Estudo randomizado, aberto, utilizando protetor cutâneo em spray à base de terpolímero acrílico versus hidratante padrão na prevenção de radiodermatite aguda em pacientes com câncer de canal anal e reto / An open randomized study using a skin protector spray made of acrylic terpolymers versus and standardized moisturizer in preventing acute radiodermatitis in patients with anal and rectal cancer

Pacientes com câncer de canal anal e reto em tratamento por radioterapia apresentam alta prevalência de radiodermatite com descamação úmida, desfecho que causa impactos clínicos, econômicos e sociais. Estudos sobre a efetividade de produtos na prevenção das radiodermatites representam uma lacuna de conhecimento na área oncológica, podendo o seu desenvolvimento contribuir para a diminuição dos impactos negativos desse evento, do tempo ocioso do equipamento pela interrupção do tratamento e da possibilidade de falha local da doença. Objetivou-se analisar a efetividade do protetor cutâneo em spray à base de terpolímero acrílico na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto em comparação com um hidratante padronizado na instituição à base de Calendula officinalis L. e Aloe barbadensis. Ensaio clínico randomizado, aberto, em instituição única, referência nacional no tratamento de doenças oncológicas, com amostra 63 pacientes que foram randomizados nos grupos: experimental, com uso do protetor cutâneo em spray, e controle, usando o hidratante Dnativ Revita Derm. Os pacientes foram acompanhados na consulta de enfermagem, com cegamento do avaliador da pele quanto ao uso da intervenção. A escala de avaliação de pele utilizada foi a da Radiation Therapy Oncology Group. A coleta de dados ocorreu por meio dos formulários de avaliação inicial e subsequente, sendo o desfecho principal medido a ocorrência de radiodermatite com descamação úmida, e os secundários a ocorrência de interrupção temporária da radioterapia por radiodermatite, de eventos adversos aos produtos e de severidade da radiodermatite. As análises se deram por Intenção de Tratar e Protocolo, sendo utilizadas as estatísticas descritiva, analítica e inferenciais no tratamento dos dados, com nível de significância de ≤ 0,10. Pesquisa aprovada pelo Comitê de Ética sob parecer nº 5.322.985 e registrado no Clinical Trials sob número: NCT04067310T. A regressão logística binária mostrou que os participantes expostos ao protetor cutâneo em spray tiveram menor chance de apresentar a radiodermatite com descamação úmida quando comparados ao grupo controle. A redução absoluta do risco de radiodermatite foi de 18% no grupo experimental. A incidência geral de radiodermatite foi de 100%, sendo 36,5% graus mais severos. A incidência de radiodermatite Grau 1 foi maior no grupo experimental, enquanto os graus mais severos (Graus 3 e 4) tiveram maior incidência no grupo controle; 17,5% dos participantes tiveram interrupção da radioterapia por radiodermatite, variando de 3 a 15 dias, com média de seis dias interrompidos. Apesar de relevantes clinicamente, esses resultados sobre a interrupção temporária do tratamento e a severidade da radiodermatite não tiveram significância estatística. Foram considerados fatores de risco para a descamação úmida: sexo feminino, diagnóstico C.21 e C.21.8, altas doses de radioterapia (5400-6000cGy), tipo histológico carcinoma espinocelular, umidade antes e durante a radioterapia e uso de proteção íntima. Concluiu-se que o protetor cutâneo em spray é um produto efetivo na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto, afirmação que sustenta a tese defendida. Nesse sentido, os resultados podem orientar a revisão dos protocolos assistenciais de prevenção da radiodermatite utilizados pelo enfermeiro no âmbito da consulta de enfermagem em radioterapia, com vistas a reduzir os impactos no seguimento terapêutico e na qualidade de vida dos pacientes com câncer de canal anal e reto.

