Skin Issues a Source of Anxiety During Radiation Cancer Treatments

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Trish Bieck, RN, senior nurse specialist at the James P. Wilmot Cancer Center at the University of Rochester Medical Center, noticed that skin issues were a source of anxiety for many patients who receive radiation as part of their cancer treatment. When conducting a thorough investigation of the routine advice given, she found that many patients were given inadequate advice on how to treat their skin.

Skin reactions are a common side effect of radiation therapy treatment. They vary depending upon the part of the body being treated and the amount and type of radiation used. They also tend to be more noticeable in patient receiving radiation and chemotherapy at the same time. Most are minor and begin about 3 weeks after the start of treatment.

Primarily, because skin damage, irritation, and dryness are common side effect of treatment, most patients are confused about moisturizer or topical agents such as deodorant on the radiation field. One widely held theory claimed that the presence of lotion can actually increase the risk of a bad skin reaction by inadvertently making the skin thicker and boosting the surface dose of radiation. Going without lotion entirely can result in infection and pain and could delay treatment.

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Most cancer institutions compromise and tell patients to avoid lotions at least four hours before therapy, however Bieck found very little evidence to support this practice. She only found five scientific articles that addressed the topic. Based on the research, Wilmont Cancer Center has changed its recommendations to avoid lotions immediately before treatment, but for patients to otherwise choose their own skin care regimen at other times.

As a result of her findings, which are published in the Clinical Journal of Oncology Nursing, the National Cancer Institute is also revising its recommendations for patients in its popular brochure “Radiation Therapy and You”.

Because skin dryness and color changes can be a source of both physical and emotional anguish, following are more recommendations for skin care compiled from the American Society for Radiologic Technologists, BreastCancer.org, the Abramson Cancer Center at the University of Pennsylvania, and the Ohio State University Medical Center:

• Avoid lotions, creams or other topical skin care treatments that contain alcohol, because they can cause more drying of the skin. Some physicians recommend aloe or Aquaphor for moisturizing.
• Wear loose, soft, lightweight cotton clothing over the treatment area. Use a mild laundry detergent without fragrances or harsh chemicals.
• Avoid exposing skin to extreme heat and cold.
• Do not use heating pads, hot water bottles, or ice packs on the affected skin.
• Keep baths and showers short, using lukewarm – not hot – water. Use a mild soap or cleanser made for sensitive skin. Pat skin lightly instead of rubbing dry.
• Be extra careful about sun exposure. Skin that receives radiation treatment has an increased risk of developing skin cancer in the future. Always wear sunscreen of at least 15 SPF
• One study from the University of Rochester Medical Center found that curcumin, a spice found in curry dishes, may protect skin from burns and blisters during radiation treatments. While they say further study is needed, consuming foods with turmeric may have some benefit.

Journal Reference:
Trish Bieck, Shannon Phillips. Appraising the Evidence for Avoiding Lotions or Topical Agents Prior to Radiation Therapy. Clinical Journal of Oncology Nursing, 2010; 14 (1): 103 DOI: 10.1188/10.CJON.103-105

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