The most common side effects of radiation therapy to the breast (after a lumpectomy) or to the chest wall (after a mastectomy) are fatigue and skin irritation.These reactions and their extent are different for every woman. Because radiation therapy is often such an important part of breast cancer treatment, it is important to know how to mitigate its side effects in order to gain the greatest benefit from the therapy.

Faces of Fatigue

Many breast cancer patients experience fatigue, whether or not they are undergoing radiation treatment. Called cancer fatigue, most people with any kind of cancer go through a period of having low energy.

Cancer-related fatigue is not an ordinary sensation of tiredness, but rather a sense of being drained, feeling short of breath with even light activity, experiencing difficulty walking short distances, noting a heaviness of arms and legs, and struggling to perform routine tasks such as showering and cooking. Furthermore, cancer fatigue can make it difficult to concentrate on reading, listening to the radio, and watching TV, and can impair a person's ability to think clearly and make decisions. The debility from such cancer-related fatigue can last for days, weeks, or months.

In addition to cancer fatigue, some breast cancer patients experience radiation therapy fatigue. Tiredness caused by radiation therapy is generally characterized by waves of tiredness. Radiation therapy fatigue can range from mild to severe but fortunately is usually mild to moderate. Rarely does someone need to stop working due to radiation-therapy fatigue. Radiation therapy-related fatigue tends to become more noticeable as treatment continues; it is often worse towards the last few days or weeks. If the fatigue is due solely to radiation therapy, it should gradually resolve after completing treatment.

While doctors do not fully understand what causes radiation fatigue, they know that during radiation therapy, the body uses a great deal of energy for healing. Traveling to and from daily treatments, Monday through Friday, over the course of seven to eight weeks is a task unto itself. In addition, the stress of breast cancer and the effects of radiation therapy on the normal cells certainly contribute to weariness.

Reasons For Fatigue

More often than not, people who are tired during radiation therapy had experienced some degree of lethargy even before they embarked on radiation therapy. They were often sleep deprived, either for no particular reason or because of specific factors such as hot flashes, emotional distress, or pain. Also, people who undergo chemotherapy for breast cancer are sometimes exhausted even before they begin radiation therapy. Other reasons for fatigue include use of other medications, metabolic imbalances, dehydration, poor appetite and other nutritional issues, anemia, inactivity, and an under-active thyroid gland.

The Prescription

Women should not hesitate to talk with their radiation oncology team about fatigue. Usually, the team evaluates a woman's fatigue weekly, rating it on a scale of zero through ten, with zero representing no fatigue whatsoever and ten representing feeling completely washed out. Understanding the intensity of the fatigue helps the team decide how to manage it.

Next, the radiation oncology team considers the source of the fatigue, because any treatment should be directed to the root cause of the sleep deprivation. For example, if a woman is sleep deprived because she is being awakened regularly by hot flashes, the treating physician should attempt to control the hot flashes. If a woman's sleep deprivation stems from anxiety, she should take measures toreduce that stress. Many women have found that support groups, psychological counseling, music therapy, art therapy, meditation, guided imagery, and yoga are useful in stress reduction. When appropriate, anti-depressants and anti-anxiety medications can be beneficial.

The radiation oncology team can also correct other medical causes of fatigue, such as an under-active thyroid, anemia, or metabolic imbalances. Sometimes a team might provide stimulant medication, especially for people with severe cancer- or radiation-related fatigue.

Learning to Take It Easy

Even if the oncology team cannot determine a specific cause for the tiredness, women can focus on conserving their energy, resting, undertaking physical activity, and restoring their energy.

Conserving energy means deliberately managing personal energy resources to reduce energy depletion. In other words, women must prioritize the tasks that are most important and delegate less vital responsibilities. For example, a woman can ask her friends and relatives to help with shopping, childcare, housework, and driving. Conserving energy also means spreading activities throughout the day and taking breaks in between, instead of trying to do everything at once.

Too much rest, however, can decrease a person's energy level. Thus, taking several short 20-minute "power" naps that do not interfere with evening sleep may be more helpful than a long rest period. In fact, scheduling activities throughout the day, including rest periods, is wise.

Remaining active is helpful. Light exercise, such as walking, tai chi, and yoga, can actually improve a person's energy level. Experts recommend doing physical activity at least three times a week, for at least a half hour each time.

Someone with radiation- or cancer-related fatigue should use her leisure time in a restful way. Women can also restore their energy by participating in activities they enjoy such as listening to music, looking at artwork, gardening, bird watching, or sitting by a duck pond.

Coping with Skin Irritation

Another common side effect of radiation therapy is skin irritations. Radiation-induced skin reactions are more likely to occur in people who received chemotherapy shortly before or during radiation therapy and in women who have a prominent fold under the crease of the breast. In fact, this area and the underarm are the most common areas of the breast to sustain a skin reaction.Most skin reactions resolve within a few weeks of completing radiation therapy.

Skin reactions are almost inevitable for women receiving radiation to the chest wall after a mastectomy. As a result, many radiation oncology facilities give such women a one-week prophylactic break halfway through the course of treatment, to reduce the severity of skin reactions.

The severity of a skin reaction varies from person to person. It can become more noticeable as the course of treatment progresses. Faint pinkness of the skin, brisk redness, sun burnt sensation, dryness, itching, peeling, darkening like a suntan, blistering, and moist oozing can occur.

When the reaction is severe, such as a brisk redness that evolves into blistering and moist weeping of the skin, women receive a treatment break, usually lasting a week or two. This rest is usually sufficient to alleviate the worst symptoms. When necessary, doctors can prescribe therapeutic creams. Radiation can be resumed once the reaction resolves.

Treating the Reaction

During radiation therapy, women can avoid chafing the irradiated skin by going braless or by wearing a cotton sports bra without an underwire that fits well below the crease of the breast or the irradiated skin of the chest wall. Women who can go braless altogether, should. If that is not a comfortable solution, women should wear a bra as infrequently as possible to reduce the likelihood and/or the degree of a skin reaction. Also, aerating the irradiated skin helps minimize skin reactions.

Over-the-counter moisturizing creams without alcohol and fragrance can reduce the extent of a skin reaction. Often, radiation oncology teams prescribe these creams at the beginning of radiation therapy.

Women should also try to be kind to the irradiated skin, which can be easily inflamed. Radiation oncologists suggest:

Do not rub, scrub, or scratch the skin in the treatment area. Instead, pat the skin dry and massage physician-prescribed anti-itch creams or ointments onto the affected area.

Avoid sun exposure to the irradiated skin. When going outdoors, wear protective opaque clothing such as a cotton tee shirt.

Steer clear of tight-fitting blouses and bras over the area unless you are instructed otherwise.

Use only lukewarm water and mild soap recommended by the radiation oncology team on the treated area.

Avoid using ice packs or heating pads on the treated skin.

Steer clear of commercial deodorants and skin care products not endorsed by the treatment team.

Do not shave the underarm on the treated side with a non-electric razor

Avoid skin care products for at least two hours before radiation treatment.

Although a number of people who undergo radiation therapy do experience fatigue and skin reactions, most get past these temporary side effects. By working with their radiation oncology teams, people pass the metaphorical finish line of the course of radiation therapy, usually victoriously. Most important, they derive substantial benefits from radiation therapy and move on to leading productive, cancer-free lives.