Patients' ongoing anal and rectal cancer radiotherapy exhibit a high prevalence of radiodermatitis with moist desquamation, impairing clinical, economic, and social outcomes. Clinical trials targeting product efficacy in preventing radiodermatitis are lacking in the current literature. These products could contribute to diminishing adverse effects, reducing equipment idle time by therapy interruption, and increasing the cure rate. Our goal is to evaluate the effectiveness of cutaneous spray based on acrylic terpolymers in preventing radiodermatitis with moist desquamation in patients with rectal or anal cancer. Spray effectiveness was defied against a standardized moisturizer in the institution made of Calendula officinalis L. and Aloe barbadensis extracts. An open, single-blind, randomized clinical study was conducted in a single institution, reference in national treatment in oncological diseases, with a sample size (n) of 63 patients. Patients were randomized into two groups: (i) experimental, using cutaneous protector spray; and (ii) control, using moisturizer Dnativ Revita Derm. RTOC's scale was used for evaluating skin condition. Data was collected in forms, which considered: (i) the primary outcome of radiodermatitis with moist desquamation occurrence; and (ii) the secondary outcome of radiotherapy interruption caused by radiodermatitis occurrence and severity, and product adverse effects. Analyses were performed by intention to treat and per protocol, using descriptive, analytical, and inferential statistics, with a significance level of ≤ 0.10 (α). Research was approved by the Ethics committee under approval nº 5.322.985 and registered in Clinical Trials under number NCT04067310T. Binary logistic regression demonstrated that patients exposed to cutaneous spray protector were less prone to develop radiodermatitis with moist desquamation compared to the control group. Absolute reduction in radiodermatitis risk was 18% in the experimental group. The radiodermatitis overall incidence was 100%, with 36.5% of higher severity. The incidence of grade 1 radiodermatitis was higher in the experimental group, while the more severe grades (3 and 4) had a higher incidence in the control group; 17.5% of the participants had an interruption of radiotherapy due to radiodermatitis, ranging from 3 to 15 days, with an average of six interrupted days. Despite being clinically relevant, these results regarding the temporary interruption of treatment and the severity of radiodermatitis were not statistically significant. Risk factors for moist desquamation were considered: female gender, diagnosis of C.21 and C.21.8, high radiation doses (5400 to 6000 cGy), histological type squamous cell carcinoma, humidity before and during radiotherapy, and use of intimate protection. In conclusion, the skin protector spray is an effective product in the prevention of radiodermatitis with moist desquamation in patients with anal and rectal cancer. In this sense, the results can guide the review of care protocols for the prevention of radiodermatitis used by nurses in the context of nursing consultations in radiotherapy to reduce the impacts on therapeutic follow-up and the quality of life of patients with cancer of the anal canal and straight.

Los pacientes con cáncer de canal anal y recto en tratamiento con radioterapia tienen una alta prevalencia de radiodermatitis con descamación húmeda, desenlace que genera impactos clínicos, económicos y sociales. Los estudios sobre la efectividad de los productos en la prevención de la radiodermatitis representan un vacío de conocimiento en el área de oncología y pueden contribuir para la reducción de los impactos negativos, el tiempo de inactividad de los equipos por interrupción del tratamiento y la posibilidad de falla local de la enfermedad. El objetivo de este estudio fue analizar la eficacia de un protector cutáneo en spray a base de terpolímero acrílico en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal frente a una crema hidratante estandarizada de la institución a base de Calendula officinalis L. y Aloe barbadensis. Ensayo clínico aleatorizado, abierto, en una sola institución, referente nacional en el tratamiento de enfermedades oncológicas, con una muestra de 63 pacientes que fueron aleatorizados en grupos: experimental, utilizando spray protector para la piel, y control, utilizando Dnativ Revita Derm hidratante. Los pacientes fueron seguidos en la consulta de enfermería, cegándose el evaluador de piel en cuanto al uso de la intervención. La escala de valoración de la piel utilizada fue la del RTOC. Los datos se recopilaron mediante formularios de evaluación inicial y posterior, siendo el resultado principal medido la aparición de radiodermatitis con descamación húmeda y los resultados secundarios la interrupción temporal de la radioterapia debido a la radiodermatitis, los eventos adversos de los productos y la gravedad de la radiodermatitis. Los análisis fueron realizados por Intención de Tratar y Protocolo, utilizando estadística descriptiva, analítica e inferencial en el procesamiento de datos, con nivel de significación ≤ 0,10. Investigación aprobada por el Comité de Ética con dictamen nº 5.322.985 y registrada en Ensayos Clínicos con el número: NCT04067310T. La regresión logística binaria mostró que los participantes expuestos al protector de piel en aerosol tenían menos probabilidades de tener radiodermatitis con descamación húmeda en comparación con el grupo de control. La reducción absoluta del riesgo de radiodermatitis fue del 18 % en el grupo experimental. La incidencia global de radiodermatitis fue del 100%, siendo el 36,5% grados más graves. La incidencia de radiodermatitis Grado 1 fue mayor en el grupo experimental, mientras que los grados más severos (3 y 4) tuvieron mayor incidencia en el grupo control; El 17,5% de los participantes tuvo interrupción de la radioterapia por radiodermatitis, variando de 3 a 15 días, con un promedio de seis días de interrupción. A pesar de ser clínicamente relevantes, estos resultados en cuanto a la interrupción temporal del tratamiento y la gravedad de la radiodermatitis no fueron estadísticamente significativos. Se consideraron factores de riesgo para descamación húmeda: sexo femenino, diagnóstico C.21 y C.21.8, dosis altas (5400-6000cGy), carcinoma epidermoide de tipo histológico, humedad antes y durante la radioterapia y uso de protección íntima. Se concluyó que el spray protector de piel es un producto eficaz en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal, afirmación que sustenta la tesis defendida. En ese sentido, los resultados pueden orientar la revisión de los protocolos de atención para la prevención de la radiodermitis utilizados por los enfermeros en el contexto de las consultas de enfermería en radioterapia, con el objetivo de reducir los impactos en el seguimiento terapéutico y en la calidad de vida de los pacientes con cáncer del canal anal y recto.

