What not to do during radiation treatment?

Side effects of radiotherapy

Most people have some redness around the area being treated.

The skin may also:

Become pinker or darker over time
Feel tender, dry, itchy and sore
Peel or flake as treatment goes on
Blister or become moist and weepy

You may hear the skin reaction being called radiation dermatitis.

Skin reactions may start during or after treatment. The skin reaction is normally at its worst between 7 and 14 days after treatment. After this it usually starts to get better.

Let your treatment team know if you develop a skin reaction. Most skin reactions are mild and should heal within three to four weeks of your last treatment, but some may need treating or monitoring more closely. For example, skin that has blistered or is peeling will take longer to heal.

The Society and College of Radiographers has information you may find useful on skin reactions and how to care for your skin.

Caring for your skin during radiotherapy

It’s important to look after your skin during treatment. This will help prevent infection, reduce pain and help keep the area being treated comfortable.

You will be given skincare instructions by your radiotherapy team. The following tips may also help.

Washing the skin

Wash the treated area gently with warm water and pat the skin dry with a soft towel.

Skincare products

If you want to use anything on the skin in the treatment area, discuss this with your therapeutic radiographer first.

You can continue to use moisturiser that is free of sodium lauryl sulphate, which can cause irritation, but it’s not recommended to apply this immediately before your treatment. If your skin blisters or peels let the radiotherapy staff know. You can continue to use soap and deodorant that suits your skin unless your treatment team has told you not to.

Heat and cold

Avoid exposing the treated area to very hot or cold temperatures such as hot water bottles, heat pads, saunas or ice packs during treatment.

Taking care in the sun

Avoid exposing the treated area to the sun while having radiotherapy and until any skin reaction has settled down.

The skin in the treated area will remain sensitive to the sun for some time after treatment. Use a sunscreen with a high SPF. Apply the cream under clothes too as you can get sunburnt through clothing.

Swimming

Skin changes from radiotherapy can be irritated by chlorine or chemicals in the pool. Speak to your treatment team if you want to go swimming during or shortly after treatment.

Clothing, bras and prostheses

Friction or rubbing from clothing can cause or worsen skin reactions.

You’ll usually be advised not to wear an underwired bra until your skin heals. Wearing clothing made from natural fibres, such as a soft cotton bra or vest, may help. You may prefer to go without a bra.

If you’ve had a mastectomy and wear a silicone prosthesis, you may find it more comfortable to wear the soft, lightweight prosthesis (softie or cumfie) you used after surgery.

2. Swelling (oedema) of the breast

Your breast or chest area may appear swollen and feel uncomfortable. This usually settles within a few weeks after treatment.

If it continues after this time, talk to your treatment team as you may need to be seen and assessed by a lymphoedema specialist.

3. Pain in the breast or chest area

You may have aches, twinges or sharp pains in the breast or chest area. These are usually mild. They may continue for months or years, but they usually become milder and less frequent over time.

You may also have stiffness and discomfort around the shoulder and breast or chest area during and after treatment.

Continuing to do arm and shoulder exercises during radiotherapy and for several months afterwards may help minimise or prevent stiffness or discomfort.

4. Hair loss in the armpit

Radiotherapy to the armpit will make the underarm hair fall out on that side. You will also lose any hair on the area of the chest that’s being treated.

Hair in the treatment area usually starts to fall out two to three weeks after treatment has started and it may take several months to grow back. For some people, hair lost from radiotherapy may never grow back.

5. Sore throat

If you have radiotherapy to the area around your collarbone or near your breastbone, you may develop a sore throat or discomfort when swallowing. If this happens, talk to your treatment team.

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It may help to take pain relief in liquid form, particularly before eating, until the discomfort improves.

6. Extreme tiredness

Fatigue is extreme tiredness that doesn’t go away with rest or sleep. It’s a very common side effect of breast cancer treatment and may affect you physically and emotionally. If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.

7. Lymphoedema

Lymphoedema is swelling of the arm, hand, breast or chest area caused by a build-up of fluid in the surface tissues of the body. It can occur as a result of damage to the lymphatic system, for example because of surgery or radiotherapy to the lymph nodes under the arm and surrounding area.

