Preparing for Radiation

Preparing ahead for radiation therapy for breast cancer, whether after a lumpectomy or after mastectomy, can pay off in spades later on when you begin to experience fatigue and the visits become tiresome. Talking to your radiation oncologist about what to expect, considering breath hold techniques if you have left sided breast cancer, asking and allowing for family and friends to help you, and streamlining your daily activities are all important. Check out these tips to ensure you have the best experience possible.

Woman receiving Radiation Therapy Treatments for Cancer
Mark Kostich / Getty Images

Radiation Therapy for Breast Cancer

The timing and purpose of radiation can vary depending on whether you have a lumpectomy or mastectomy.

Radiation therapy after a lumpectomy usually begins several weeks after surgery, and is used to eliminate any remaining cancer cells in the breast or armpit area.

Radiation therapy is done less often after a mastectomy, but may be done if positive lymph nodes are found during surgery or other reasons. Unlike radiation after a lumpectomy, radiation after a mastectomy is usually done after chemotherapy has been completed, and is often given several months after the mastectomy surgery.

There are two primary types of radiation used in treating breast cancer. They are:

  • External beam radiation: a traditional approach to delivering radiation. Treatment usually takes several weeks with a Monday through Friday schedule. In certain instances, a shorter treatment regimen, called accelerated radiation, is used, and involves the delivery of a higher dose of radiation over three or four weeks. Daily treatment with external beam radiation consists of set up time and positioning activities followed by receiving radiation; a process that only takes a few minutes. Treatment is painless, but fatigue tends to worsen as time goes on.
  • Internal breast cancer radiation: Brachytherapy or internal radiation is a newer treatment that injects radioactive treatments only in the area that was affected by the breast cancer.

There are several considerations in planning ahead for these treatments.

Talk to Your Radiation Oncologist About What to Expect

While many people seem to have an idea what to expect with surgery and chemotherapy, it is common for people to be surprised at how radiation affects them. Unlike scars with surgery and hair loss with chemotherapy, the effects of radiation are less visible.

Talk about what to do if you develop skin redness and rashes, and ideally how to prevent this. There are some personal care products that you will need to avoid, and your radiation oncologist help you to understand what products to use and what to avoid.

If you had a mastectomy and reconstruction, talk about how the radiation may affect your healing, as well as the risk of infection if you develop open sores. Many people are unaware of the risk of reconstruction failure related to radiation. Make sure to talk about not only the risk that reconstruction may be more challenging following radiation, but complications that may occur during or shortly after reconstruction if you have tissue expanders in place.

It’s also important to be sure you understand not only the short-term side effects but also the potential long-term effects of radiation therapy.

Talk to Your Radiation Oncologist About Respiratory Gating

If you have left sided breast cancer, some radiation will likely make its way to your heart, and heart disease related to radiation for breast cancer is a significant concern. Radiation has been linked with a number of different forms of heart disease ranging from valve disease, to rhythm disturbances, to coronary artery disease.

Fortunately, there are techniques that reduce the amount of radiation that hits your heart: “respiratory gating” and “deep-inspiration breath-hold” (DIBH). Respiratory gating synchronizes the radiation doses to your breathing to deliver a dose when the tumor is farthest from your heart. DIBH involves taking a deep breath then holding it while a dose of radiation is delivered. It is important to ask about these techniques before beginning your treatments, as special measurements will need to be taken to be sure that inhaling air into your lungs will move your heart away from the field of radiation.

Streamline Home and Work Responsibilities

Many people continue to work and care for their home during radiation therapy, but this can be challenging, especially when the fatigue hits in full force later in treatment. Don’t plan any major projects during the weeks of treatment.

If the plan is to work during treatment, know that when the cumulative effects of treatment set in, adjustments may have to be made, such as: a shorter work day, rest periods during the day, and an earlier bed time.

