Sarah Cannon - October 10, 2018

Dr Cherylle HayesAfter receiving radiation oncology treatment, you may experience some acute and chronic side effects, many of which are common and can be addressed through conversations with your care team. Most often, acute effects from radiation therapy begin within a few weeks of starting treatment and go away within two to four weeks after treatment ends. Chronic effects, however, may persist and have recently garnered attention with breast cancer patients as survival continues to improve, creating the largest group of cancer survivors. It is important to be mindful of your body and tell your doctor about any changes you may see as quality of life as a survivor is an important goal.

Dr. Cherylle Hayes, Radiation Oncologist and Medical Director at North Florida Radiation Oncology, a part of Sarah Cannon at North Florida Regional Medical Center in Gainesville, Florida, discusses possible late side effects one may experience when treated with radiation therapy, including what to look for and how to prevent them.

What should patients know?

As treatment approaches and techniques have improved over the last few decades and continue to improve with newer systemic (chemotherapy) and endocrine therapies, the most important thing a patient can do is to understand their own body and its reactions to treatment up front. Dr. Hayes tells all of her patients “You are the CEO and president of your body and you help direct the future of your outcomes.”

One must note that side effects can be compounded by external factors including being overweight or having chronic medical problems like diabetes or heart disease. Going into treatment with the healthiest of mind and body are of utmost importance.

Are there late effects of breast cancer radiation therapy? What should patients expect?

Late effects after radiation therapy may occur, but not all cancer survivors will experience them. Some types of late effects of radiotherapy may include fatigue, changes in the skin and breast size and contour, and less commonly lymphedema, cardiac and lung toxicity, alterations in bone health and arm and shoulder mobility.  

Many advancements have been made in techniques and technologies that are available and now used across radiation therapy. Cutting-edge therapies have shortened radiation courses, which have shown to improve skin effects, pain and fatigue.

With newer technologies such as dynamic scanning (4D CT scan), an optimized target is created for when the breast is in the radiation field, and other organs and tissues are not. These technologies have helped decrease the occurrence of lung and secondary side effects because the breast can be treated without the lung being in the field of radiation. This technology has also decreased nausea in patients undergoing breast radiation therapy because organs and nerves in and around the stomach can be contoured out of the field.

For treatment of the left breast, modern techniques have also improved cardiac toxicity. By practicing Deep Inspiration Breath Hold (DIBH), the heart moves away from the chest, resulting in a decrease of cardiac toxicity.

What should patients look for, or be aware of?

First a patient should be aware of all risks after radiation therapy (and the combined effects with other therapies such as chemotherapy, immunotherapy and endocrine therapy, which may compound side effects). If a patient has any comorbidities (like diabetes, skin diseases, connective tissue disorders, etc.) they need to understand additional risks they may have with treatment. Some specific anatomic sites to be aware of include:

  • Heart: Pre-existing heart disease may worsen side effects. Women should get help from their care team to reduce their heart disease and pay attention to heart healthy habits, like a healthy diet, exercise and not smoking.
  • Lungs: Discuss the potential for side effects with your doctors. Symptomatic inflammation of the lungs is rare but you want to be informed on prevention. Ask yourself, “Are my lungs healthy, or do I have co-existing problems like COPD, pulmonary diseases?” Have you received chemotherapy which may cause pneumonitis itself? Being informed upfront can improve outcomes.
  • Bone: Radiation therapy can cause changes in bone health to the bones within the treatment field. This is not common in the case of treating breast cancer with radiation. However, if you and your doctor are concerned about bone health, consider doing bone density tests upfront so that you understand your baseline before beginning radiation therapy. By doing so, you and your doctor can closely and effectively monitor your bone health throughout your treatment, and introduce bone strengtheners, if necessary.
  • Lymphedema prevention: Again, with improved surgical and radiotheraputic techniques, this is not common. Early detection can be subtle. Be aware of discomfort, tightness and swelling in the hand or forearm, as these are typically the first signs of lymphedema. Exercise, maintain a healthy weight and ask your doctor about preventive techniques or garments utilized.

What can patients do to prepare themselves for these late effects?

There are things that you can do to help prepare yourself and prevent late effects of breast cancer radiation therapy.

  • Massage & physical therapy: Seeing a physical therapist and having a massage may help prevent lymphedema. Additionally, manual lymphatic massage is a light massage that mobilizes fluid from the outside in, helping keep the breast healthy. Physical therapy may also improve arm and shoulder mobility issues, which may result from being sore from surgery and radiation.
  • Bone health: In addition to having bone testing, consider beginning a Vitamin D and Calcium regimen prior to your radiation therapy. Always speak with your doctor before beginning a vitamin or supplement regimen as megavitamins are usually contraindicated.
  • Maintain a healthy lifestyle: People who are heavier tend to experience more side effects. Maintaining a healthy weight, being active and not smoking are key to improving outcomes.
  • Talk to your doctor: Always speak with your doctor about their technique as it pertains to your anatomy to determine the best treatment options for you. This is key for successful outcomes.

If you have questions about late effects of breast cancer radiation therapy, call askSARAH at (844) 482-4812 and speak to a nurse available 24/7.