Instruments and scales for the evaluation of acute radiation dermatitis: A systematic review.

Various assessment instruments have been proposed to document and evaluate radiation dermatitis. In this systematic review, we identified nineteen instruments or scales for the evaluation of radiation dermatitis and performed a critical review of the signs and symptoms included in each of them. Of those scales, only two have been validated. There is a need to revise the currently used instruments so to improve their capability to measure all relevant aspects of radiation dermatitis and their severity. In addition, it would be important to add the patients' view of their conditions and how they affect their lives. Finally, in order to be useful in clinical and research settings, instruments for evaluation of radiation dermatitis should be submitted to the validation process that is currently prescribed in the field of outcome measures development.

Use of Chamomile Infusion to Mitigate Radiotherapy-Induced Dry Desquamation in Head and Neck Cancer Patients.

PURPOSE: To evaluate the effect of using a compress with Chamomilla recutita infusion in the regression of dry desquamation and in the prevention of moist desquamation in head and neck cancer patients undergoing radiotherapy. METHODS: A prospective intervention study was carried out from May 2019 to May 2021. In total, 43 participants were included, who were instructed to apply the compress with the infusion 3 times a day, after occurrence of dry desquamation. Skin evaluation took place daily from initiation of the intervention up to the end of radiotherapy. RESULTS: All the participants presented dry desquamation regression, where 65.1% (95% CI 50.1-78.1) had total regression until the end of radiotherapy, with a mean of 9 days of regression. Only 34.9% (95% CI 21.8-49.9) of the participants developed moist desquamation by the end of the radiotherapy sessions, with a mean accumulated dose of ionizing radiation of 50.9 Gy. CONCLUSION: This study highlighted the potential clinical benefits of using Chamomilla recutita in the regression of dry desquamation and in the prevention of moist desquamation.

Acute radiodermatitis in cancer patients: incidence and severity estimates.

OBJECTIVE: To estimate the incidence and distribution of the degree of radiodermatitis in cancer patients submitted to radiotherapy in the regions of head and neck, breast, and pelvis. METHOD: Prospective, longitudinal, quantitative study conducted from March 15, 2016 to May 4, 2017 with patients observed for five weeks of treatment. The primary outcome was the proportion of grade 1 or higher radiodermatitis each week. The degree of radiodermatitis and mean time of occurrence for each patient were secondary outcomes. RESULTS: This study included 112 patients. The incidence of radiodermatitis was 100% among those whose head and neck region was irradiated, followed by 98% for breast and 48% for the pelvic region. The degree of radiodermatitis varied with the irradiated site; the worst degrees were found in the head and neck region, followed by the breast. In the three groups, the mean time of the first occurrence of radiodermatitis was approximately eleven days. CONCLUSION: The incidence of radiodermatitis in the studied groups was high, which reinforces the need to perform the same evaluation nationwide. This would support creating and standardizing protocols and recommendations for a proper management of radiodermatitis, specially concerning its prevention.

Acute radiodermatitis in cancer patients: incidence and severity estimates / Radiodermatitis aguda en pacientes con cáncer: estimación de la incidencia y la severidad / Radiodermatite aguda em pacientes com câncer: estimativa de incidência e severidade

ABSTRACT Objective: To estimate the incidence and distribution of the degree of radiodermatitis in cancer patients submitted to radiotherapy in the regions of head and neck, breast, and pelvis. Method: Prospective, longitudinal, quantitative study conducted from March 15, 2016 to May 4, 2017 with patients observed for five weeks of treatment. The primary outcome was the proportion of grade 1 or higher radiodermatitis each week. The degree of radiodermatitis and mean time of occurrence for each patient were secondary outcomes. Results: This study included 112 patients. The incidence of radiodermatitis was 100% among those whose head and neck region was irradiated, followed by 98% for breast and 48% for the pelvic region. The degree of radiodermatitis varied with the irradiated site; the worst degrees were found in the head and neck region, followed by the breast. In the three groups, the mean time of the first occurrence of radiodermatitis was approximately eleven days. Conclusion: The incidence of radiodermatitis in the studied groups was high, which reinforces the need to perform the same evaluation nationwide. This would support creating and standardizing protocols and recommendations for a proper management of radiodermatitis, specially concerning its prevention.

