Side effects from radiation therapy to the head and neck

During radiation therapy to the head and neck, you may experience different short-term side effects.

What are the possible short-term side effects?

Radiation therapy to the head and neck may cause a number of short-term side effects. However, everyone is different and you’re unlikely to experience all of the same side effects as someone who is receiving the same treatment as you.

If you’re concerned about any side effects during your radiation therapy treatment to the head and neck, we encourage you to speak with your care team who can help you with strategies to manage your side effects.

Types of short-term side effects

Skin reaction

Two to three weeks after your treatment begins, your skin may become red, dry and tender. This reaction can last the remainder of your treatment, and usually returns to normal four to six weeks after treatment finishes.

Towards the end of treatment, the skin reaction can become more intense. You may experience some minor skin loss on your head or neck. This can be managed with a simple dressing until the area heals.

Your nurses will show you how to care for your skin and manage any skin reactions. Tell your nurse if you’re worried about a skin reaction or are experiencing any skin changes.

Pain and discomfort

We will provide you with information to help control any pain or discomfort you may be experiencing. If required your doctor will also prescribe pain relief to help control any pain.

Pain flare

Radiation therapy to bone areas in the head and neck can cause a temporary increase in pain in the area being treated. It can occur after one dose of radiation and usually lasts for 12 to 36 hours. Let us know as soon as possible if you experience a pain flare, as we can control this with the use of additional
pain medication.

Hair loss

Radiation therapy to the head and neck may cause the hair in the treatment area to fallout, usually a few weeks after treatment begins. Hair will usually regrow within three, to six months. The colour or texture may be different, and it may grow back thinner or patchy.

Occasionally, hair loss can be permanent if you have a high dose of radiation therapy. Your doctor will discuss this with you before you start your treatment. We understand that hair loss can be upsetting. Please talk to us if you find losing your hair difficult to cope with. Our nursing team can discuss options to help you manage your hair loss, including headwear and wigs if required.

Difficulty swallowing

Difficulty swallowing is a common reaction when the throat is in the treatment area. As a result of inflammation, the throat can feel painful when swallowing or produce a sensation like a lump in the throat.

Let us know if you’re experiencing difficulty swallowing. We can help to prevent swallowing difficulties from becoming worse. Referral to a dietitian and/or speech therapist can be arranged to support you with weight management and appropriate dietary needs.

Oral thrush

It can appear as a coating on the tongue or as white spots on the lining of the mouth. Please let us know if you have any concerns about oral thrush. We can help you manage any changes you may experience.

Mouth ulcers

The inside of your mouth may become sore due to inflammation, causing mouth ulcers. It’s important to follow the mouth care advice provided to you by your care team. Your nurse will monitor the condition of your mouth during the course of treatment.

Taste change

Radiation therapy to the head and neck region may result in a change or loss of taste. This is usually a temporary problem and should slowly resolve after treatment has finished, although this can sometimes take a few months.

Dry mouth

This may occur as early as the first two weeks of treatment. Your saliva can become thick and sticky or cease to flow. This can be managed by having a bottle of water with you and sipping regularly to make your mouth feel moist and comfortable. Dry mouth moisturising gels and sprays are available—check with your nurse for products that may be appropriate.

Fatigue

You may feel tired or lack energy for daily activities during your treatment. You may feel increasingly tired as you reach the end of your treatment. This is a common reaction to radiation therapy and each person is usually affected to varying degrees. Fatigue usually eases a few weeks after treatment finishes. Finding a balance between rest and activity will help you manage.

How can I manage skin changes?

Washing and styling your hair

Avoid frequently shampooing your hair. You may wash your hair with warm water and a mild, non-perfumed shampoo. Let hair dry naturally. Avoid hair dryers, curling irons and straighteners. Continue this for two weeks after completing treatment or until there are no signs of irritation. Avoid using hairsprays, gels or styling products.

Moisturise twice a day

Your care team will recommend a cream to help manage any skin changes. At the start of your treatment, apply cream to the area being treated twice a day. As treatment progresses, you may need to apply the cream three to four times per day. Do not apply cream within the hour prior to your treatment, as cream needs to be well absorbed. Let your nursing team know if you continue to experience skin changes.

Hair colours and perms

Do not colour or perm your hair until four weeks after your treatment is complete.

Shaving

Avoid wet shaving with a razor blade, as this may further irritate your skin in the area being treated. We recommend that you either avoid shaving or use an electric shaver instead.

Cosmetics and perfumes

Do not use cosmetics, perfumes or other lotions on your head or neck once you begin radiation therapy. These products can increase the skin irritation caused by radiation.

Avoid excessive temperatures

Avoid exposing the treatment area to excessive temperatures, such as direct sunlight, heat packs, ice packs, saunas or hot spas.

Protect your head in the sun

Wear a wide brimmed soft hat at all times when outdoors. Avoid applying sunscreen to the treatment area.

Dental care

Dental care is important before, during and after radiation therapy treatment. Your radiation oncologist may ask you to see a dentist before you begin treatment to assess your teeth and prepare them for radiation therapy. Dentures may also need to be adjusted to avoid irritation to the gums and mouth. Remove dentures (if applicable) after each meal and rinse both your dentures and mouth. If you see your dentist any time after treatment, always inform them that you have had radiation therapy.

Caring for your mouth

It’s important to keep your mouth clean and moist to prevent infection and reduce discomfort.

From the start of treatment:

  • Clean teeth gently with a soft toothbrush
  • Rinse mouth after every meal with one of the following options: ¼ teaspoon of bicarbonate of soda in one cup of warm water, ¼ teaspoon salt in one cup of warm water or alcohol-free mouthwash

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