Managing the side effects from head and neck cancer radiotherapy

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Your treatment

Regular medications:

Continue taking your regular medications, unless advised otherwise by your oncology doctor.

You may be asked to stop taking certain medication including NSAID’s (Nurofen, Naproxen, Diclofenic, Ibuprofen). Some blood thinners (Warfarin, Rivaroxaban) may need to be reviewed when you start chemotherapy.

Please inform the team if you are on any of these medications. Make a list of them in the table below (please see PDF version of this leaflet).

How can I manage the side effects of head and neck cancer radiotherapy?

Side-effects are common during head and neck cancer radiotherapy. This document outlines the common side-effects treatments that your team will advise you to use.

Oral hygiene

This is important for comfort and to prevent infections.

Action

Thick secretions

Action

Skin and lip care

Your skin and lips may become red and inflamed. This often starts about 2-3 weeks after you start your treatment.

Action

Painful mouth and throat

A painful mouth and throat are very common during radiotherapy.

We ask your GP to prescribe Caphosol (calcium phosphate), which helps to minimise the severity of mucositis (inflammation/ulcers) in your mouth. It must be used a minimum of 4 times a day.

To sooth and reduce discomfort we advise mouthwashes and painkillers like paracetamol.

Please start taking regular pain medication if you feel some discomfort at the back of your throat when eating and drinking.

Action

How do I take Oromorph?

The majority of our patients will require a strong pain-killer such as Oramorph by week 3 or 4 of radiotherapy treatment.

The strength of the morphine solution is 10mg/5ml. The normal starting dose is 2.5-5mg. You will be advised to take a regular dose every 4 hours.

If you get unexpected or ‘breakthrough’ pain in between your regular Oramorph doses, you can take an extra dose then take the next regular dose on schedule. Oramorph takes about 20-30 minutes to work. You may be advised to take an extra dose 20-30 minutes before eating to help with swallowing food.

You do not need to set an alarm to wake yourself up in the night, but if you do wake up in pain you can take a dose then.

Please write down the dose and time of any rescue doses you take, and if it helps your discomfort. This will help your doctor or nurse calculate how much morphine you need. We expect your dose to increase during the weeks of your treatment and gradually start to decrease in dose about 2 weeks after treatment completion. Oramorph taken for pain like this is not addictive.

Oramorph may make you feel drowsy. Do NOT drive or drink alcohol while taking Oromorph. Alcohol may make you even drowsier.

The common side effects of Oramorph are as follows:

• Constipation: Laxatives are often prescribed to prevent or treat this. Drinking plenty of fluids will help.
• Drowsiness: Many people feel tired or find they cannot concentrate as well when they first start taking morphine or when the dose is increased.
• Sickness (nausea and vomiting): Some people will feel sick or even vomit when they start taking morphine. This normally settles after a few days. Your doctor may prescribe an anti-sickness medication.

(for the pain diary and Analgesic regime, please refer to the PDF version of this leaflet)

After completing your treatment:

We understand that the period immediately after treatment can be a worrying time, especially as your side-effects may continue to worsen over the next 2 weeks before they get better.

Please remember that we are still here to help.

Appointments:

2 weeks post-treatment:

You will be reviewed by the Clinical Nurse Specialist and if needed, by the Dietitian

Six weeks post-treatment:

You will have a consultant review, to discuss scans and follow-up.

Three months post-treatment:

You will attend the joint head and neck clinic, to discuss results of your scans and any follow-up as an outpatient.