Page 146 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Executive Summary

The executive summary is a synopsis of my research project. The purpose and
preliminary findings from separate phases of the study, along with the analysis and
recommendations, are presented. There are 5 guiding questions on page 5 for your valuable
feedback.

Introduction
Patients undergoing radiation treatment typically experience changes to the skin in the
area where the treatment is administered. In some cases, patients undergoing radiotherapy may
have pre-existing wounds in the treatment area, while for others; wounds are generated by the
radiation therapy itself. Radiation to the site can delay wound healing, which relates to overall
patient wellbeing, and is thus an integral component of nursing care. There has been some
discussion in both literature and clinical settings whether radiating through wound dressings will
cause a boost effect or harm to patients with cancer during radiotherapy. The purpose of the
thesis is to describe the current evidence and practice in relation to wound dressings during
cancer radiotherapy. The methods employed are a literature review and national environmental
scan of existing wound care practices with the aim of developing the foundation for further
research.
Preliminary Findings

Phase 1: Literature Review

The two extraction questions for the literature review were: (i) what is the existing
evidence regarding radiating through dressings? and (ii) which dressings can be left in place on
wounds of patients with cancer during radiation treatments? The literature review included peer-
reviewed published articles, books and grey literature and revealed that, limited evidence
regarding the benefits and or potential harms of radiating through dressings during radiotherapy
is available.
 Existing evidence suggests that it may be safe to radiate through thin dressings
such as Mepitel® (Butson, Cheung, Yu & Metcalfe, 2002; Naylor & Mallett,
2001; Thilmann et.al., 1996; Adamietz et. al., 1995) and Mepilex® Lite in
relation to the potential radiation induced skin reactions and relatively less boost
effect (Mac Nally & Woodings, 2012; Diggelmann, Zytkovicz, Tuaine, Bennet,
Kelly & Herst, 2010). It is noteworthy that only Adamietz et. al. and Diggelmann
et.al. have published clinical trials.

 Two studies (laboratory- based, not with human subjects) reported that while any
of the wound dressings can be left on the skin during electron irradiation, with
photons the dose increase depends on the thickness of the dressing (Mac Nally &
Woodings, 2012; Thilmann et.al., 1996).

 The same study (Thilmann et.al., 1996) reported that in the case of ulcerating
tumors or fungating wounds, all non-adhesive wound dressings whose clinical