Changing the Skin Care Protocol for External Beam Radiation

Radiation induced skin reaction effects 85% of patients receiving radiation therapy (Glover and Harmer, 2014). Current medical and nursing literature identifies that there is not a standardized protocol followed for skin care during radiation therapy (Dendaas, 2012). Over the past three decades, radiation technology and treatment techniques have progressed, thus allowing minimal dose to the skin when possible (Gosselin, 2010). Even with these advances patients undergoing radiation therapy can expect to develop some degree of radiation –induced dermatitis (Iwamot, 2012). Skin reactions vary depending on individual factors, such as total dose, type of radiation and energy used, treatment volume, and size of daily fraction (Gosselin, 2010). At White Plains Hospital, we explored current oncology guidelines to develop a to guide us in defining an appropriate skin care protocol for women receiving external beam radiation to the breast. Designated as a Performance Improvement, our study compared and evaluated axillary, and breast skin reaction during breast external beam radiation, while using aluminum based deodorant or aluminum free- deodorant. Sources of data collection include chart review, and observation baseline, and with weekly status checks. Degree of reaction was rated as 0-for no reaction, 1-for minimal erythema, and 3-for brisk erythema based upon the Oncology Nursing Society (ONS) Toxicity Scale. After three weeks 50% of patients had a skin reaction of 1 to the treated breast, and no axillary reaction with the use of aluminum free deodorant. 50% of patients had a skin reaction of 1 to the treated breast, and no axillary reaction with the use of aluminum based deodorant. At four weeks 50% of patients had a skin reaction of 1 to the treated breast and no axillary reaction with the use of aluminum free deodorant; 70% of patients had a skin reaction of 1 to the treated breast, and no axillary reaction with the use of aluminum based deodorant. After five weeks 80% of patients had a skin reaction ranging from 1 to 2, to the treated breasts and, 20% had a skin reaction of 1 to the axilla with the use of aluminum free deodorant. 80% of patients had a skin reaction ranging from 1 to 2, to the treated breasts, and 10% had a skin reaction of 1 to the axilla with the use of aluminum based deodorant. Finally, after six weeks 90 % of patients had a skin reaction ranging from 1 to 2, to the treated breasts and 30 % had a skin reaction of 1 to the axilla with the use of aluminum free deodorant. Further, 90% of patients had a skin reaction ranging from 1 to 2, to the treated breasts, and 10% had a skin reaction of 1 to the axilla with the use of aluminum based deodorant. Our protocol, therefore, was found to be safe, effective, and useful to women across the lifespan. Moreover, based upon these findings, this study concluded that an appropriate, patient centered protocol designed for specific at risk populations, such as women with breast cancer receiving external beam radiation could be developed.