Given the complexity of cancer treatment, skin care may seem like a small matter. But as anyone who has undergone radiation knows, a common side effect of the cancer treatment is developing sensitive skin.
Until now, cancer patients have been routinely advised for years to avoid using any moisturizer or any topical agent on the radiation field within four hours of treatment even though a moisturizer is viewed as a way to prevent unpleasant skin changes, including dry, itching, peeling or blistering skin, all common and distressing side effects of radiation.
That’s because in the medical world, one widely held theory is the presence of lotion can actually increase the risk of a bad skin reaction by inducing a ‘bolus effect’ that is, inadvertently making the skin thicker and thereby boosting the surface dose of radiation.
However, going without lotion can result in skin damage and discomfort, leading to infection and pain severe enough to interrupt the treatment and increase the chance that malignant cells will repopulate while the skin heals.
Trish Bieck, R.N, a nurse at the James P. Wilmot Cancer Center in Rochester, NY, knew firsthand that skin issues were a constant source of anxiety for many patients receiving radiation therapy, and through her research she discovered that long-held, routine advice was rooted more in myth than scientific evidence.
“It always bothered me that there didn’t seem to be any rationale behind restricting lotions during that particular timeframe,” said Bieck, who has worked in Radiation Oncology for 20 years. “When I looked into it, I discovered little evidence to support the four-hour policies. Instead, the practice was based on historical practice – in other words, ‘just because, that’s the way we do it.’ ’’
Bieck conducted a literature review of relevant articles published between 1992 and 2009, interviewed experts, examined benchmarks at international cancer centers, and consulted with professional organizations. Her findings, now published in the Clinical Journal of Oncology Nursing are prompting mindset and policy changes locally and across the country.
As a result of Bieck’s research, the National Cancer Institute revised its recommendations for patients and has rewritten its widely distributed brochure, Radiation Therapy and You, to incorporate the new findings. The Oncology Nursing Society also invited Bieck to serve on its national committee to update patient guidelines.
Not surprising, during her research Bieck found wide variation in practice exists within the United States: for example, among five cancer treatment institutions spread across all regions of the country, their advice ranged from no lotion restrictions at all to complete avoidance of lotions to restriction of lotions one hour before treatment.
Furthermore, no scientific evidence supported a four-hour restriction of lotions, and no evidence showed that lotion or topical agents such as deodorants made radiation therapy less effective. Only five scientific articles even addressed the topic. As such, Bieck believes more research is needed on the safety of lotions used on irradiated skin based on that small number.
Meanwhile, as a direct result of the project, the Wilmot Cancer Center developed standardized skin-care guidelines and revised its education materials. Now, staff recommends that patients avoid applying lotions immediately before treatment, but allows the patient to maintain some control over his or her usual skin care regimen.
“We’ve had a lot of feedback and we’re very pleased we could explore a topic that makes a difference for patients going through cancer treatment,” said Bieck, who also credited co-author Shannon Phillips, R.N. Both authors are senior nurse specialists at Wilmot.
Lynette Summerill, is an award-winning journalist who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events