, taking an antacid one hour prior to meals or three hours after meals should help control the nausea and heartburn which may be associated with this treatment.
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Treatment To The Prostate And Pelvic Areas

The side effects that may occur due to treatment in this area of the body are bladder irritation and skin changes. Increased cramping, frequency and/or burning on urination, or a feeling of pressure on the bladder may also occur. An expected side effect is loose stools or a mild form of diarrhea.
Please let your doctor know as soon as diarrhea occurs and medication will be prescribed to help keep the diarrhea under control. Over-the-counter remedies (Immodium) can help with this problem but a radiation oncologist should advise on which type of over the counter medicine you should use.
If you don’t feel well after the radiation therapy, avoid eating for several hours before your next treatment. Also consider the following:
• Eat small, low fat meals more often and rest after eating; however, avoid lying down flat for two hours after eating.
• Drink liquids sixty minutes prior to eating your meals.
• Follow any special dieting recommendations provided to you by the nurse or doctor.
• Include mild liquids, such as cranberry juice, weak tea, and clear broth into diet. Liquids should be warm or at room temperature, never icy or hot. Avoid coffee as it may cause cramping. Carbonated ( non-caffenated) drinks should be opened and de-fizzed before they can be consumed.
• Avoid foods high in fiber, seeds, and nuts (raw fruits, vegetables, tomatoes, strawberries, raspberries).
• Eat salty foods rather than sweet ones especially if you are experiencing nausea and vomiting.

Eating and keeping your nutrition at its peak is one of the most important things the patient can do – try not to lose weight. A low diet residue will be recommended once the diarrhea starts and for some time after.

The patients skin due to the radiation will also change in color and may become itchy. Please note the following:
• Wear loose fitting clothes
• Do not use lotions or creams in the treatment area unless prescribed for by the Radiation Oncologist
• Use mild soap(Ivory) and luke warm water when showering
• Avoid heat to the area – no hot water bottles, heating pads or hot water
• The marks drawn on this part of the body should not be washed off
• Do not apply tape or bandages to the treated area

If you are a woman and being treated for a tumor in your reproductive organs, a dilator will be provided to you to be used once every other day. Its purpose is to help you keep the vaginal canal open. Lubricate the dilator with a sterile lubricant and insert into your vagina while lying down and leave in place for ten minutes. Cleansing the dilator after each use should be done. There is no restriction on sexual activity during your treatments, however, using the dilator is an option as well.

Becoming increasingly lethargic during the last weeks of treatment will also occur. This is not unusual. Avoiding exercise and planning for rest periods for each day is strongly recommended.
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Special Instructions Upon Finishing Treatments

The following applies to all patients who have received radiation therapy to any part of the body.
• Once skin has healed, and the redness has subsided, an aloe vera based cream on the area should be used. Avoid any product which contains alcohol.
• Side effects such as mouth sores and inflamed skin may not begin healing for several weeks after the conclusion of your treatment. The radiation therapy continues to effect your body for ten to twenty-one days after your last treatment.
• A sunscreen should be used on all parts of the skin that are exposed to the sun; however, it is absolutely necessary to keep the treated skin out of the sun. A specific product will be recommended by your Radiation Oncologist for sun protection. The skin will be sensitive for one year, therefore, gardening and walking must be avoided unless protective clothing and sunscreen has been applied. Sunbathing and heat applications must be avoided entirely.
• A mild soap should be used when bathing.
• Eat a regular diet unless you have been given other instructions by your physician.
• If you’re energy level has increased, returning to all normal activities, including sex, is fine.
• Upon completion of your radiation therapy, a 4-6 week follow up appointment should be scheduled with your Radiation Oncologist.

It is very natural and normal to ask “whether the radiation therapy has cured the cancer.” Some cancerous tumors shrink throughout the treatment course, and some may take months to shrink. The first two years following treatment are an important indication in determining if the cancer recurs. Observation by your radiation oncologist, time, and patience, can only be applied during this time of revealing the outcome of your treatment.
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