Uso e efetividade de terapias tópicas no tratamento de radiodermatites: revisão integrativa / Use and affectiveness of topical therapies in radiodermatitis treatment: integrative review / Uso y efectividad de terapias tópicas en el tratamiento de radiodermatitis: revisión integrativa

Objetivo: descrever, a luz da pesquisa bibliográfica, o uso das terapias tópicas no tratamento de radiodermatites. Método: revisão integrativa de ensaios clínicos randomizados nas bases de dados: MEDLINE, LILACS, biblioteca COCHRANE, CINAHL e EMBASE. Após observância dos critérios de inclusão, encontrou-se 1.289 estudos, dos quais, após etapas de exclusão resultaram em 10 estudos. Resultados: foram expostos em categorias num quadro síntese incluindo: dados do estudo, participantes da pesquisa, tipo de terapia tópica utilizada; indicações, contraindicações e resultados. Conclusão: encontraram-se lacunas nos estudos e estas necessitam de investigação. Sugerem-se novos ensaios experimentais a fim de trazer respostas quanto aos tipos de terapias tópicas mais efetivas em radiodermatites, o que trará melhores condições de tratamento e assegurará ao enfermeiro uma assistência de qualidade e ao cliente oncológico uma melhor qualidade de vida

Objective: to describe, in the light of bibliographic research, the use of topical therapies in the treatment of radiodermatitis. Method: integrative review of randomized clinical trials in the databases: MEDLINE, LILACS, COCHRANE, CINAHL and EMBASE. After observing the inclusion criteria, there were 1,289 studies, of which, following exclusion stages, resulted in 10 studies. Results: they were presented in categories in a summary table including: study data, research participants, type of topical therapy used; indications, contraindications and results. Conclusion: gaps have been found in the studies and these need investigation. New experimental trials are suggested in order to provide answers regarding the types of topical therapies more effective in radiodermatites, which will bring better treatment conditions and will ensure the quality of care and the oncological client a better quality of life

Objetivo: describir, a la luz de la investigación bibliográfica, el uso de las terapias tópicas en el tratamiento de radiodermatitis. Método: revisión integrativa de ensayos clínicos aleatorizados en las bases de datos: MEDLINE, LILACS, biblioteca COCHRANE, CINAHL y EMBASE. Después de la observancia de los criterios de inclusión, se encontraron 1.289 estudios, de los cuales, después de etapas de exclusión resultaron en 10 estudios. Resultados: fueron expuestos en categorías en un cuadro síntesis incluyendo: datos del estudio, participantes de la investigación, tipo de terapia tópica utilizada; indicaciones, contraindicaciones y resultados. Conclusión: se ha encontrado lagunas en los estudios y éstas necesitan investigación. Se sugieren nuevos ensayos experimentales a fin de traer respuestas en cuanto a los tipos de terapias tópicas más efectivas en radiodermatitis, lo que traerá mejores condiciones de tratamiento y asegurará al enfermero una asistencia de calidad y al cliente oncológico una mejor calidad de vida

