Appraising the Evidence for Avoiding Lotions or Topical Agents Prior to Radiation Therapy

Abstract

This project aimed to determine whether avoiding the use of lotions or topical agents for four hours prior to radiation therapy is supported by evidence. A comprehensive literature review, interviews with clinical experts, benchmarking with international cancer centers, and consultation with professional nursing organizations were conducted. Results showed limited evidence as well as variation in practice.

Nursing-led management of side effects of radiation: evidence-based recommendations for practice

“…Patients do not need to avoid topical agents for any set period of time prior to treatment, but should not apply them immediately before treatment. 13 Calendula ointment has been found likely to be effective and thus may be recommended for women receiving breast irradiation. 14,15 The skin in the treatment area should be protected from irritants and extremes of hot or cold.…”

Dosimetric impacts on skin toxicity for patients using topical agents and dressings during radiotherapy

“…Optimal prevention and management of skin reactions in RT is complicated by wide-spread concerns among professionals in the field that applying products on the skin during radiation delivery will increase skin dose and toxicity 6 8 Patient education often includes teaching patients to avoid applying creams, lotions and deodorants on the skin before RT due to fear of increasing the severity of skin reactions 2 …”

“…Staff indicated this was a common practice learned primarily from colleagues although it was not known whether or not this was evidence based. One study 6 discovered that some American and Canadian cancer centres provide no restrictions to patients applying topical agents to the skin, while others gave specific time restrictions and some centres instructed patients to completely avoid applying topical agents to the skin at any time before RT. Only one institution was found to reference their practice using evidence based guidelines.…”

“…1,4,5 Optimal prevention and management of skin reactions in RT is complicated by wide-spread concerns among professionals in the field that applying products on the skin during radiation delivery will increase skin dose and toxicity. [6][7][8] Patient education often includes teaching patients to avoid applying creams, lotions and deodorants on the skin before RT due to fear of increasing the severity of skin reactions. 2,9 Informal surveys in our department revealed that staff members routinely instruct patients to avoid applying any skin products 1-2 hours before treatment or to wipe off residual creams before treatment delivery, in spite of any institutional practice guidelines recommending these restrictions.…”

Evaluating the relevance of dosimetric considerations to patient instructions regarding skin care during radiation therapy

“…Patients are commonly instructed to avoid applying products before treatment delivery, and staff may remove cream they consider to be excessive, potentially causing further trauma. Other researchers have reported that such practices are common and seem to be based more on tradition than evidence 5 , 14 , 16 , 17 . Surveys among UK practitioners reveal a range of clinical practices often based on historical practice and personal preference 10 , 18 .…”