Lymphoedema can occur at any time after treatment, sometimes years later.

If the arm, hand, breast or chest area on the side where you had the radiotherapy or surgery swells or feels uncomfortable and heavy, contact your treatment team or GP.

8. Change in breast shape, size and colour

If you’ve had radiotherapy after breast-conserving surgery, the breast tissue and nipple on the treated side may feel firmer than before, change colour or the breast may be smaller and look different.

Although this is normal, you may be concerned about differences in the size of your breasts, or worry that the difference is noticeable.

You can discuss this with your breast surgeon to see if anything can be done to make the difference less noticeable. These side effects may affect how you feel about your body, including how you feel about intimacy and sex.

9. Tenderness over the ribs

Tenderness can occur over the ribs during treatment. In some people, this discomfort may continue but it usually improves gradually over time.

10. Late side effects

Some side effects can develop months or years after radiotherapy treatment ends. However, these side effects are much less common.

Serious side effects are very rare and experts agree that the benefits of the treatment in reducing the chances of breast cancer returning outweigh the risk of possible side effects.

Hardening of tissue

Hardening of the tissue (fibrosis) is rare but may happen several months or years after radiotherapy has finished. If the fibrosis is severe, the breast can become noticeably smaller and firmer.

Changes to the reconstructed breast

If you have a breast reconstruction using an implant, radiotherapy can cause the reconstructed breast to become firmer, change shape or become uncomfortable. You may hear this called capsular contracture.

If you have a breast reconstruction using your own tissue (tissue flap), radiotherapy can cause the tissue of the reconstruction to change shape or shrink.

If you notice changes to your reconstructed breast talk to your breast surgeon or breast care nurse.

Broken blood vessels

Under the skin you may see tiny broken blood vessels. This is known as telangiectasia. Although it’s not harmful to you, it’s permanent and there’s no treatment for it. It may affect you emotionally and the way you see your body. If you are worried about this talk to your breast care nurse.

Changes to the lungs

Sometimes after treatment to the breast or chest wall area, part of the lung behind the treatment area can become inflamed. This may cause a dry cough or shortness of breath. It usually heals by itself over time. More rarely, hardening of the upper lung tissue can occur which can cause similar side effects.

Heart problems

There is a small risk of heart problems in the future from radiotherapy given on the left side. The risk is very low as care is taken to reduce the dose of radiotherapy to the tissues of the heart.

Risk of another cancer developing

There is a small risk of developing another cancer in the future from having radiotherapy. This is very rare, and much less of a risk than your breast cancer returning if you do not have radiotherapy. Your specialist will discuss this risk with you.

Other effects

Other side effects include:

Weakening of the bones in the treated area – can lead to rib and collarbone fractures
Damage to the nerves in the arm on the treated side – may cause tingling, numbness, pain, weakness and possibly some loss of movement
Long-term skin reactions (chronic radiation dermatitis) – see ‘Skin reactions’

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If you’re concerned about late side effects, speak to your treatment team.

11. Further support

If you’re worried about any side effects, regardless of whether they are listed here, talk to your treatment team. You can also talk things through with one of our nurses on our free Helpline.

You never have to face breast cancer alone. Find somebody who understands what you’re going through with Someone Like Me.

Foods to eat and avoid during radiation treatment

Radiation treatment (radiotherapy) can result in side effects such as fatigue, skin damage, and injury to the heart and lungs. A number of foods or their component molecules have been shown to help obtain relief from these adverse effects without lessening the cytotoxic impact of radiation on breast cancer cells.

The foods listed below are recommended during radiation treatment. The food list, which is updated continually as new research becomes available, has been developed based solely on the results of published academic studies. Clicking on any of the foods will take you to its webpage, which contains specific information concerning that food’s relationship to beast cancer (including its overall ranking, for example, highly recommended or recommended in moderation), as well as links to supporting studies. Emphasizing the foods below will help maximize the treatment effects of radiotherapy while increasing well-being and reducing side effects such as fatigue.