Prevalência de radiodermatite em pacientes com câncer de canal anal e reto e fatores de risco associados à radiodermatite severa / [Prevalence of radiodermatitis in patients with anal canal cancer and rectum and risk factors associated with severe radiodermatitis]

A radioterapia é uma modalidade importante para o tratamento do câncer e, apesar dos avanços nas técnicas de radiação, os pacientes ainda experimentam eventos adversos. A radiodermatite é definida como um conjunto de lesões cutâneas provocadas por exposição á radiação ionizante, além de ser considerada uma queimadura complexa que ocorre das estruturas internas às externas, podendo levar a complicações secundárias, como infecção. Seu desenvolvimento em pacientes com câncer de canal anal e reto é comum, sendo sua toxicidade relacionada principalmente devido à pele no campo de tratamento apresentar muitas dobras, umidade e atrito constantes, além de depender de seu estado nutricional e tratamento associado com quimioterapia. Este evento quando severo tem um impacto negativo ao tratamento pela possibilidade de falha devido às interrupções transitórias para recuperação da pele. O enfermeiro desempenha um papel importante na educação dos pacientes em tratamento de radioterapia, visto que através da consulta de enfermagem orienta o indivíduo e seus familiares nos cuidados necessários para minimizar e tratar este evento através do processo de enfermagem, onde, na avaliação de pele, o enfermeiro utiliza os critérios de graduação da radiotoxicidade aguda da Radiation Therapy Oncology Group. Em decorrência dos efeitos adversos provocados na pele, o presente estudo teve como objetivos: identificar a prevalência da radiodermatite e sua associação com fatores de risco para graus mais severos em pacientes com câncer de canal anal e reto acompanhados pela consulta de enfermagem; e analisar os impactos dos casos com graus mais severos de radiodermatite no seguimento terapêutico. Trata-se de um estudo exploratório, seccional, realizado através da análise documental de 112 prontuários de pacientes com câncer de canal anal e reto submetidos à radioterapia com indicação curativa acompanhados na consulta de enfermagem no ano de 2017. Aplicou-se formulário estruturado para a coleta de dados das variáveis no prontuário, que posteriormente foram tabulados e analisados com auxílio do softaware SPSS, empregando-se estatística analítica e descritiva. Os resultados evidenciaram que 99,1% dos pacientes apresentaram radiodermatite, sendo 34,8% radiodermatite severa. A radiodermatite severa esteve associada ao sexo, idade e tipo de aparelho. 100% dos pacientes que tiveram suspensão temporária do tratamento, apresentaram graus 3 ou 4 de radiodermatite. O estudo mostrou que graus severos de radiodermatite é uma reação adversa de alta prevalência em pacientes com câncer de canal anal e reto em tratamento com radioterapia de indicação curativa. Acredita-se que a consulta de enfermagem tem uma significativa função na prevenção de radiodermatite e diminuição da suspensão do tratamento.

