Radiotherapy is a cornerstone in cancer treatment, nearly 40% of cancer patients receive at least one course of radiotherapy (Lalani et al., 2017) during their cancer treatment.
Radiotherapy is used for curative and palliative intent: to treat early-stage or locally advanced tumours it has a curative impact, instead for symptom management in advanced disease it has a palliative purpose (Dilalla et al., 2020). Even though it is highly effective against malignant cells, it also affects healthy tissues, leading to a variety of side effects. The oncology nurse plays a crucial role in recognizing, managing and educating patients and caregivers about these side effects.
The side effects of radiotherapy can occur during or shortly after treatment, are they identified as “early seffs “and those developing months or years after treatment are termed as “late seffs” (Bentzen, 2006).
The Common early Side Effects are:
Skin reaction
It occurs in almost 95 % of patients treated with radiotherapy (Porock et al., 1999). These reactions can appear as erythema, dry desquamation or moist desquamation (D’HAESE et al., 2005).
The common advice to avoid or manage this side effects are:
- Wearing loose-fitting clothing preferring use of natural fibre such as cotton.
- Wash and hydrate the skin with non-aggressive products.
- Avoid the exposure of high temperature or sunlight during the treatment.
Fatigue
Acute fatigue occurs in up to 80% of patients, and chronic fatigue can persist in up to 30% for months to years after treatment (Turriziani et al., 2005). The approach can be a pharmacologic or non-pharmacologic treatment. The common advice to manage fatigue is to practice physical activities to improve physical functioning.
Gastrointestinal Symptoms
The patients who receive radiation to a pelvic/abdominal/thoracic malignancy commonly experience gastrointestinal side effects (O’Reilly et al., 2020). Nausea, vomit and diarrhoea can occur during radiotherapy. It is important to implement dietary modifications and evaluate the nutritional status of the patient. In some cases, to manage the symptoms, it is necessary to introduce a pharmacological treatment.
Some late Side Effects are:
Radiation Pneumonitis
Radiation pneumonitis is an inflammatory reaction of lung tissue that can occur weeks to months after thoracic radiotherapy. Patients may present with a dry cough, dyspnea, low-grade fever, and fatigue, which can sometimes be mistaken for infection or disease progression. From a nursing perspective, early recognition is key monitoring for subtle respiratory changes, educating patients to report new symptoms promptly, and assessing oxygen saturation trends are essential. Coordination for timely imaging and initiation of corticosteroids when indicated can significantly improve outcomes.
Cardiotoxicity
Cardiac toxicity is a potential late effect of radiotherapy, particularly when the heart is within or near the field of radiation (e.g., breast or mediastinal irradiation). It may manifest months to years later as pericarditis, coronary artery disease, arrhythmias, or cardiomyopathy. Nurses play a critical role in long-term surveillance by monitoring symptoms such as chest pain, palpitations, or unexplained fatigue, and ensuring adherence to follow-up protocols. Promoting cardiovascular risk reduction, such as blood pressure control, lipid management, and lifestyle counseling, is also an important component of survivorship care.
Radiotherapy can be delivered as a standalone treatment or in combination with chemotherapy, depending on the tumor type, stage, and treatment intent. When given concurrently, it may enhance treatment efficacy but also increases the risk of toxicity, requiring close coordination across the care team. Importantly, certain medications—such as specific targeted therapies, immunotherapies, or radiosensitizing agents—may need to be temporarily discontinued or held during particular radiotherapy courses to reduce overlapping toxicities and ensure patient safety.
Radiotherapy side effects can vary depending on the treated area and can be very challenging. Nurses, with a proactive approach, are essential in ensuring patient safety, comfort, and quality of life throughout the treatment journey.
Bibliography
Bentzen, S. M. (2006). Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. Nature Reviews Cancer, 6(9), 702–713. https://doi.org/10.1038/nrc1950
D’HAESE, S., BATE, T., CLAES, S., BOONE, A., VANVOORDEN, V., & EFFICACE, F. (2005). Management of skin reactions during radiotherapy: a study of nursing practice. European Journal of Cancer Care, 14(1), 28–42. https://doi.org/10.1111/j.1365-2354.2005.00510.x
Dilalla, V., Chaput, G., Williams, T., & Sultanem, K. (2020). Radiotherapy Side Effects: Integrating a Survivorship Clinical Lens to Better Serve Patients. Current Oncology, 27(2), 107–112. https://doi.org/10.3747/co.27.6233
Lalani, N., Cummings, B., Halperin, R., Rakovitch, E., Brundage, M., Vigneault, E., & Milosevic, M. (2017). The Practice of Radiation Oncology in Canada. International Journal of Radiation Oncology*Biology*Physics, 97(5), 876–880. https://doi.org/10.1016/j.ijrobp.2016.11.055
O’Reilly, M., Mellotte, G., Ryan, B., & O’Connor, A. (2020). Gastrointestinal side effects of cancer treatments. Therapeutic Advances in Chronic Disease, 11. https://doi.org/10.1177/2040622320970354
Porock, D., Nikoletti, S., & Kristjanson, L. (1999). Management of radiation skin reactions: literature review and clinical application. Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses, 19(4), 185–192, 223; quiz 191–192.
Turriziani, A., Mattiucci, G. C., Montoro, C., Ferro, M., Maurizi, F., Smaniotto, D., & Cellini, N. (2005). Radiotherapy-related fatigue: incidence and predictive factors. Rays, 30(2), 197–203.