Patient Comfort Is Key to Managing Radiation Side Effects
Radiation therapy may cause traumatic side effects in patients with cancer, yet many standard management strategies lack strong evidence. During their session at the ONS 44th Annual Congress in Anaheim, CA (https://congress.ons.org/), Renata Benc, RN, BA, MSc(A), CON(C), of Jewish General Hospital of the Integrated Health and Social Services University Network for West-Central Montréal in Quebec, Canada, and John Hillson, RN, BSN, BA, OCN®, of Duke Cancer Institute in Durham, NC, instructed nurses on how to support patients undergoing radiation treatment (https://ons.confex.com/ons/2019/meetingapp.cgi/Session/2059).
Evidence-Based Approaches to Radiation Dermatitis
Radiation dermatitis is the most common side effect of radiation treatments, affecting 50%–95% of patients. Severity ranges from slight erythema to moist desquamation and ulceration, and effects may persist for up to 90 days after treatment.
Benc emphasized that the primary goal of care is patient comfort, as well as to prevent infection, but cautioned that no “one-size fits all” treatment exists for radiation dermatitis. “Engaging patients to participate in their care empowers them, and gives them a voice at a time where they may feel like things are all out of control,” Benc said.
Benc cited a lack of well-designed trials to support many current practice recommendations. For example, aloe is often recommended but is not evidence-based.
Evidence-based management strategies include:
- Washing: In addition to being a quality-of-life concern for patients, skin reactions are actually worse when patients are instructed not to wash the radiation site.
- Deodorant: No different has been found in skin reactions when patients apply deodorant.
- Creams, lotions, and moisturizers: No evidence exists to support restriction of creams and lotions prior to radiation therapy, yet 50%–85% of clinicians still advise it. Doing so may actually irritate the skin.
- Barrier products: Some evidence is emerging that prophylactic use of barrier creams or films can reduce the severity of dermatitis.
However, all interprofessional team members must give patients the same advice. “Communication is the key to teamwork. Inconsistent or conflicting information can cause distress to the patient,” Benc said.
The Human Side of HNC Treatment
Hillson explained that head and neck cancer (HNC) is not a homogenous disease because of the complex anatomy in the head and neck. Depending on the location, side effects may range from discomfort (e.g., eye and nasal irritation, sore throat) to debilitating (e.g., hearing impairment, nasal obstruction, disfigurement).
Patients often present with late-stage disease, and most HNCs result from preventable causes:
- Human papillomavirus (HPV): 70% of oropharyngeal tumors are HPV positive. The risk increases with smoking.
- Alcohol and tobacco: Drinking and smoking remain the leading risk factors for all HNCs, with a worse prognosis than HPV-positive disease.
Patients with HNC have increased risk for suicide because of physical and financial strain. Vulnerable populations include African Americans, Native Americans, Hispanic Americans, and patients in Appalachian regions. Risk factors include poverty, low levels of education, and limited access to health care. Hillson said improved outcomes rely on new techniques and equipment that are not available in all regions, and this challenge will only increase.
“Good side effect management and better outcomes all start with getting to know your patients well and developing a good, active, therapeutic relationship, and then continuing that relationship through a plan tailored to patients’ needs,” Hillson said.