Radiotherapy is an important modality for the treatment of cancer and, despite advances in radiation techniques, patients still experience adverse events. Radiodermatitis is defined as a set of cutaneous lesions caused by exposure to ionizing radiation, in addition to being considered a complex burn that occurs from internal to external structures, and may lead to secondary complications such as infection. Its development in patients with anal and rectal cancer is common, and its related toxicity is mainly due to the skin in the treatment field presenting many folds, constant moisture and friction, besides depending on its nutritional state and treatment associated with chemotherapy. This severe event has a negative impact on the treatment because of the possibility of failure due to transient interruptions to skin recovery. The nurse plays an important role in the education of patients in radiotherapy treatment, since through the nursing consultation the individual and his / her relatives are guided in the necessary care to minimize and treat this event through the nursing process, where, in the evaluation of the skin, the nurse uses the Radiation Therapy Oncology Group graded criteria for acute radiotoxicity. As a result of the adverse effects on the skin, the present study had the following objectives: to identify the prevalence of radiodermatitis and its association with risk factors for more severe degrees in patients with anal and rectum cancer, followed by the nursing consultation; and to analyze the impacts of cases with more severe degrees of radiodermatitis in the therapeutic follow-up. This is an exploratory, sectional study carried out through the documentary analysis of 112 medical records of patients with anal and rectum cancer submitted to radiotherapy with curative indication followed up at the nursing consultation in 2017. A structured form was used to collect variables data in the medical record, which were later tabulated and analyzed using the SPSS software, using analytical and descriptive statistics. The results showed that 99.1% of the patients presented radiodermatitis, 34.8% of them being severe radiodermatitis. Severe radiodermatitis was associated with gender, age and type of appliance. 100% of the patients who had temporarily suspended treatment presented grades 3 or 4 of radiodermatitis. The study was that severe degrees of radiodermatitis is a highintensity adverse reaction in patients with anal canal cancer and resumed in treatment with curative indication radiotherapy. It is believed that the nursing consultation has a significant role in the prevention of radiodermatitis and decreased suspension of treatment.

[NURSING CARE PROTOCOL ON MANAGEMENT OF RADIODERMITIS]. / ProtocoLo de cuidados de enfermería en el tratamiento de la radiodermitis.

INTRODUCTION: Cases of radiation recall may be experienced by radiotherapy patients, which are named as radiodermitis. To gradate it the RTOG (Radiation Therapy Oncology Group) scale is the most used. Due to the complexity on the management of radiotherapy, a protocol based on the evidence is stablished to prevent and treat it. MATERIAL AND METHODS: Bibliographic revision of main data bases from last six years. RESULTS: 14 different studies which have the criteria for their inclusion are selected. These studies will gather, with different levels of evidence, several prevention and treatment methods and products for radiodermitis. DISCUSSION: To prevent it from happening, it is a must to clean and dry the skin appropriately. Urea, hyaluronic acid and Tex-OE based creams have shown their effectiveness on grades 0-1. Regarding treatment, the use of medium-high corticoids, the barrier creams, silver sulfadiazine, hyaluronic acid and no sting barrier film can reduce the gravity of the wounds. The use of the healing in humid environments is also recommended on the treatment of radiodermitis. Some products like hydrocolloids, silver dressings and hydrogel also improve the scarring. CONCLUSION: Managing radiodermitis is a complex matter. Therefore the action protocol based on evidence is the ideal tool to improve the efficiency and effectiveness of the cares, giving an increase on the tolerance to treatment and a reduction on the public health cost and a higher quality of life fo rpatients.

Radiotherapy-induced skin reactions: assessment and management.

Patients undergoing radiotherapy often experience a skin reaction to their treatment. In an attempt to assist clinicians in the recognition and care of these radiotherapy-induced skin reactions, an assessment and management tool has been designed for use. This patient-focused assessment tool has been distributed across the counties that the authors' trust serves. It has standardised the care of patients with these skin reactions, so that the patients can be treated with the same interventions whether they visit their GP, hospital or district nurse.

Protocolo de cuidados de enfermería en el tratamiento de la radiodermitis / Nursing care protocol on management of radiodermitis

Introducción. Todo paciente que recibe tratamiento radioterápico puede experimentar algun tipo de toxicidad cutanea, denominada radiodermitis. La escala RTOG (Radiation Therapy Oncology Group) es que mas se usa para su graduacion. Debido al tratamiento tan complejo de la radioterapia, se decide la elaboracion de un protocolo basado en la evidencia para su prevencion y tratamiento. Material y métodos. Revisión bibliografica en las principales bases de datos de los ultimos seis años. Resultados. Se identifican 14 estudios que cumplen los criterios de inclusion, que recogen, con diferentes niveles de evidencia, varios metodos y productos de prevencion y tratamiento de la radiodermitis. Discusión. En la prevencion, destaca como herramienta imprescindible el lavado y secado correcto de la piel. La urea, el acido hialuronico y cremas con Tex-OE han demostrado efectividad en los grados 0-1. Con respecto al tratamiento, el uso de corticoides de media-alta, las cremas barrera, la sulfadiazina argentica, el acido hialuronico y la pelicula barrera no irritante (PBNI) pueden reducir la gravedad de las lesiones. El empleo de la cura en ambiente humedo (CAH) tambien se recomienda en el tratamiento de la radiodermitis. Algunos productos como los hidrocoloides, los apositos con plata y el hidrogel mejoran las tasas de cicatrizacion. Conclusiones. El tratamiento de la radiodermitis es complejo, por lo que un protocolo de actuacion basado en la evidencia es la herramienta idonea para mejorar la eficiencia y eficacia de los cuidados, y proporciona un aumento de la tolerancia al tratamiento, la reduccion de los costes sociosanitarios y una mayor calidad de vida del paciente (AU)

