WHAT WAS LEARNED
The researchers found a 71% to 98% agreement between participants’ DLQI ratings and narratives. The first item on the DLQI tool asks about 3 sensations — pruritus, pain, and stinging — and it had the lowest level of agreement. The women had to mention these 3 sensations in their narrative response to meet the requirement for agreement. The highest levels were found with the item that focused on sports. The majority of women responded that their skin did not impact their ability to participate in any sports; however, most did not often engage in sporting activities.
Seasonality was found to affect choice of clothing. Those women undergoing radiotherapy during summer months reported more difficulty selecting clothing to cover their irradiated skin compared with participants undergoing radiotherapy during the winter.
“All of the women participating in this study indicated their skin (radiodermatitis) did not prevent them from working or studying. We believe our participants either stopped working or continued to work during systemic therapy. Radiotherapy and radiodermatitis did not seem to significantly affect ability to work or study. This is an important concern for women dealing with a breast cancer diagnosis,” Ms Beamer told Oncology Nurse Advisor.
The researchers concluded that the overall validity and reliability of the DLQI in this pilot study was moderately good. However, seasonality influenced some participant responses on the DLQI. Women in the summer responded they needed to cover up and avoid sun exposure to radiated areas. The study showed that embarrassment was an issue because summer clothes are more revealing than winter clothes. The researchers concluded that skin-related QOL may be influenced by the season and geographic location and this effect could confound studies of radiodermatitis prevention or management.
IMPLICATIONS FOR NURSES
Ms Beamer said the DLQI was the first instrument developed to measure skin-related quality of life (QOL) among people with dermatologic conditions. It was designed to measure QOL weekly with a minimal amount of survey burden. Women receiving radiotherapy for breast cancer typically already have completed surgery and systemic therapy, putting them at increased risk for fatigue and other factors that harm their QOL. “Nurses working in radiation oncology typically assess their patients once a week during radiotherapy. It is desirable to have a short, but reliable and valid instrument to assess skin-related QOL in this population for clinical and research purposes. However, the DLQI has never been formally validated for use in radiodermatitis,” explained Ms Beamer.
She noted that further studies with more diverse populations are warranted to continue to validate the DLQI for use in breast cancer radiodermatitis. She and her team hope this study can serve as a pilot for future, larger studies. They noted that the sample size in the current study was modest and they write that caution must be taken regarding applying these results to other populations, since this cohort was almost entirely white.
1. Beamer LC, Grant M. Using the Dermatology Life Quality Index to assess how breast radiodermatitis affects patients’ quality of life [published online April 12, 2019]. Breast Cancer (Auckl). doi: 10.1177/1178223419835547