Part 4: Radiation Therapy...cancer's sunburn

---

While pain was a surprise for chemotherapy, I anticipated some pain with my radiation treatments. I just wasn’t sure how much or how little pain there’d be.  My only radiation experiences were associated with the x-rays I had when I went to the dentist’s office and the ones I had trying to determine whether I had cancer. In both cases, there was no pain. 

My other exposure to radiation was through the sun’s UV rays. Now there, I could fully appreciate pain.  I was born during a time when putting baby oil on your skin was a good way to get a tan. I’m not quite sure the words 'sun screen' had been combined yet. There was only ‘sun-tan lotion’ and ‘sunburn’.

With this in mind, I wasn’t sure which end of the spectrum when it came to my radiation treatments.

Everyone is Different
Just like your emotional reaction to a cancer diagnosis and any pain associated with surgery and chemo, your reaction to your radiation treatments may not be the same as some of the stories in this post. It’s no different than people who burned easily in the sun and those who only seemed to tan. This difference wasn’t just luck. There were variables like skin (those poor blondes and red heads), number of previous burns, sun screen use, clothing worn, the strength of the sun, and the amount of available shade.

My Experience
My experience with radiation wasn’t too bad, even without putting on any creams or lotion after each treatment. In fact, about a week before my last treatment, my radiation oncologist commented that it looked like I wasn’t going to burn. And with those fatal words, my skin started to do just that.  I began to burn and radiated heat (like a bad sunburn). Although I thought I could, I never experimented to see if I could cook an egg on my chest.

I started to use Glaxal Base in an effort to save my skin but it was too late. A little over six years ago, when I went for treatments, you were told not to put anything on your skin until there was a problem with burning or blistering. This meant the damage had already been done to some extent. I didn’t blister, so I didn’t need to use a saline solution to help with blisters that may have broken open.  

While I was able to work during my chemo treatments I was worried that radiation would be my undoing. As treatments progressed, it was getting more and more uncomfortable to wear a bra. Being at work and only having one breast to show for myself, I wasn’t quite sure what to do. Luckily I thought of the camisole that I had received to put my drains in after my surgery. There were breast inserts (foobs) but the material wasn’t restrictive like a bra. The only problem was that it was not cotton, so it trapped the heat against my body. Luckily, with a little practice, I could reach in, pull out my foob, and throw it in my drawer at work if the heat was too bad. At that time I sat in a desk that was way off the beaten path so I could get it back in place just as quickly if anyone came my way.

Marg’s Experience
Marg’s radiation experience was much more recent but, like me, she ended up reacting to a skin problem rather than proactively trying to prevent a burn in the first place. She said, “I had the wrong impression about putting moisturizer on my breast. I had the impression that I was not to put anything on it and then, on my 10th treatment, I was told that I should have been putting on cream. I was so sore and blistered and raw under my breast. I was in tears and in so much pain.” Marg even considered stopping her treatments. Luckily, she spoke to someone who suggested a cream and life became much more bearable. 

Marg’s story could have been so much different if she had received clear instructions about what she could do to minimize the pain while allowing the radiation to still have the same impact on any cancer cells. 

Ann’s Experience
Ann is our new-age representative. She is using a Mepitel film, which she describes as “clear, sticky Saran wrap”.  Relatively new (about a year) for use where she lives, she’s been told “there will be a notable reduction in side effects to the skin.” Although she’s finished 17 of 25 rounds, there has only been a bit of “pinkening” compared to the non-radiated skin around it.   Ann goes on to say, “Sections of the film peel off or peel back with wear and tear (showers, going to the gym, changing clothes).”  When this happens, the radiation therapists just keep patching those areas; although, she has been asked a few times to stop showering because the film is peeling off too quickly. 

About two weeks before radiation started, Ann started slathering her skin with Vitamin E cream and Glaxal Base so she is not certain if her success to date is totally the film or a combination of cream and film. Either way, she’s happy to be pain-free.

Water-based Products
Being proactive is the way to go. Becky, a radiation therapist says, “We recommend Glaxal Base and lanolin-free, unscented Lubriderm.” While she mentions these two particular products, she indicates that it isn’t so much what product to use but making sure that that the product is water-based.  Paul, a Nurse Practitioner at a Radiation Nursing Clinic, explains, “Petroleum or oil-based cream can intensify the radiation reaction.”

Becky suggested that applying the lotion right from the start was a good way of getting the skin to a healthy state “before the radiation starts to dry out the skin and cause a reaction.” 

The thing to remember is timing, “Don’t use the cream one to two hours before the treatment because it can create an extra layer/film on your skin.”

Saline Solution
Where Becky works, patients are told to use saline solutions “as soon as the skin starts to get red and tender (erythema). We especially want patients to use them if their skin is starting to blister.  Most people like to use this solution because it is soothing on their skin.”

Cool Idea
For a special treat, put creams and the saline solution in the fridge before applying it to your skin. 

Patient Recommendations
Looking at women’s comments in various online groups and forums, there are certain products that are mentioned more often than others such as the following:

• Aquaphor or - identified as good but messy with a recommendation to wear an old cotton T-shirt to protect your other clothing like your favourite night gown
• Silvadene - WebMD identifies it as belonging to the sulfa antibiotics class and, therefore, requires a prescription
• Aloe vera - sometimes taken and used right from the plant 

Hydration
Many people talk about keeping hydrated when having chemotherapy, but it wasn’t until I communicated with Paul, that I realized it was just as important to stay hydrated during radiation treatments. Paul says, “It is important to keep hydrated because radiation can cause fluid loss and lead to dehydration. The standard goal for fluid intake is 1.5 -2L/day. Fluid includes any liquid that does not include caffeine or alcohol. Examples include: water, juice, milk, soup, Jell-O, puddings, shakes, smoothies or herbal teas.” 

In addition to creams and lotions, keeping hydrated will also help maintain the health of your skin. 

Keeping Skin Dry
Ironically, after a paragraph about keeping hydrated, I’m sharing suggestions from the breastcancer.org site about keeping the skin dry under your breast(s) dry. Some suggestions are to do the following:

• Wear a bra (no underwire) that lifts your breast or put a cloth of some kind (for example, wash cloth) under the breast.
• Use your blow dryer on a cool or no heat setting to dry your skin  
• Wear an over-sized cotton T-shirt, which will allow the radiated are to breathe. 

Communication is Key
Talk to your health care professionals. Ask questions. Tell them if your skin is having a serious reaction to the radiation and are in pain. You don’t have to wait for your next appointment with your radiation oncologist.  Be your own advocate.