Foods that enhance the effectiveness of radiation treatment

The following foods are good sources of compounds that have been shown to increase the anti-cancer effects of radiation treatment and/or protect normal tissues, but not tumors, from radiation:

Tamoxifen has been shown to enhance the effects of radiotherapy in ER+ breast cancer. The antidiabetic drug metformin has also been reported to increase the effectiveness of radiotherapy. Research also suggests that cholesterol-lowering drugs could result in less radiation resistance among hormone receptor positive (ER+/PR+) and inflammatory breast cancer (IBC) patients who undergo radiotherapy. There is also some evidence that limiting calories to some extent could heighten the treatment effects of radiation treatment. Topical application of honey has been shown to be effective in reducing the severity of radiation-induced oral mucositis. Cigarette smoking during radiotherapy can result in increased treatment-related complications.

Supplements for patients being treated with radiotherapy

The following supplements generally have been found to be safe and beneficial for those being treated for breast cancer, including with radiation:

Supplement	Dosage
CoQ10 (if needed for heart health)	100 to 400 mg/day
Fish oil (from wild-caught fish)	1000 to 2000 mg/day
Vitamin D	1000 to 2000 IU/day

Please consult your oncology team for advice concerning your situation and dosages. It might make sense to be tested for deficiency in vitamin D and plan for follow up to determine if your reading has reached a desirable level.

Foods that should be limited or avoided during radiation treatment

The foods listed below have been found to protect cells against radiation treatment (i.e., they are radioprotective) without having been proven not to interfere with the cytotoxic effects of radiotherapy.

Shellfish, especially raw shellfish, should also be avoided during radiotherapy since they have the potential to cause foodborne illness that could interfere with the timely completion of treatment.

Supplements that should not be used during radiation treatment

While antioxidants consumed in food as part of the diet do not appear to interfere with the effectiveness of radiotherapy (or chemotherapy), the use of antioxidant supplements during such treatment has long been a source of controversy. Radiation oncologists and others have expressed concern that antioxidants are capable of diminishing the effectiveness of radiotherapy by protecting tumor cells from radiation. This is because radiation destroys cancer cells in part by generating high levels of free radicals and antioxidants have the potential to neutralize and nullify this mechanism of action.

On the other hand, it has been argued that antioxidants do not interfere with treatment and may, in fact, increase tumor response. Furthermore, the adverse side effects of radiotherapy can be mitigated with antioxidant and other supplements, thereby enabling patients to endure the treatment. In addition, radiation itself reduces the level of antioxidants such as vitamin A, C, and E in tissues, which may need to be replenished. (However, this leaves the question of dosage for the most part unanswered.)

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We do not intend to try to solve this question. However, it is clear that the chemical and other interactions that lead to tumor cell death are complex and this complexity is too profound to be explained in all cases by relatively simple theories or clear-cut narratives. High-quality academic research still reports conflicting conclusions as to whether it is safe to take certain antioxidants and other supplements in combination with radiotherapy. Since research is in disagreement, we lean on the side of caution and recommend against taking the supplements listed below, which have been studied and reported (in some, but not all or even most studies) to reduce the effectiveness of radiotherapy:

Genistein, daidzein or equol supplements
Multivitamins
Propolis supplements
Vitamin A supplements

Vitamin C supplements
Vitamin E supplements

We also caution against taking micronutrients such as apigenin, lycopene, or resveratrol that have been reported to be radioprotective and/or to increase radiosensitivity. This is because of the possibility of unintended outcomes. Safe and effective dosages for these supplements during radiation treatment have not been established; it is best to obtain them through diet.

Please also see our article on how to optimize your breast cancer diet for more information on tailoring your diet according to treatment and breast cancer type and subtype.