RESUMEN Objetivo: Estimar la incidencia y la distribución del grado de radiodermatitis en pacientes con cáncer sometidos a radioterapia en las regiones de la cabeza y el cuello, la mama y la pelvis. Método: Estudio prospectivo, longitudinal y cuantitativo realizado entre el 15 de marzo de 2016 y el 4 de mayo de 2017 con pacientes observados durante cinco semanas de tratamiento. El resultado primario fue la proporción de radiodermatitis grado 1 o superior cada semana. El grado de radiodermatitis y el tiempo medio de la primera aparición en cada paciente fueron resultados secundarios. Resultados: Participaron 112 pacientes. La incidencia de radiodermatitis fue del 100% entre los que se irradiaron en la región de la cabeza y el cuello, seguida del 98% en la mama y el 48% en la pelvis. El grado de radiodermatitis variaba según el sitio de irradiación, con peores grados en la región de la cabeza y el cuello, seguida de la mama. En los tres grupos, el tiempo medio para la primera aparición de radiodermatitis fue de aproximadamente 11 días. Conclusión: La incidencia de la radiodermatitis fue elevada en los grupos estudiados, lo que reitera la necesidad de hacer la misma evaluación en todo el país. Esta evaluación fomentaría la creación y la uniformización de los protocolos y recomendaciones para el manejo adecuado de la radiodermatitis, especialmente en lo que respecta a su prevención.

RESUMO Objetivo: Estimar a incidência e a distribuição de graduação de radiodermatite em pacientes com câncer submetidos à radioterapia nas regiões de cabeça e pescoço, mama e pelve. Método: Estudo prospectivo, longitudinal, quantitativo, realizado durante o período de 15 de março de 2016 a 4 de maio de 2017 com pacientes observados ao longo de cinco semanas de tratamento. O desfecho primário foi proporção de radiodermatite grau 1 ou superior em cada semana. Graduação de radiodermatite e tempo médio para a primeira ocorrência em cada paciente foram desfechos secundários. Resultados: Participaram 112 pacientes. A incidência de radiodermatite foi de 100% entre os que irradiaram a região de cabeça e pescoço, seguida por 98% em mama e 48% na pelve. A graduação de radiodermatite variou de acordo com o local da irradiação, com piores graduações na região de cabeça e pescoço, seguida por mama. Nos três grupos, o tempo médio para a primeira ocorrência de radiodermatite foi de aproximadamente 11 dias. Conclusão: A incidência de radiodermatite foi alta nos grupos estudados, o que reitera a necessidade de se fazer a mesma avaliação em âmbito nacional. Essa avaliação incentivaria a criação e a uniformização de protocolos e recomendações para o manejo adequado da radiodermatite, principalmente no que concerne à sua prevenção.

Gel of chamomile vs. urea cream to prevent acute radiation dermatitis in patients with head and neck cancer: a randomized controlled trial.

AIM: To compare a gel made with chamomile (Chamomilla recutita) with a cream of urea as an intervention to delay the time to occurrence of radiation dermatitis. BACKGROUND: Radiation dermatitis is one of the most common adverse effects of radiotherapy in patients with head and neck cancer. It is characterized by erythema, itching, pain, skin breakage and burning sensation, and there is no consensus on how to prevent it. DESIGN: The study is a randomized controlled clinical trial. METHODS: We will recruit 48 individuals with head and neck cancer who will be starting their radiotherapy and randomize them to receive either gel of chamomile or cream of urea, as an intervention for prevention of radiation dermatitis. Social-demographic data will be collected at baseline, and clinical data will be collected before the initiation of radiotherapy. Participants will be followed weekly to assess development of radiation dermatitis. The protocol is funded by Conselho Nacional de Pesquisa e Desenvolvimento Científico (Brazil). The study was approved by a research ethics committee. DISCUSSION: Given the clinical relevance of preventing radiation dermatitis and the lack of evidence supporting specific preventive interventions, it is important to study new products that might be efficacious to prevent this complication. This article presents the protocol of a randomized controlled trial comparing a gel made with chamomile (intervention) with a cream of urea (control) to prevent radiation dermatitis in patients with head and neck cancer undergoing radiotherapy.

