03 Jan 5 Tips: How-To Manage Radiation Side Effects by Dr. Siavash Jabbari
Q: Who typically needs radiation therapy and why?
There are two common approaches to treating breast cancer that has not spread. The most common is lumpectomy, where the visible tumor is removed, often with sampling or sometimes removal of lymph nodes in the axilla (underarm). After lumpectomy, most women benefit from radiation therapy to the breast and sometimes the lymph node regions. The second option is a mastectomy, where the entire breast is removed (usually with lymph node sampling or removal). In that case, some women, but not all, benefit from radiation therapy, usually in the case of involved lymph nodes and/or large tumors.
Q: What do you say to a patient to prepare for radiation? Any words of wisdom or precautions?
Always discuss the details of your case with your physician, as each individual and situation is unique. In general, recovery from surgery (and/or chemotherapy) can require several weeks prior to the start of radiation treatments. During that time, learning about range of motion exercises for the arm is important for both short- and long-term function and comfort. For most types of breast radiation treatments, both arms need to be raised above the head while lying on your back, so range of motion exercises can be very helpful. Also important is learning about lymphedema and its risk factors, monitoring, and precautions to decrease your life-time risk. Lymphedema is a minor or severe swelling of the arm and/or the hand, and is typically related to some forms of breast surgery and radiation. With appropriate monitoring and preventive measures, the risks can be greatly reduced, and especially with newer surgery and radiation techniques. Your treatment team (including specialist lymphedema therapists), can be a tremendous resource to minimize the risk of lymphedema.
1. Always discuss the use of topical creams, deodorants, supplements and vitamins with your physician.
Some of these may interfere with radiation treatments or require modification. With the appropriate information, your treatment team can guide you through the course of treatment and provide you with the most helpful options appropriate for your care.
2. Share with your physicians your prior medical history, and current medications.
Certain auto-immune conditions, such as lupus or scleroderma, can sometimes increase the side effects of radiation treatments. Some medications (or supplements) can also potentiate its side effects or impact its effectiveness, so always discuss these with your physicians.
3. If you are of child-bearing age, discuss any chance of being pregnant with your physicians prior to any scans or treatments. Always use safe contraceptive precautions prior to and during workup or treatment.
Most x-rays and scans, some forms of chemotherapy and anesthesia, and all radiation treatments, can be detrimental and potentially catastrophic for a pregnancy. An unplanned pregnancy can also delay your treatments. Effective and safe family planning can often be done when the appropriate precautions are taken.
4. During and shortly after the completion of radiation treatments, mild to moderate fatigue can be expected. But, while it’s always great to plan ahead, don’t change your life too much unnecessarily!
Moderate activity and exercise, such as 20 minutes of brisk walking per day, can often be the best remedy to the fatigue caused by radiation therapy. Physical activity, and keeping your usual routine at home and work (to a reasonable degree) can also be very helpful for your overall sense of well-being.
5. It’s generally important to avoid sun exposure on the treatment area, and swimming or using a jacuzzi/spa during and for at least a period of time after radiation therapy.
The skin affected by radiation therapy will always be more sensitive to sun exposure, particularly during and shortly after the treatment course, but also for the long-term. Prolonged sun exposure to this skin will increase the long-term radiation effects, and contribute to further aging and/or color changes of the skin. During or shortly after the completion of radiation therapy, the skin can also be more prone to infections, so exposure to irritants or bacteria during swimming or using a spa/jacuzzi can be detrimental.
Q: Types of long-term side effects some people experience and any way to mitigate them?
Minimizing the life-time risks of lymphedema and skin care (as discussed above) are very helpful as you move on from your breast cancer treatments. Other important things to keep in my mind are minimizing risks to your general health and those related to the breast cancer and its treatments. Some forms of chemotherapy and radiation treatments may potentially impact your heart’s health. While modern and well-done radiation treatments can greatly minimize these risks, it’s important to work with all your providers to minimize other and likely more important risks to your heart, such as a healthy life-style and body weight, plenty of activity and healthy diet, stress management, and monitoring and treating (when needed) your blood pressure, cholesterol, and any diabetes. These measures will also be helpful for the health of your brain, muscles, and bones. Eliminating the use of any tobacco will also be a huge factor in minimizing the risk of many diseases, including lung disease or lung cancer. And always be mindful of the “modifiable” risk factors that can contribute to the risk of the cancer returning, or a second cancer arising, such as weight gain or alcohol use (the less the better, we now know that there really is no “safe” amount of alcohol!). Maintaining a healthy body weight can also greatly reduce your future risk of lymphedema. And of course, always follow your physician’s recommendations for monitoring for breast and other cancers.
Q: Anything you want to share with other women or men who are fighting breast cancer?
A cancer diagnosis and its treatments can be emotionally and physically taxing. While the completion of treatment brings about the improvement and resolution of physical side effects, this “survivorship” period can often be accompanied by lingering emotional effects and other changes. These feelings are normal. Be it anxiety about the cancer, physical, emotional, or sleep changes, or the impacts on relationships, work, or finances, all survivors can be affected to one degree or another. Do not hold it all inside. Talk with others about these feelings. Just like your treatment phase, you should not feel alone after the completion of treatments. Your providers and their support teams are specially equipped to help guide you through your survivorship journey, and help with resources that can be of tremendous relief and support.
Finally, it’s critical to have a good “fit” with your providers. If you do not, or even if you do, but would feel better about it, never hesitate to ask for or seek second opinions. No provider should ever fault you for it or take it personally. Your feelings may very well be right if they do. You always deserve a sense of comfort and confidence when it comes to your treatment team and proposed treatment plan.
Dr. Siavash Jabbari
Radiation Oncology Director, Laurel Amtower Neuro-Oncology Program & Cancer Institute
Named one of San Diego Magazine’s “Top Doctor-Physicians of Exceptional Excellence,” in 2016, 2017 and 2018, Dr. Jabbari is a devoted advocate for public health and cancer patients.