Page 9 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Chapter One: Introduction and Background

Although wounds are common among patients with cancer undergoing radiotherapy,

there are inconsistencies in the management of these wounds, particularly during daily radiation

treatments. This inconsistency is the focus of this nursing research study. 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. Skin changes are unavoidable side-

effects of radiotherapy (Perez, Medina, Perez, & Garcia, 2011). Radiation induced dermatitis is

one of the most common side effects of external beam radiotherapy (Harris et al., 2012). The

National Cancer Institutes’ common toxicity criteria reveal that this radiation induced dermatitis,

also referred to as radiation skin reactions, may vary from faint erythema or dry desquamation

(NCI 1) to moderate to brisk erythema (NCI 2) to moist desquamation (NCI 3) to ulcerating

dermatitis (NCI 4) (National Cancer Institute, 1999). Radiation to a site can delay wound

healing, which relates to overall patient wellbeing, and is thus an integral component of nursing

care. Radiodermatitis has the potential to impact an individual’s quality of life as patients may

suffer from changes in body image; physical discomfort such as pain and itching; difficulty with

activities of daily living such as wearing clothes, movement of a limb or ambulation; and sleep

impairment (McQuestion, 2006). Management of cancerous wounds and radiation dermatitis

(wound greater than NCI 2) include the use of both topical agents and dressings. Currently,

standard practice at the local Radiation Oncology Centre where I work involves the removal of

wound dressings prior to daily fractionated radiotherapy. In my own practice as an oncology

radiation nurse, many patients report the daily removal of dressings as painful and traumatic. I

have noted that, on the patient’s request, very thin dressings such as Mepitel® have been left in

place with the approval of the radiation oncologist.