Selected breast cancer studies

Efficacy of curcumin for amelioration of radiotherapy-induced oral mucositis: a preliminary randomized controlled clinical trial Cite

Ramezani V, Ghadirian S, Shabani M, Boroumand MA, Daneshvar R, Saghafi F. Efficacy of curcumin for amelioration of radiotherapy-induced oral mucositis: a preliminary randomized controlled clinical trial. BMC Cancer. Springer Science and Business Media LLC; 2023; 23 10.1186/s12885-023-10730-8

Mirzaei Dahka S, Afsharfar M, Tajaddod S, Sohouli MH, Shekari S, Bakhshi Nafouti F, et al. Impact of Curcumin Supplementation on Radiation Dermatitis Severity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Asian Pacific Journal of Cancer Prevention. EpiSmart Science Vector Ltd; 2023; 24:783-789 10.31557/apjcp.2023.24.3.783

SHARMA P, CHATURVEDI S, KHAN M, RAI Y, Bhatt A, Najmi A, et al. Nanoemulsion Myricetin preparation increases the anticancer efficacy against Triple-negative Breast Cancer cells. Authorea, Inc.; 2023; 10.22541/au.167939853.32039231/v1

Naumann FV, Sweep FCGJ, Adema GJ, Peeters WJM, Martens JWM, Bussink J, et al. Tamoxifen induces radioresistance through NRF2-mediated metabolic reprogramming in breast cancer. Cancer & Metabolism. Springer Science and Business Media LLC; 2023; 11 10.1186/s40170-023-00304-4

Shaheer K, Prabhu S, Ali HS, Lakshmanan D. Estrogen Receptor-positive Breast Cancer Cells are Sensitized by Piperine to Chemo/Radio Therapy through Lowering the expression of a NHEJ repair protein DNA-PK. Research Square Platform LLC; 2022; 10.21203/rs.3.rs-2401099/v1

Krejbich P, Birringer M. The Self-Administered Use of Complementary and Alternative Medicine (CAM) Supplements and Antioxidants in Cancer Therapy and the Critical Role of Nrf-2—A Systematic Review. Antioxidants. MDPI AG; 2022; 11:2149 10.3390/antiox11112149

Khozooei S, Lettau K, Barletta F, Jost T, Rebholz S, Veerappan S, et al. Fisetin induces DNA double-strand break and interferes with the repair of radiation-induced damage to radiosensitize triple negative breast cancer cells. Journal of Experimental & Clinical Cancer Research. Springer Science and Business Media LLC; 2022; 41 10.1186/s13046-022-02442-x

Alonso-González C, González-Abalde C, Menéndez-Menéndez J, González-González A, Álvarez-García V, González-Cabeza A, et al. Melatonin Modulation of Radiation-Induced Molecular Changes in MCF-7 Human Breast Cancer Cells. Biomedicines. MDPI AG; 2022; 10:1088 10.3390/biomedicines10051088

Michmerhuizen AR, Lerner LM, Pesch AM, Ward C, Schwartz R, Wilder-Romans K, et al. Estrogen receptor inhibition mediates radiosensitization of ER-positive breast cancer models. npj Breast Cancer. Springer Science and Business Media LLC; 2022; 8 10.1038/s41523-022-00397-y

Khazaei S, Nilsson L, Adrian G, Tryggvadottir H, Konradsson E, Borgquist S, et al. Impact of combining vitamin C with radiation therapy in human breast cancer: does it matter?. Oncotarget. Impact Journals, LLC; 2022; 13:439-453 10.18632/oncotarget.28204

Song PN, Mansur A, Lu Y, Della Manna D, Burns A, Samuel S, et al. Modulation of the Tumor Microenvironment with Trastuzumab Enables Radiosensitization in HER2+ Breast Cancer. Cancers. MDPI AG; 2022; 14:1015 10.3390/cancers14041015

El-Sheikh MM, Abdel-Naby DH, EL-Hamoly T. Polyphenols, Luteolin and Pelargonidin, Modulate Radio- and Chemo-Sensitivity on Breast Cancer. Egyptian Journal of Radiation Sciences and Applications. Egypts Presidential Specialized Council for Education and Scientific Research; 2022; 0:0-0 10.21608/ejrsa.2022.113425.1127

Li M, Lin L, Guo T, Wu Y, Lin J, Liu Y, et al. Curcumin Administered in Combination with Glu-GNPs Induces Radiosensitivity in Transplanted Tumor MDA-MB-231-luc Cells in Nude Mice. BioMed Research International. Hindawi Limited; 2021; 2021:1-11 10.1155/2021/9262453

