Skin care protocol and algorithm helps manage skin reactions in oncology patients undergoing radiation therapy

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Skin reactions, common side effects of cancer radiation treatment, can be managed using a skin care protocol and algorithm, according to a presentation at the Oncology Nursing Society 36th Annual Congress.

Radiation therapy is a common treatment modality for the local control of multiple cancers, and a palliative intervention for cancer-related symptoms. However, radiation damages and destroys the basal cell layer of the skin, results in decreased cell proliferation and maturation, and leads to weakened skin integrity, noted Carla Grieshop, BSN, RN, BA, The Ohio State University, Columbus, Ohio.

Reaction severity varies greatly among patients, depending on preexisting health conditions, lifestyle choices, age, nutritional status, type and total dose of radiation, and adjunctive chemotherapy. Reactions usually occur 1 to 4 weeks following treatment initiation and can persist following treatment completion. Severity can range from no reaction to moist, painful ulcerations, and even necrosis. Chronic skin changes can persist for a lifetime with a negative effect on cancer survivorship.

A comprehensive guide to the care of radiated skin is not found in the literature, Grieshop reported. Since quality of life for oncology patients receiving radiation therapy may be improved by decreasing irritation, discomfort, pain, burning, or itching at the radiation site(s), which can negatively affect activities of daily living and lead to possible treatment interruptions, a skin care protocol and algorithm were written to provide guidelines in the management of skin reactions secondary to radiation therapy, and throughout the cancer trajectory.

Interventions and product recommendations were based on the evidence, best practice, ONS Classification System for Radiated Skin, and enterostomal therapy nursing specialty knowledge of the physiologic processes related to moist wound healing. Specific treatment guidelines include promotion of skin integrity, provision of comfort, maintenance of cleanliness, reduction of pain, protection from trauma, prevention of infection, and supportive care in wound healing.

For example, for the treatment of dry desquamation: grade 3, goals include providing comfort by using topical agents for a cooling effect, such as applying aloe vera gel twice daily, lidocaine with Aquaphor (per physician order), saline compass, or hydrogel dressing. Inflammation can be inhibited with antiinflammatory creams, such as corticosteroid or hydrocortisone (per physician orders). Product names and instructions for use are also included in the algorithm.

Since the enterostomal therapists have instituted the algorithm in the treatment of radiation-induced skin changes, results have included improved patient outcomes, ease of treatment decision-making options, and provision of skin products in the institution's boutique. The algorithm will also allow for future study of nurse-directed patient outcomes and prevention of severe skin-related changes secondary to radiation therapy, she concluded.
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