Prophylaxis and management of acute radiation-induced skin toxicity: a survey of practice across Europe and the USA

Abstract

Radiation-induced toxicity is a common adverse side effect of radiation therapy. Previous studies have demonstrated a lack of evidence to support common skincare advice for radiotherapy patients. The aim of the current study was to investigate the management of radiation-induced skin toxicity across Europe and the USA. Where previous surveys have focused on national practice or treatment of specific sites, the current study aimed to gain a broader representation of skincare practice. An anonymous online survey investigating various aspects of radiotherapy skincare management was distributed to departments across Europe and the USA (n = 181/737 responded i.e. 25%). The UK was excluded as a similar survey was carried out in 2011. The results highlight the lack of consistency in both the prevention and management of radiation-induced skin toxicity. Recommended products are often not based on evidence-based practice. Examples include the continued use of aqueous cream and gentian violet, as well as the recommendations on washing restrictions during treatment. To our knowledge, this is the most extensive survey to date on the current management of radiation-induced skin toxicity. This study highlights significant disparities between clinical practice and research-based evidence published in recent systematic reviews and guidelines. Ongoing large prospective randomised trials are urgently needed.

Gel of chamomile vs. urea cream to prevent acute radiation dermatitis in patients with head and neck cancer: a randomized controlled trial

“…These effects may lead to dose reduction or discontinuation of therapy, especially in patients with head and neck cancer (O'Donovan et al . ) and that might interfere with the treatment outcome (Bensadoun et al . ).…”

“…These reactions produce pain, local discomfort and pruritus, with consequent reduction of quality of life (McQuestion 2011). In some cases, the cutaneous reaction might limit the therapeutic dose (McQuestion 2011, Harris et al 2012 or require stopping the treatment while the person heals (Andrade et al 2012, Harris et al 2012, O'Donovan et al 2015, jeopardizing the result of the radiotherapy (Harris et al 2012).…”

“…Acute effects are erythema, pigmentation, oedema and epilation. The erythema might start shortly after the initial radiotherapy sessions, but it is usually more intense after the second week of radiation, as a result of capillary dilation and increased vascular permeability, accompanied by oedema (McQuestion 2011, Ryan 2012, O'Donovan et al 2015. The dryness occurs because of the reduction of skin lubrification, resultant from the damage to the sweat and sebaceous glands, which could be destroyed permanently, especially at 30 Gyr levels of radiation (McQuestion 2011), usually achieved in 15 radiation sessions.…”

Measuring the costs of cancer treatment - what model should we use?

“…), and O'Donovan et al . () demonstrate a range of approaches to its management. Other clinical papers examine the safety of cytotoxic agents and occupational health implications in oncology units (Kieffer et al .…”

“…In the clinical domain we have an interesting practice survey on acute radiation-induced skin toxicity; this is a very significant and potentially disabling condition (Salvo et al 2010), andO'Donovan et al (2015) demonstrate a range of approaches to its management. Other clinical papers examine the safety of cytotoxic agents and occupational health implications in oncology units (Kieffer et al 2015), while Schwappach and Gehring (2015) examine safety concerns among oncology staff -their study highlights the need for high levels of interpersonal communication and coping skills to promote communication about safety issues in workplaces.…”