Michmerhuizen A, Pesch A, Schwartz R, Wilder-Romans K, Liu M, Harold A, et al. Inhibition of Estrogen Receptor Signaling as a Strategy for Radiosensitization of ER+ Breast Cancers. International Journal of Radiation Oncology*Biology*Physics. Elsevier BV; 2021; 111:e253 10.1016/j.ijrobp.2021.07.842

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Gacche RN. Revisiting the Anticancer Drug–Food Interactions. Dietary Research and Cancer. Springer Singapore; 2021;:113-120 10.1007/978-981-16-6050-4_11

Lee H, To NB, Kim M, Nguyen YT, Cho SK, Choi H. Metabolic and lipidomic characterization of radioresistant MDA-MB-231 human breast cancer cells to investigate potential therapeutic targets. Journal of Pharmaceutical and Biomedical Analysis. Elsevier BV; 2021;:114449 10.1016/j.jpba.2021.114449

Wang Y, Liu R, Chang M, Wei W, Guo Y, Jin Q, et al. Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. Informa UK Limited; 2021;:1-16 10.1080/10408398.2021.1984199

Michmerhuizen AR, Pesch AM, Schwartz R, Wilder-Romans K, Liu M, Azaria R, et al. Abstract 737: Estrogen receptor inhibition with tamoxifen mediates radiosensitization of ER+ breast cancer models. Endocrinology. American Association for Cancer Research; 2021; 10.1158/1538-7445.am2021-737

Agbele AT, Faromika OP, Awe OO, Amodu FR, Edaogbogun GO, Bello KA. Impact of metformin on the therapeutic effect of radiotherapy. Radiation Medicine and Protection. Elsevier BV; 2021; 2:17-22 10.1016/j.radmp.2020.12.002

Lima ICGdS, de Fátima Souto Maior L, Gueiros LAM, Leão JC, Higino JS, Carvalho AAT. Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis. Clinical Oral Investigations. Springer Science and Business Media LLC; 2021; 10.1007/s00784-020-03743-1

Manda K, Juerß D, Fischer P, Schröder A, Koenen A, Hildebrandt G. Simvastatin treatment varies the radiation response of human breast cells in 2D or 3D culture. Investigational New Drugs. Springer Science and Business Media LLC; 2020; 10.1007/s10637-020-01046-6

Bracone F, De Curtis A, Di Castelnuovo A, Pilu R, Boccardi M, Cilla S, et al. Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?. Clinical Nutrition. Elsevier BV; 2020; 10.1016/j.clnu.2020.09.030

Jung AY, Cai X, Thoene K, Obi N, Jaskulski S, Behrens S, et al. Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy. The American Journal of Clinical Nutrition. Oxford University Press (OUP); 2019; 109:69-78 10.1093/ajcn/nqy223

Cancer Diet: Foods to Add and Avoid During Cancer Treatment

Cancer can affect every aspect of your health, including your appetite and diet. Selvi Rajagopal, M.D., a specialist in internal medicine at Johns Hopkins Medicine, explains why your diet is so important during cancer treatment, and provides tips on foods to add and avoid.

How does cancer treatment affect your diet?

Treatments such as chemotherapy and some forms of radiation therapy can cause a variety of side effects, including:

Constipation, which can cause discomfort and further reduce your desire to eat
Diarrhea, which can drain your body of nutrients
Fatigue, which means you’re less active, so you burn fewer calories and don’t feel as hungry throughout the day
Loss of taste, which can make food unappealing
Nausea and vomiting, which might reduce your appetite and cause weight loss

“Sometimes it also depends on the specific type of cancer you have,” explains Rajagopal. “Treatment for breast cancer and blood cancers often involve steroids. Steroids can actually increase your appetite and increase your blood sugar levels, which might lead to insulin resistance and weight gain. So instead of losing weight, it’s possible to gain quite a bit of weight from the combination of medications and a more sedentary lifestyle during cancer treatment.”

Some people also have hormone therapy after chemotherapy for breast cancer or endometrial cancer. The drugs suppress production of estrogen, a hormone that plays an important role in metabolism. If your metabolism slows down, you may put on weight.

People with pancreatic cancer often find it difficult to maintain their weight. Since the pancreas isn’t functioning the way it should, they may not be able to digest food normally. This can lead to weight loss or malnourishment.

