Journal of Community Nursing - page 16

16 JCN
2013,Vol 27, No 4
SKIN CARE
R
adiotherapy is a primary
treatment for many types
of cancer — over 60% of
individuals receive it as part of their
treatment. Furthermore, 40% of all
patients cured of cancer will have
received radiotherapy as part of
their treatment, with 16% of cures
attributed to radiotherapy alone
(Department of Health [DH], 2012).
In recent decades, it was thought
that the demand for radiotherapy
would gradually diminish as
advances in chemotherapy and
immunotherapy emerged (Cancer
Research UK, 2009). However,
the opposite has proved to be the
case and today radiotherapy is
the second most effective cancer
treatment after surgery (DH, 2012).
Radiotherapy care pathways not
only involve specialist clinicians
from within radiotherapy centres,
but frequently include colleagues
in hospital wards and primary care
settings. However, many nurses
outside of specialist treatment
Managing radiotherapy-induced skin
reactions in the community
Ellen Trueman
centres have little or no knowledge
of the effect of radiotherapy on tissue
viability or wound healing. Similarly,
colleagues in the community setting
are often involved in patient care
post treatment when the skin
reaction can be at its worst.
The aim of this article is to increase
understanding of radiotherapy-
induced skin reactions by offering an
insight into their aetiology, assessment
and grading, as well as appropriate
management strategies.
Whether community nurses are
involved in supporting patients and
families, providing information,
symptom management or
administration of treatment, they
play an essential role in improving
the patient experience and as such,
require relevant knowledge and
skills. Inevitably, cancer treatments
often come with a range of side-
effects, and the nursing care
for patients being treated with
radiotherapy must be aimed not
only at problems associated with
the disease, but also at minimising
and managing the side-effects
associated with the treatment.
One of the most common
radiotherapy-induced side-effects
is an acute skin reaction, which
can range from mild erythema to
confluent moist desquamation.
All patients receiving external
beam radiotherapy are at potential
risk of developing a skin reaction
within the treatment field, with
approximately 85–87% experiencing
a moderate-to-severe skin reaction
(Salvo et al, 2010) — of these,
10–15% will progress to moist
desquamation (Hornsby et al, 2005).
Ensuring these reactions are
assessed and managed effectively
throughout the pathway is essential
to providing optimum patient care.
Evidence suggests that radiation-
induced skin reactions cannot be
prevented (McQuestion, 2006).
Therefore, goals of care should
focus on:
Minimising treatment-induced
symptoms
Supporting patients with self-
care interventions
Preventing further trauma
and pain from inappropriate
management
Promoting a wound
healing environment.
Radiotherapy and the skin
Skin is composed of the dermis
and epidermis. The former contains
nerves, lymphatic and blood vessels,
glands and hair follicles. The
epidermis contains
a renewing cell population, in
which cell production equals
cell loss, creating a continuous
cycle whereby new cells from the
basal layer replace shedding cells
from the outer cornified layer
(McQuestion, 2006).
Radiation skin reactions occur as
a result of damage to basal cells and
the resultant imbalance between
new cell production at the basal
Ellen Trueman, Senior Sister, Radiotherapy Review
Clinic, St James’s Institute of Oncology, Leeds
Teaching Hospitals NHS Trust;
Nursing Times
2011 Winner — Cancer Nurse Leader Award
Over 60% of individuals receive radiotherapy as part of their cancer
treatment, either with curative or palliative intent. Radiotherapy
is usually provided as an outpatient service, which means
that community nurses need to understand the most common
radiotherapy-induced side-effect, an acute skin reaction, which can
range from mild erythema to confluent moist desquamation. All
patients receiving external beam radiotherapy are at potential risk
of developing this reaction. This article presents information on the
assessment and management of what can be a debilitating side-effect.
KEYWORDS:
Radiotherapy
Skin reactions
Cancer treatment
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