Intervenções terapêuticas em feridas tumorais: relato de casos / Therapeutic interventions in fungating wounds: case reports / Intervenciones terapéuticas de ulceras tumorales: reporte de casos

Introdução: Feridas tumorais (FT) são formadas pela infiltração de células malignas na estrutura da pele, havendo perda da solução de continuidade cutânea em virtude da proliferação celular descontrolada. Sinais e sintomas como odor, dor, sangramento, exsudato e prurido são observados com frequência. Objetivo: Descrever as intervenções de enfermagem empregadas para minimizar sinais e sintomas da FT. Relato de casos: Dois pacientes com FT foram acompanhados para avaliação quanto ao estadiamento da ferida e controle de sinais e sintomas. Diferentes coberturas foram utilizadas nos curativos, de acordo com a demanda de cada FT. Para controle do odor, utilizaram-se carvão ativado, clorexidina degermante e metronidazol. O manejo do exsudato foi realizado por meio do uso de alginato de cálcio e sódio em fibra e curativos absortivos com carvão ativado. O sangramento era controlado com alginato de cálcio e sódio em fibra e gaze embebida em petrolato. A dor foi mensurada e controlada por meio de analgesia. Conclusões: As FT apresentam características peculiares e necessitam de atenção especializada. A associação de coberturas nos curativos possibilitou minimizar sinais e sintomas.

Introduction: Fungating wounds (FW) are formed by the infiltration of malignant cells in the skin structure, with local invasion, which occurs as the result of uncontrolled cell proliferation. The signs and symptoms such as odor, pain, bleeding, itching and exudate are observed with great frequency. Objectives: This study aimed to describe the nursing interventions employed to decrease the signs and symptoms of FW. Cases report: This is a series of two cases followed during the dressing change for evaluating FW in relation to staging and symptoms. Different dressings were used according to the characteristics of each FW. The odor was controlled with charcoal dressings, chlorhexidine gluconate 4% and metronidazole. To absorb and contain exudate, we used calcium and sodium alginate fiber and absorptive dressings with charcoal. The bleeding was controlled with sodium and calcium alginate fiber and petrolatum gauze. The pain was measured and controlled by analgesia. Conclusion: FW have individual characteristics and need specialized attention. The association between distinct dressing choices can decrease signs and symptoms.

Introducción: Úlceras tumorales (UT) se forman por la infiltración de células malignas en la estructura de la piel, con pérdida de la solución de continuidad de la piel debido a la proliferación celular. Los signos y síntomas más comunes son mal olor, dolor, sangrado, comezón y exudado. Objetivo: Este estudio tuvo como objetivo describir las intervenciones de enfermería para reducir los signos y síntomas de HT. Reporte de Casos: Dos pacientes fueron acompañados para la evaluación en relación al estado previo de la úlcera y el control de señales y síntomas. Diferentes apósitos se han utilizado según las características de cada UT. Para el control del mal olor se usó apósitos de carbón con plata, degermante clorhexidina y metronidazol. Se utilizó la fibra de alginato de calcio y sodio y apósitos absorbentes con carbón activado en la contención y absorción del exudado. El sangrado se controló con fibra de alginato de sodio y calcio y gasa con petrolatum. El dolor se midió y se controló con la analgesia. Conclusión: Las UT tienen características particulares y la necesitan de una atención especializada. La asociación entre distintos productos en el tratamiento de las úlceras tumorales puede reducir los signos y síntomas.