Why is your diet important during cancer treatment?

Since cancer treatment can lead to fluctuations in appetite and body weight, it’s important to pay close attention to your diet. In addition to helping you maintain a healthy weight, eating a balanced diet during chemotherapy or radiation therapy can:

Help manage treatment side effects
Increase energy
Increase muscle tone
Preserve immune function
Reduce inflammation

What foods should you add to your diet during cancer treatment?

“Anyone with a chronic illness, even if it’s not cancer, should eat foods high in protein, healthy fats, whole grains, and vitamins and minerals,” Rajagopal emphasizes. “If possible, make these dietary adjustments before cancer treatment begins so you’ll be healthier going into treatment.

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Plant-based Proteins

Some of the best foods to eat during chemotherapy or other cancer treatments are plant-based proteins. They offer the highest levels of vitamins and minerals, Rajagopal says. This means eating lots of vegetables as well as beans, legumes, nuts and seeds. If you do eat animal proteins, choose lean options like chicken or fish.

Healthy Fats

Monounsaturated and polyunsaturated fats also have health benefits. Avocados, olive oil, grapeseed oil and walnuts are all high in omega-3 fatty acids, which help combat inflammation and improve cardiovascular health.

Healthy Carbs

When choosing carbohydrates, opt for foods that are minimally processed, like whole wheat, bran and oats. These have soluble fiber, which helps maintain good gut bacteria. Soluble fiber also promotes the production of short-chain fatty acids (SCFAs), which lend a hand to everything from metabolism to cellular repair.

Vitamins and Minerals

“Vitamins and minerals help our bodies’ enzymatic processes, which play a big role in boosting immune function and reducing inflammation,” Rajagopal says. When possible, select foods fortified with vitamin D. These may include milk, orange juice, yogurt and some cereals.

Should you take supplements during cancer treatment?

If you’re not eating as much as usual during treatment, or if you have side effects like vomiting and diarrhea that cause you to lose vitamins and nutrients, you might consider taking a multivitamin.

“Vitamin D tends to be the most common vitamin deficiency,” says Rajagopal. “Vitamin D helps keep your immune system strong, reduces fatigue and supports bone health. Especially if you’re on steroids, you’ll be at risk for bone density loss.”

Talk to a registered dietitian and your oncologist before adding any vitamins or supplements to your diet.

How can your diet help manage cancer treatment side effects?

Some dietary changes can help you manage side effects after your treatment begins. These side effects include:

Appetite loss. Eat small meals or nutritious snacks throughout the day, rather than three large meals.
Constipation. Drink plenty of water, consider a fiber supplement, and add veggies and beans to your meals.
Diarrhea. Choose foods or drinks with sodium (sports drinks or broth) and potassium (bananas and all natural fruit juices).
Loss of taste. Knowing what to eat when you can’t taste can be difficult. Consider trying new foods with different spices or marinades. You can also add strong flavors, such as lemon or lime juice.
Nausea. Anti-nausea foods include citrus, ginger and peppermint oil. You can suck on a slice of lemon, drink ginger tea or eat ginger chews.

What foods should you avoid during cancer treatment?

Be aware of what’s going into your body during cancer treatment. Read nutrition labels and prepare as much of your own food as you can. It’s best to stay away from highly refined, processed food. You should also avoid fried foods that contain a lot of hydrogenated oils, which can increase inflammation.

Since people with cancer often have compromised immune systems, consider skipping foods that carry the risk of foodborne illnesses, including:

Lightly cooked or raw fish, such as sushi
Soft-cooked eggs or foods that contain raw eggs, such as homemade mayonnaise
Unpasteurized cheeses and dairy products
Unwashed fruits or vegetables

Planning your cancer treatment diet

Registered dietitians have specialized training in the nutritional needs of people with specific diseases. Your dietitian can help you plan meals that give you the right number of calories and nutrients.

“It’s also important to build an eating plan that’s practical for you,” says Rajagopal. If you’re busy in the evenings and don’t have the time or energy to cook, try to select healthy takeout options. If you’re on a budget, adding inexpensive, nutritious foods like beans or frozen fruit or vegetables to simple meals can go a long way.

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