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To the skin

Cancer nurses’ research searches for innovative strategies in the management of treatment-related toxicities. 

Cancer care treatment has advanced tremendously over the past decades; however, each novel treatment is often associated with debilitating toxicities.

For example, dermatological toxicities are associated with the epidermal growth factor receptor inhibitors. Diarrhoea has been reported in 50–60 per cent of patients receiving tyrosine kinase inhibitors. The vascular endothelial growth factor (VEGF) inhibitors have been implicated in inducing cognitive impairment. The list goes on. Much research is now under way to find innovative ways to manage these toxicities.

As cancer nurses, we are required to be innovative in exploring the contribution from nurses and to evaluate our management strategies with due diligence. Whilst many inquiries focus on developing innovations to manage the toxicities of the newer agents, which is extremely important, cancer nurses have been largely dissatisfied with how well skin toxicities are managed in patients taking radiation therapy, a clinical problem that patients have reported consistently over the last five decades.

Despite advances in understanding of the pathophysiology, radiologic techniques and other various interventions for radiation-induced skin toxicities, the prevalence of this condition remains high in cancer patients undergoing radical radiation treatment. More than 90 per cent experience erythema and more than 30 per cent experience moist desquamation. Radiation-induced skin toxicities, though self-limiting after weeks beyond treatment, can negatively impair the patient’s quality of life and, if severe, cause changes to the person’s radiation schedule.

For this reason, our research team has recently undertaken three pieces of work that investigated the efficacy of treatment or prevention strategies for managing radiodermatitis in cancer care. The first was an overview of systematic reviews that are in the literature. This overview, including six systematic reviews, summarised the interventions now available: skin-care advice; steroidal/non-steroidal topical agents; systemic therapies; mode of radiation delivery and dressings.

The project highlighted a number of methodological limitations of the existing level 1 evidence, which subsequently informed the conduct of our systematic review. The results of this review have recently been published, in BMC Cancer 2014. Results suggested that non-metallic deodorant is not contraindicated in this patient group. This review also concluded that systemic therapies such as Wobe-Mugos E and oral zinc hold promise, deserving future investigations.

Despite the existing 47 randomised controlled trials in the area (published from 1962 to 2012, see chart), no single intervention is yet reported to eliminate or significantly improve this clinical problem. It was also fascinating to observe the developments over the past 50 years in managing this issue.

Between 2012 and 2013, the research team conducted a double-blind, randomised controlled trial that investigated the effects of a natural oil-based emulsion on managing radiation-induced skin toxicities. This trial was conducted due to anecdotal reports by a number of patients and radiation oncologists. These reports suggested that this emulsion might be effective in promoting healing, comfort, and pain relief. The results of this study have now been finalised and have been accepted for publication by the International Journal of Radiation Oncology, Biology and Physics. We are looking forward to sharing our results with the community.

Despite a large volume of work in the literature, there is not yet a solution for managing this important clinical issue. The clinical community should and will continue to develop innovative strategies. As cancer treatments continue to advance, it is truly an exciting time for cancer nurses to participate in multidisciplinary efforts at managing treatment-related toxicities and enhancing the quality of life in our patients.









Times of publication of the randomised controlled trials concerning radiation-induced skin toxicities management

Dr Raymond Chan is president-elect, Cancer Nurses Society of Australia. 

For a fully referenced version of this article, please visit www.nursingreview.com.au

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