External Radiation Side Effects Worksheet
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1 Page 1 of 6 External Radiation Side Effects Worksheet Radiation therapy uses special equipment to deliver high doses of radiation to cancerous tumors, killing or damaging them so they cannot grow, multiply, or spread. Although some normal cells may be affected by radiation, most appear to recover fully from the effects of the treatment. Unlike chemotherapy, which exposes the entire body to cancer-fighting chemicals, radiation therapy affects only the tumor and the surrounding area. Radiation therapy is one of the most common treatments for cancer and is used in more than half of all cancer cases. On the following pages are the most common side effects experienced by patients receiving external radiation therapy. You may have none, some, or all of these, or you may have side effects not listed here. With each side effect listed below there are suggestions on how to describe them to your doctor. Some side effects are more serious than others. Ask your doctor which side effects he or she needs to know about immediately. Record these on the last page. How to Use This Worksheet This worksheet will cover 6 weeks of radiation therapy. Fill in the date for the start of each week. For example, the week you start therapy is Week #1. If your therapy lasts beyond 6 weeks, you will need to print an additional worksheet. Side effects are listed in the left column. For each week, go down the column for that week and check the appropriate box describing the severity of each side effect. If you do not have a particular side effect, check the box. Take this worksheet with you to your doctor visits. If you have a side effect that can be described as severe, notify your doctor right away. At the end of the list, we have left spaces for you to add any side effects you may have that are not listed here. Use the same format to describe the severity of the symptom and any medications you took to treat it. *Remember, your doctor may want know immediately if you have some of these side effects. For more information on Radiation Therapy see our documents: Radiation Therapy Principles and Understanding Radiation Therapy
2 Page 2 of 6 Date / / / / / / / / / / / / GENERAL SYMPTOMS Fatigue: Mild- Normal activity with effort Moderate -In bed less than half of day** Severe- In bed more than of day** Skin Irritation (in areas where radiation therapy is given): Mild-Faint redness and scaling Moderate-Redness or moist peeling especially at skin folds** Severe-Swelling and moist peeling in large area or ulcer in skin** Fever/Chills: Write down your highest temperature for the week. Temperature 98.6 F Mild Fever 98.6 F to F Moderate Fever F to 104 F ** Severe Fever greater than 104 F ** Write any medicines taken for this here.fi the Head or Neck Area: Sore Mouth: Mild - Soreness, with no ulcers Moderate - Soreness or painful ulcer / able to eat** Severe - Painful ulcer and cannot eat or toothache** **Notify your doctor immediately
3 Page 3 of 6 Date / / / / / / / / / / / / Dry mouth (Xerostomia) Decreased saliva Thick saliva No saliva the Abdomen: Nausea: Mild Able to eat Moderate Eating/drinking less than normal** Severe Can t ** Vomiting: Mild - Vomiting once Moderate - Vomiting 2 to 5 times in a day** Severe - Vomiting 6 or more times a day** Diarrhea: (Write down highest number of bowel movements in a day) Mild-2 to 3 stools per day over normal Moderate-4 to 6 stools per day over normal** Severe-Watery stools or 7 to 9 stools per day or more or bloody stools** Change in Appetite Reduced food and fluid intake Call doctor if you are unable to eat or drink** Note any changes here.fi change eat or drink change change change change change **Notify your doctor immediately
4 Page 4 of 6 Date / / / / / / / / / / / / the Chest: Pain or difficulty with swallowing Mild - Pain but can eat Moderate - Pain requiring soft or liquid diet** Severe - Unable to eat at all** Soreness of the breast the Pelvis (Females): Notify your doctor if you have any vaginal discharge or dryness** Note any symptoms here fi Write any medications taken here....fi the Brain: Notify your doctor if you have any of the following: **Headache **Seizure **Nausea/vomiting **Decreased hearing/loss **Note any symptoms here.. fi **Notify your doctor immediately
5 Page 5 of 6 Date / / / / / / / / / / / / LIST ANY OTHER SIDE EFFECTS YOU EXPERIENCE IN THE BOXES BELOW
6 Page 6 of 6 Questions to Ask My Doctor Which side effects should I notify you about right away? What Should I Do for the Side Effects That I Have? Notes For More Information We re available to answer your questions about cancer, any time, day or night. Contact us at ACS-2345, or visit us online at
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