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A Society and College of Radiographers UK Survey of Radiotherapy Skin Care
R Harris; C Beardmore; S James; C Dumbleton; H Probst; A Bolderston; S Faithful; M Wells; E Kedge Contact author: R Harris ,The Society and College of Radiographers, Aim: The primary objective of the survey was to evaluate skin
Approximately what percentage of patients in your department get a dry desquamation reaction care practice at radiotherapy centres across the United Kingdom. The results will be used to review guidelines issued by The Society and College of Radiographers to improve seem unknown.
continuity and consistency of patient care by advocating the use of evidence based practice.
Moist desquamation Introduction: Skin reactions are one of the commonest side-
effects from external beam radiotherapy. A current driver for
Main products used many research projects has been to attempt to minimise and delay the onset of symptoms.1 21 silicone dressing i.e. Mepitel®18 hydrocolloids Method and sample: A link to an on-line survey, using the
Survey Monkey™ tool, was e-mailed to all radiotherapy centres
Recent evidence suggests that the use of hydrogels for moist in the United Kingdom (N = 67). Sixty-one questions were desquamation may not be supported.8 grouped into eight sections. Fifty-four centres responded Lanolin (3) and gentian violet (2) are still in use, despite the within the allocated timeframe, with a response rate of 81%.
evidence to contraindicate this practice.9 Approximately what percentage of patients in your department get a moist desquamation reaction Guidelines and Assessment Which guidelines does your department follow 46 centres had skin care Departmental developed guidelines for staff.
College of Radiographers Improvement Scotland 36 have updated in the last Management of moist desquamation seems to be shared almost equally between radiographers and nurses.
Has the person who primarily undertakes skin care for moist Who primarily issues the products your department desquamation received additional training in wound care recommends for moist desquamation? Does you departmental protocol include the use of a skin assessment tool to determine each patient's skin prior to Prior to radiotherapy 38 centres state that skin assessment is conducted by a Yes, some patients Yes, all patients 30 centres do not use a skin assessment tool.
Of those undertaking care of moist desquamation 29 centreshave staff with additional training in wound care management.
The RTOG skin assessment tool2 is the most commonly used by20 centres.
Discussion: As the underlying cause of a radiation reaction is
Despite papers emphasising potential risk factors3 36 physiological and the extent is genetically predisposed there respondents reported no formal documentation.
will be inter patient variation which makes conducting clinicaltrials in this area statistically compromised.3 Prophylactic skin care The type of regime applied preventatively and to erythema 26 centres recommend an aqueous cream.
appears to have no influence.5 It would seem that topical 5 recommend an Aloe vera product.
agents are unlikely to realistically affect skin reactions from Despite a lack of evidence to support prophylactic use of any specific product.4 Conclusions: The extent of skin conditions is largely unknown.
42 centres specify the type of soap to use: ‘simple®', ‘dove®' or Although the majority of skin reactions subside after a few ‘none' being the most common answers.
weeks, some can be prolonged, uncomfortable and distressing Evidence indicates that gentle skin and hair washing should be thereby affecting a patient's quality of life. It may not be unrestricted for patients and there should be no restriction to possible to stop or even reduce the rates of skin reaction from using a specific type of soap.5 occurring, but there may be comfort and psychosocial benefits 9 specify the type of deodorant to use: ‘none' or ‘Pitrok®' that skin care products provide.10 being the most common answers. Some departments are stillsaying ‘no deodorant' despite updated evidence.6 Radiotherapy skin care be improvedwith more evidence and documentation of practice.
Main products used References:
1. Faithfull, S. et al. (2002). Survey of information leaflets on advice for acute radiation skin reactions
in UK radiotherapy centres: a rationale for a systematic review of the literature. Eur J Oncol Nurs 6(3): 176-8 2. Cox, J. et al. (1995). Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the
European Organisation for Research and Treatment of Cancer (EORTC). Int J Rad Onc Biology Physics
31 (5): 1341-1346
3. Russell, N. et al. (1994). Quantification of patient to patient variation of skin erythema developing
Approximately what percentage of patients in your department get an erythema as a response to radiotherapy. Radiotherapy and Oncology 30 (3): 213-221 4. Wells, M. et al. (2004). Does aqueous or sucralfate cream affect the severity of erythematous
1 RCT erythema products.
radiation skin reactions? A randomised controlled trial. Radiotherapy and Oncology 73 (2): 153-162 5. Bolderston, A. et al. (2006). The prevention and management of acute skin reactions related to
Reaction rates seem unknown.
radiation therapy: a systematic review and practice guideline. Supportive Care in Cancer 14 (6): 802- 6. Theberge, V. et al. (2009). Use of axillary deodorant and effect on acute skin toxicity during
radiotherapy for breast cancer: a prospective randomised noninferiority trial. Int J Rad Onc Biology
Physics 75 (4): 1048-105
7. Sperduti, A. et al. (2006). A feasibility study of an internal control methodology using
Main products used hydrocortisone cream for the management of skin reactions in patients receiving radical radiationtherapy for cancers of the head and neck. Journal of Radiotherapy in Practice 5: 211-218 35 aqueous cream Macmillan, M. et al. (2007). Randomized comparison of dry dressings versus hydrogel in 24 hydrocortisone 1 % - despite management of radiation induced moist desquamation. Int J Rad Onc Biology Physics 68 (3): 864-872
9. Gollins, S. et al. (2008). RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced
contradictory evidence7 moist skin desquamation. J Wound Care 17 (6): 268-70, 272, 274-5
10. Gosselin, T. et al (2010). A prospective randomized, placebo-controlled skin care study in women
diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 37 (5): 619-626
Scottish Intercollegiate Guidelines NetworkPart of NHS Quality Improvement Scotland Autism spectrum disordersBooklet for parents and carers We would like to thank all the young people who took part in the focus groups to provide us with their ideas and illustrations for this booklet. © Scottish Intercollegiate Guidelines Network ISBN 978 1 905813 27 8