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Innovation

Skin reactions in radiotherapy

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How a toolkit helped staff to assess and manage radiotherapy-induced skin reactions

Author: Ellen Trueman is radiotherapy sister, Leeds Teaching Hospitals Trust and winner of the Cancer Nurse Leader Award in the Nursing Times Awards 2011

Introduction

Radiotherapy can cause a variety of side-effects. One of the most common is acute skin reaction, which can range from mild erythema to severe confluent moist desquamation.
All patients receiving external beam radiotherapy are at risk of some degree of skin reaction. Ensuring these reactions are assessed and managed throughout the pathway promotes patient comfort and concordance and enhances quality of life.
Radiation-induced skin changes cannot be prevented (McQuestion, 2006). Goals of care should therefore focus on minimising symptoms, preventing further trauma and pain from incorrect management, and promoting a wound-healing environment.
Pathways often involve health professionals from outside radiotherapy units and feedback from professionals and patients has suggested that knowledge of assessment and management of these reactions outside specialist units - often in primary care - was inconsistent. A lack of knowledge was a common barrier to providing the “right care at the right time”, particularly for those requiring ongoing care and management of skin reactions in the community.
Another problem we found, supported by Harris et al 2011, concerned obtaining ongoing supplies of dressings for managing moist desquamation, with patients being given unsuitable “alternatives” that caused further damage and trauma. The cumulative effect of radiotherapy means that as treatment continues the skin reaction can worsen, often reaching a peak in severity around 7-10 days after it finishes. It is imperative that staff involved in continuing care and recovery know how to assess and manage these reactions and about suitable products (Department of Health, 2010).

Why develop a toolkit?

Sharing knowledge with non-specialist staff was an ongoing challenge. Delivering seminars and clinical workshops for staff outside the radiotherapy unit proved unsuccessful as staff shortages, resource restrictions and economic challenges resulted in sessions being cancelled.
The team had to be more resourceful. Working with colleagues and external stakeholders, we developed a multi-professional toolkit and training pack that could be adapted for many settings. The aim was to improve awareness about the assessment and management of radiotherapy skin reactions by providing information on:

  • The effects of radiotherapy on the skin;
  • The radiotherapy cycle in relation to skin changes;
  • How radiotherapy skin reactions differ from burns;
  • Goals of care;
  • Assessment and grading of reactions;
  • Treatment objectives and rationales for recommended interventions.

Before the toolkit was released, 20 nurses took part in a pilot study. Feedback was positive, with one nurse describing it as “a great resource and educational tool”.

Summary

This toolkit offers guidance and education for supporting patients with radiotherapy-induced skin reactions.
Early evaluation has shown it to benefit staff at all levels, with and without specialist knowledge, in a variety of settings.
It provides a framework that helps staff to do “the right thing, at the right time, in the right way” based on practice and evidence (Byrne et al, 2010; NHS Quality Improvement Scotland, 2010).
It will be reviewed and updated as new evidence for managing radiotherapy-induced skin reactions becomes available.

  • For further information and a copy of the toolkit, email ellen.trueman@leedsth.nhs.uk or call 0113 2067587
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