Guide — Oncology
Radiation Therapy Nursing Care
Radiation therapy uses ionizing radiation to damage cancer cell DNA and prevent replication. Nurses caring for radiation oncology patients must understand the types of radiation, site-specific side effects, skin care, brachytherapy safety precautions, and systemic radiation protocols.
11 min read · Oncology
Educational use only. This content is intended for nursing students and exam preparation. Radiation therapy protocols are individualized and must be followed per institutional radiation oncology department guidelines. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Types of Radiation Therapy
| Type | Description | Radiation Safety |
|---|---|---|
| External Beam Radiation Therapy (EBRT) | Radiation delivered from a machine outside the body. Includes 3D-CRT, IMRT (intensity-modulated), SBRT (stereotactic body), and proton therapy. Most common type. | Patient is NOT radioactive. No isolation required. Healthcare workers are not at risk from the patient. |
| Brachytherapy — sealed source | Radioactive implants placed inside or near the tumor (interstitial or intracavitary). Examples: cervical cancer (LDR/HDR tandem and ovoids), prostate seeds, breast (MammoSite). | Patient IS radioactive while implant is in place (LDR). Requires time, distance, shielding precautions. Seed loss monitoring required. |
| Systemic radiation — I-131 | Radioactive iodine administered orally or IV. Taken up by thyroid tissue. Used for thyroid cancer and hyperthyroidism. | Patient excretes radioactive iodine in body fluids. Isolation required. Specific precautions for waste, linens, and visitor time limits. |
| Total Body Irradiation (TBI) | Radiation delivered to entire body prior to bone marrow or stem cell transplant — kills remaining cancer cells and suppresses immune system to prevent graft rejection. | Patient is NOT radioactive. Severe myelosuppression results — full neutropenic and bleeding precautions post-treatment. |
Side Effects by Site
| Radiation Site | Acute Side Effects | Late/Long-term Effects |
|---|---|---|
| Head and Neck | Mucositis, xerostomia (dry mouth), dysphagia, loss of taste, skin erythema/desquamation, fatigue | Dental caries, osteoradionecrosis of jaw, lymphedema, trismus (jaw fibrosis), hypothyroidism if thyroid in field |
| Chest / Lung | Esophagitis (dysphagia, odynophagia), cough, fatigue, skin changes, pneumonitis | Pulmonary fibrosis, cardiac injury (pericarditis, coronary artery disease) if heart is in field |
| Abdomen / Pelvis | Nausea, vomiting, diarrhea, cystitis (urinary frequency/urgency/dysuria), fatigue | Bowel stricture, fistula, sexual dysfunction, bladder fibrosis |
| Brain | Fatigue, alopecia (in radiation field), cerebral edema (headache, nausea, cognitive changes), dermatitis | Radiation necrosis, cognitive impairment, pituitary dysfunction, secondary malignancy |
| All sites (systemic) | Fatigue (most universal side effect of radiation therapy), anxiety, skin changes in treatment field | Secondary malignancy risk at radiation field edges (rare) |
Radiation Dermatitis — Skin Care
| Grade | Appearance | Nursing Management |
|---|---|---|
| Grade 1 — Mild | Faint erythema, dry desquamation, decreased sweating in field | Gentle washing with mild soap and lukewarm water, pat dry, avoid friction and sun exposure |
| Grade 2 — Moderate | Moderate erythema, patchy moist desquamation, edema | Topical agents (prescribed or institutional protocol), barrier creams, loose clothing, no tape on affected skin |
| Grade 3 — Severe | Confluent moist desquamation, bleeding with minor trauma | Wound care consult, moisture-retentive dressings, pain management, infection monitoring |
| Grade 4 — Life-threatening | Full-thickness skin necrosis, spontaneous bleeding, ulceration | Medical emergency — radiation oncology immediate notification, hospitalization may be required |
Skin care education for radiation patients
- ✦Do NOT remove radiation field markings (pen marks or tattoos) unless instructed
- ✦Avoid sun exposure to the treatment field during and for 1 year after treatment
- ✦No heat lamps, heating pads, or ice packs on radiation skin — altered sensation can cause injury
- ✦Avoid tight clothing, bras, or anything that rubs the field
- ✦No alcohol-based lotions or perfumed products in the treatment field
- ✦Aloe vera, calendula cream, or institutional-prescribed moisturizer is acceptable
Brachytherapy Safety — Time, Distance, Shielding
For patients with SEALED RADIOACTIVE SOURCES (LDR Brachytherapy)
Time
Minimize time spent at the bedside. Complete care efficiently and leave. Cumulative exposure risk increases with duration of contact.
Distance
Increase distance from the patient when not providing direct care. Radiation intensity decreases with the square of distance (inverse square law).
Shielding
Lead shields and barriers are used in the room. Nurses wear dosimeters to track cumulative exposure. Pregnant nurses are typically reassigned.
- !Visitor restrictions: typically 6 feet minimum distance; no children <18 or pregnant visitors
- !Dislodged seeds or implants: do NOT handle with bare hands — use long-handled forceps, place in lead container, call radiation safety immediately
- !Personal dosimeters: worn by all staff who care for patient; monitored for cumulative exposure
Patient Education
Fatigue management
Fatigue is the most common side effect and typically worsens as treatment progresses. Encourage rest but also gentle activity (walking). Teach energy conservation techniques. Fatigue typically peaks mid-treatment and resolves weeks to months after completion.
Nutritional support
Radiation to the head/neck/abdomen impairs nutrition. Refer to dietitian early. Encourage high-calorie, high-protein foods. If mucositis is severe: soft/liquid diet, supplemental nutrition drinks, or enteral feeding may be required.
Skin protection
Keep treatment field skin clean and moisturized per protocol. Report worsening redness, peeling, or open areas. Avoid heat, cold, and sun. Protect skin from friction.
Follow-up adherence
Radiation requires consistent daily treatment — skipping sessions reduces effectiveness and must be communicated to the radiation oncology team. Appointments for wound checks and symptom management are equally important.
When to call the team
Instruct patient to call for: fever >38°C (100.4°F), severe or uncontrolled pain, inability to eat or drink, shortness of breath, neurological changes, or severe skin reactions.
NCLEX Pearls — Radiation Therapy
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Oncology Nursing Society (ONS) · National Comprehensive Cancer Network (NCCN) · American Society of Clinical Oncology (ASCO). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →