Not everyone will have long term side effects after radiotherapy. Most side effects gradually go away in the weeks or months after treatment. But some can continue or start some months or years later

• Late Effects of Radiotherapy

On going cough after radiotherapy:

An ongoing cough after radiotherapy can be a chronic symptom caused by lingering treatment effects, a cough that does not go away can be distressing and tiring. It can interfere with your daily life. For example, coughing may affect your sleep.

Always talk to your GP about an on going cough so they can find the cause of it and know how to treat it

Sometimes a cough and breathlessness can be caused by inflammation or scarring (fibrosis) in the lungs. This can be a late effect of radiotherapy to the chest area. Your doctor may prescribe steroids to treat this.

If you have a chest infection, your doctor will prescribe antibiotics.

Tell your GP straight away if you are coughing up blood

Top tips for managing a cough:

• Make sure you drink enough. Drinking plenty of fluid can make mucus thinner.
• Always tell your GP if your cough gets worse, or if you start coughing up yellow or green mucus (phlegm). You may have an infection and need antibiotics..
• Codeine or morphine are drugs that are usually used to control pain. But they can also be used to treat an ongoing cough, even if you do not have pain. •

If you have a dry, irritable cough, your healthcare team may prescribe a cough medicine to help. You can buy some cough medicines at supermarkets or pharmacies. Talk to your doctor or pharmacist before you buy anything to help with a cough.

• Sometimes a steam inhalation or breathing in salt water (saline) through a nebuliser can help. This can help clear thick mucus from the airways.
• Smoking increases your risk of lung problems. If you smoke your doctor will usually advise you to stop smoking. It can be difficult to stop smoking, especially when you are stressed. Using the NHS Stop Smoking Services improves your chances of success. Your GP can also give you support and advice.
• Relaxation exercises may help you manage a cough

Some people find the stress of a cancer diagnosis or treatment can increase the amount they smoke or vape, which can lead to other health concerns such as an ongoing cough or shortness of breath

For support with this you can speak to your GP or search for local support on the link below:

• Find stop smoking support services - NHS

Repeated Infections 

Repeated infections for most people after cancer treatment should improve as the immune system recovers. As a late effect long after cancer treatment repeated infections or increased infection risk can be due to tissue damage from radiotherapy.

• Reduced Immunity (Lymphopenia):Radiation can reduce the number of white blood cells (lymphocytes), which are essential for fighting infection. This risk is highest in the first 3 months post-treatment but can persist.
• Tissue Scarring (Fibrosis):Radiation can cause tissues to become thick, rigid, and have reduced blood flow (vascularity). This reduced blood flow hinders the body’s ability to deliver immune cells to the area, resulting in poor healing and increased infection risk.
• Damaged Lymphatic System (Lymphoedema):Damage to lymph nodes or channels leads to fluid buildup, swelling, and a higher vulnerability to skin infections (cellulitis) in the affected area.
• Reduced Spleen Function:If the spleen is within or near the radiation field, its function can be permanently reduced, creating a high risk for severe, life-threatening infections.

Infections by Treatment Area

The location of the radiation determines the types of infections likely to develop.

• Head and Neck: Permanent dry mouth (xerostomia) and thick saliva can lead to:
  • Oral Candidiasis (Thrush): A fungal infection causing white patches in the mouth.
  • Dental Infections: Rampant tooth decay (radiation caries) due to lack of saliva can lead to dental abscesses and infections of the jaw bone (osteoradionecrosis).
  • Chronic Sinusitis: Chronic inflammation of the sinus tissues.
• Pelvis and Abdomen: Damage to the intestines and bladder can cause:
  • Bladder Infections (Cystitis): Chronic irritation causing burning and frequent urination, often accompanied by blood in the urine.
  • Bowel Bacterial Overgrowth (SIBO): Bacteria can grow in the damaged small bowel, leading to severe diarrhoea, malabsorption, and infection.
  • Rectal Infections (Proctitis): Chronic bleeding and pain in the back passage.
• Chest and Lung:
  • Chronic Lung Infections: Scarring (fibrosis) in the lungs can make them more susceptible to infections.

Poor nutrition, lack of sleep, and underlying conditions like diabetes can compound risk.

Management and Prevention Strategies

• Oral Hygiene:Regular dental checkups every 3–6 months are crucial for those who had head and neck radiation.
• Antibiotics/Antifungals:Treatment of infections with antibiotics or antifungal medications
• Preventative Care: Frequent hand washing, avoiding crowded places, and avoiding sick individuals are essential.
• Vaccinations: Discuss annual flu shots with your doctor.
• Nutrition: Eat a balanced diet to support immune recovery

Please see your GP to discuss any repeated infections as a result of your treatment

Contact your GP or call 999 for symptoms of sepsis, such as severe shivering, slurred speech, confusion, or no urine output in a day.