Introduction. Cases of radiation recall may be experienced by radiotherapy patients, which are named as radiodermitis. To gradate it the RTOG (Radiation Therapy Oncology Group) scale is the most used. Due to the complexity on the management of radiotherapy, a protocol based on the evidence is stablished to prevent and treat it. Material and methods. Bibliographic revision of main data bases from last six years. Results. 14 different studies which have the criteria for their inclusion are selected. These studies will gather, with different levels of evidence, several prevention and treatment methods and products for radiodermitis. Discussion. To prevent it from happening, it is a must to clean and dry the skin appropriately. Urea, hyaluronic acid and Tex-OE based creams have shown their effectiveness on grades 0-1. Regarding treatment, the use of medium-high corticoids, the barrier creams, silver sulfadiazine, hyaluronic acid and no sting barrier film can reduce the gravity of the wounds. The use of the healing in humid environments is also recommended on the treatment of radiodermitis. Some products like hydrocolloids, silver dressings and hydrogel also improve the scarring. Conclusion. Managing radiodermitis is a complex matter. Therefore the action protocol based on evidence is the ideal tool to improve the efficiency and effectiveness of the cares, giving an increase on the tolerance to treatment and a reduction on the public health cost and a higher quality of life for patients (AU)

Topical antioxidants in radiodermatitis: a clinical review.

Radiation-induced skin toxicity is the most prevalent side effect of radiation therapy. Not only does it have a significant effect on patients' quality of life, but it also results in poor follow-up and early termination of radiotherapy treatment. Several skin care practices and topical applications have been studied in the field of radiodermatitis, including skin washing, topical steroids, and mechanical skin barriers. Aside from these methods, many patients turn to complementary and alternative medicine for the prevention and treatment of radiodermatitis. Many of these alternative therapies are topically applied antioxidants. While the rationale behind the use of antioxidants in treating radiodermatitis is strong, clinical studies have been far less consistent. Even in large scale randomised controlled trials, findings have been limited by the inconsistent use of topical vehicles and placebos. In this article, the authors review the role of topical antioxidants to better help the practitioner navigate through different available skin directed antioxidants.

[Post-radiotherapy care and monitoring of head and neck cancers]. / Soins et surveillance post-radiothérapie des cancers ORL.

Radiotherapy performed to treat head and neck cancer results in considerable side effects and the patient must be provided with all the necessary information and regular monitoring. From the announcement of the diagnosis, during and after the radiotherapy, the nurse coordinator identifies and assesses the needs, expectations and concerns of the patients. Their role helps to simplify and personalise the care pathway, providing a liaison between the different professionals and offering support for the patient.

Protocol Paper: A Randomized Trial of 2 Creams in the Skin Care of Patients Receiving Radiation Therapy for Breast Cancer in the Tropics.

BACKGROUND: Nurses working in a northern Australia Radiation Therapy Unit advise all patients undergoing radiation therapy to use a readily available nonprescription moisturizing cream to minimize the severity of radiation skin reactions. However, patients report that the cream is thick and difficult to use in the humid tropical climate, and nurses anecdotally suspect an increase in severe skin reactions during the summer months. OBJECTIVE: This article presents the protocol for a randomized controlled trial that addressed a lack of evidence pertaining to the use of topical creams to prevent acute radiation skin reactions in a tropical climate. METHODS: Two skin care creams were used in the trial. The trial's primary outcome measure was the incidence of moist desquamation during treatment and 1 month after treatment completion. The secondary outcome was the participants' acceptance of the allocated cream at similar time points. RESULTS: Recruitment to the trial has been completed. Findings of the research will be reported in a separate publication. CONCLUSIONS: This article presents the protocol for a randomized controlled trial that addresses a lack of evidence pertaining to the use of topical creams to prevent acute radiation skin reactions in a tropical climate. IMPLICATIONS FOR PRACTICE: This protocol can be adapted by other researchers conducting practice-based research.

