Multidimensional Approach Promotes Adherence, Decreases Severity of Radiation Dermatitis

Three weeks after a multidimensional intervention, 90% of patients with head and neck cancer undergoing radiation reported full adherence.
Three weeks after a multidimensional intervention, 90% of patients with head and neck cancer undergoing radiation reported full adherence.

ORLANDO, FL—Three weeks after participating in a multidimensional intervention on skin care practices, 90% of patients with head and neck cancer undergoing radiation therapy reported full adherence to the regimen, according to a poster presentation at the ONS 40th Annual Congress.

In addition, better adherence to skin care not only delayed onset of dermatitis but it was less severe.

In addition to the majority of patients reporting satisfaction with the teaching methods, “skin toxicities were delayed in onset and of lesser intensity among patients using this approach,” noted Pamela Laszewski, RN, OCN®, of Karmanos Cancer Center, in Detroit, MI.

Radiation dermatitis occurs in 95% of patients receiving radition therapy; however, research related to radiation dermatitis has primarily focused on comparing the effectiveness of topical products.

Little attention is given to adherence, noted Laszewski. “Benefits accrued from using even the most efficacious skin care products will not be realized if adherence is poor.”

One assumption underlying nonadherence to a prescribed therapy is lack of patient knowledge. However, “knowledge alone is not sufficient to ensure adherence.”

The World Health Organization (WHO) identified five types of interacting factors/dimensions that affect adherence: health system, social economic, therapy related, patient related, and condition related. This suggests that interventions to enhance adherence “are more apt to be successful when using multidimensional approaches,” she noted.

Laszewski and colleagues sought to determine which teaching method would be most effective in terms of improved patient outcomes through better adherence to skin care practices.

Patients with head and neck cancer undergoing radiation therapy were educated about skin care using multidimensional video, verbal patient education sessions, and written instructions prior to starting treatment.

The instructions included washing their skin with  baby wipes and Aquafor twice daily, even on nontreatment days. Instructions were reinforced on weeks 1 and 3.

The measures the researchers focused on were patient satisfaction, adherence to regimen, and patient preference of teaching method. Posttreatment survey results showed video was the most preferred teaching method, then verbal instructions, and written instructions.

“Patients were asked if they followed their skin care practices, and many would say ‘Yes.' But after watching the video, they would shake their heads and say ‘No,'” explained Laszewski.

Although use of appropriate skin care products to prevent radiation dermatitis is important, if those products fail to perform, the patient's adherence and understanding of the regimen should be evaluated before deciding that the product is ineffective, she concluded.

This study is ongoing, with the researchers enrolling a second group of patients. Their goal is to enroll 60 patients with breast cancer; to date, 22 patients are enrolled.

Underwriting or funding source for this study is the ONS Foundation.

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