Enlist Help

Many people want to be the hero who can do it on on their own, but with breast cancer, sometimes the most courageous act is to ask for help; sometimes lots of it. Speak with family members, friends and neighbors who are aware you are going through cancer treatment about your upcoming radiation treatment. Accept offers of help with things like grocery shopping, laundry, errands, meal prep and child care. Most people want to help and prefer being told what they can do to help.

Come up with a schedule of what help will be needed and when it will be needed. Radiation has a cumulative effect. There will probably be no decrease in energy or other side effects for the first several sessions (although you will still likely be fatigued from your surgery, and chemotherapy if you also received this).

Online sites such as Lotsa Helping Hands can be priceless because they can spare many phone calls. People can sign up to help with child care, to bring meals, or to give you a ride to radiation, and those who want to help, but have not yet signed up, can see where you most need help.

Eat Well

It’s important to eat healthy, well-balanced meals throughout radiation. Unfortunately, as fatigue worsens, some people become too tired to eat. Allowing family and friends to bring meals, and stocking up on easy to prepare foods before radiation can help when those times come.

This is also not the ideal time to try and lose weight. You need your strength or your body needs to nutrients to repair itself after each treatment. It’s also important to get enough protein for healing, and if you eat a vegetarian or vegan diet, you’ll want to be extra vigilant about getting your protein.

It’s important to eat a healthy diet rich in fruits and vegetables, but it may not be wise to use antioxidant supplements. Radiation works by creating oxidative stress (free radicals) to kill cancer cells. You don’t want to protect your cancer cells from radiation by taking an antioxidant supplement that reduces this oxidative stress.

Find or Purchase Comfortable Clothes

Your skin can become tender as radiation goes on, and loose-fitting camisoles and tops will be most comfortable. If you must wear a bra, make it a comfortable one and place a soft cloth between your bra strap and skin.

Don’t starch your blouses or shirts, and use a mild laundry detergent when washing your clothes.

Protect Your Skin

It’s important to keep your skin clean and dry during radiation. Your radiation oncologist can recommend soaps and lotions to use that won’t interfere with treatment or worsen your symptoms. When showering or taking a bath, gently blot your skin dry and don’t rub. Don’t use any lotions, powders, perfumes, soaps or deodorants on the area being treated without checking them out first with your healthcare provider.

When bathing, use lukewarm water and avoid extreme hot or cold.

Sunscreen can sometimes irritate skin treated with radiation, and it’s ideal to use conservative measures to protect yourself from the sun, such as long sleeves, a hat, an umbrella, and avoiding the mid-day sun. Keep in mind that you may also burn more easily during radiation.

Be Good to Yourself

We are often our own worst critics when it comes to things we aren’t accomplishing. Be good to yourself and forgive yourself for not having energy this time. When you feel up to it, go out with friends and family and have some fun. Get as much sleep as you want and need after radiation. Fatigue can last for up to six weeks after treatment. When the “what ifs” get the best of you, turn to a fellow survivor or trusted family person and talk until you get things in perspective again. Once treatment is over, fatigue will fade away. It will happen gradually; it may take time to return to your energy level prior to radiation therapy.

Use the Weekends to Recuperate, Not Catch Up

Many people try to delegate to the weekends what doesn’t get done during the week, but this can lead to exhaustion. Make your number one weekend priority be to rest and heal, rather than trying to complete your to-do list.

A Word From Verywell

Taking the time to prepare not only physically but mentally for radiation can pay off when the fatigue hits full force. While the treatments may seem to go on forever, in reality it is just a short hiatus from life. Let yourself rest and pamper yourself as you would a good friend.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. Radiation for breast cancer.

  2. Piruzan E, Vosoughi N, Mahdavi SR, Khalafi L, Mahani H. Target motion management in breast cancer radiation therapy. Radiol Oncol. 2021;55(4):393-408. doi:10.2478/raon-2021-0040

Jean Campbell, MS

By Jean Campbell, MS
Jean Campbell, MS, is a breast cancer survivor and advocate, and the founding director of the American Cancer Society Patient Navigator Program.