Radiotherapy-induced skin reactions: assessment and management.

Radiotherapy, the use of high-energy rays to either kill cancer cells or treat some benign tumours, is undoubtedly a positive intervention. However, as the primary mode of action in radiotherapy treatment is the killing of cells to prevent replication, other non-cancerous cells may be affected. For example, up to 85% of patients will experience some form of skin reaction, which will range from local erythema to moist desquamation. Such reactions are not only distressing and painful for the patient, if severe enough, they may warrant a halt in treatment. This article outlines the aims and nature of radiotherapy, and then discusses the aetiology of skin reactions, risk factors for reaction, and assessment tools. Management interventions will also be shown, with emphasis on silicone dressings.

Identification of need for an evidence-based nurse-led assessment and management protocol for radiation dermatitis.

BACKGROUND: Radiation therapy is used globally as a standard treatment for many forms of cancer. Skin damage or radiation dermatitis is the most common effect of radiation therapy. OBJECTIVES: The study aims were to survey nurses to identify methods used to screen, manage, and monitor acute skin reactions within the radiation departments of an urban, northeastern teaching hospital and its network facilities and identify strategies to establish a mechanism for ongoing communication among the nurses to develop and implement an evidence-based protocol. METHODS: Using an online self-report survey format (SurveyMonkey), radiation nurses were asked to describe their current practice related to assessing and monitoring radiation dermatitis, areas of expertise, skin assessment tools used, frequency of skin assessment, and interventions used to manage patients with radiation dermatitis. RESULTS: Twenty-two radiation nurses (100%) representing all 8 facilities within the network responded. Tools to assess patients' skin, the frequency of skin assessments, and products used to manage skin reactions varied among the nurses. Nurses also assessed patients for additional factors including nutritional status, presence of other diseases, and medications. CONCLUSIONS: Our results validated the need for a system-wide approach to manage patients undergoing radiation therapy, specifically a skin care protocol that defines type and frequency of skin assessments as well as recommends treatments for prevention and management of common skin conditions. IMPLICATIONS FOR PRACTICE: The establishment of a standard method of assessing the skin will improve quality of care provided in the radiation departments and potentially limit patient complications and costs.

Putting evidence into practice.

Radiation dermatitis, or radiodermatitis, is a significant symptom caused by radiation therapy for the treatment of cancerous and noncancerous conditions. Radiodermatitis can negatively affect patients' physical functioning and quality of life. The Oncology Nursing Society coordinated a Putting Evidence Into Practice (PEP) project team to develop a PEP resource summarizing current evidence for the management of patients with radiodermatitis. Oncology nurses play an important role in educating, assessing, and monitoring patients for this symptom. Many common nursing interventions for radiodermatitis are based on tradition or opinion and have not been researched thoroughly. In addition, evidence to support some current interventions in practice is lacking. This article presents information concerning radiodermatitis, summarizes the evidence-based review for its prevention and management, and identifies gaps in the literature, as well as opportunities for research, education, and practice.

A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy.

PURPOSE/OBJECTIVES: To compare the effectiveness of three different skin care products versus a placebo in reducing the incidence of radiation therapy-induced skin reactions prophylactically. DESIGN: Prospective randomized, double-blinded, placebo-controlled study. SETTING: A radiation oncology department at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States. SAMPLE: 208 women with breast cancer who were to receive whole breast radiation therapy. METHODS: Patients were invited to participate after radiation therapy was documented as part of their treatment plan. Patients applied a skin care product starting on the first day of treatment and were assessed weekly by their radiation oncology nurse. MAIN RESEARCH VARIABLES: Skin reaction score and skin product. FINDINGS: None of the products were statistically better than placebo in preventing skin reactions. Increases in skin reaction over time did not vary with treatment group for the linear (p = 0.16) and nonlinear (p = 0.94) effects of time and for both time components tested together (p = 0.41). CONCLUSIONS: Ninety-five percent of women participating in this study experienced a radiation therapy-induced skin reaction. IMPLICATIONS FOR NURSING: The development of guidelines to support safe patient care is encouraged because patients prefer to take action rather than do nothing. However, the findings do not demonstrate improved clinical outcomes with the use of skin care products. Healthcare providers should proactively educate patients about acute skin reactions and self-care strategies to minimize skin breakdown.

Management of skin toxicity during radiation therapy: a review of the evidence.

Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were divided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice.

Managing acute skin reactions to radiotherapy treatment.

Promoting tissue viability and caring for skin damaged as a result of radiotherapy are critical to the quality of care patients receive. However, few nurses recognise fully the effect of radiotherapy on tissue viability and wound healing. This article considers the causes and types of skin damage resulting from radiotherapy treatment that nurses may encounter, and how this damage can be graded. Based on the extent of skin reaction to radiotherapy, management options are explored, illustrated by a case study. A guide to product selection, derived from the authors' experience, is presented.

Management of skin reactions during radiotherapy in Flanders (Belgium): a study of nursing practice before and after the introduction of a skin care protocol.

PURPOSE OF THE RESEARCH: To evaluate nursing practice in Flanders (Belgium) regarding skin care during radiotherapy and the effect of the introduction of an evidence based protocol on daily nursing practice. METHODS AND SAMPLE: Nurses working at radiotherapy departments in Flanders were invited to complete a 58-item questionnaire. The survey was undertaken in 2001 (n=67) and end of 2006 (n=89). Following the survey in 2001 an evidence based skin care protocol was made available for radiotherapy nurses and presented at their respective radiotherapy services. The questionnaire asked to what extend they advised their patients about skin care topics grouped in four sections: prevention, erythema, dry desquamation, moist desquamation. KEY RESULTS: The surveys revealed large varieties in the management of skin reactions although there seems to be less variety and more consensus in the 2006 survey. Regarding preventive advice and the advice in case of erythema, dry desquamation and/or moist desquamation a major improvement was observed in the adoption of key principles such as washing and hydrating the irradiated site and the use of occlusive dressings and the omission of outdated techniques such as talcum powder, Eosin 2% and Gentian violet. CONCLUSIONS: The management of skin reactions does not always correspond with current scientific knowledge. However, the results of this study show that the dissemination and implementation of a skin care protocol enhanced standardization in Flanders, improved adheration to evidence based guidelines and lead to the disappearance of outdated ritualistic practices.

A comparison of wound treatments in nasopharyngeal cancer patients receiving radiation therapy.

The purpose of this study was to compare the effectiveness of gentian violet and nonadherent absorbent dressing in the healing of postirradiation wounds in nasopharyngeal carcinoma patients. This was a randomized controlled trial. A sample of 146 nasopharyngeal carcinoma patients who had developed postirradiation wounds was assessed. Comparisons were made regarding parameters related to wound healing, including healing time, presence of infection, and wound pain, and also regarding the impact of wound on the patient, including mood changes, restriction of neck movement, social isolation, sleep problem, and disturbance in body image. The results showed that patients in the 2 groups did not have any significant difference on wound-healing time, disturbance in mood, sleep, social interaction, appearance, and neck mobility. However, there was a trend of higher wound pain score, not reaching statistical significance, in the gentian violet group.

Catrix: an easy-to-use collagen treatment for wound healing.

Collagen plays a major role in wound healing. Its presence is important in all stages of the healing process. Catrix is a new collagen wound-healing powder that has been shown to be effective in the treatment of wounds healing by secondary intent such as pressure ulcers, venous stasis ulcers and diabetic ulcers as well as second-degree burns and post-radiation dermatitis. Catrix has also been shown to be effective in the treatment of wounds unresponsive to conventional treatments. It promotes the growth of fibroblasts and keratinocytes in the wound, prevents loss of fluid from the wound and protects the wound from bacterial infections and other agents. Catrix is biodegradable and therefore does not require removal from the wound bed before re-application.