Given the complexity of cancer treatment, skin care may seem like a small matter. However, a nurse at the James P. Wilmot Cancer Center knew that skin issues were a constant source of anxiety for many patients receiving radiation therapy, and through research she discovered that routine advice was rooted in myth instead of scientific evidence.
Her findings, which have been published in the Clinical Journal of Oncology Nursing, are prompting change locally and across the country.
"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 Trish Bieck, R.N., the study's lead author, who also credited co-author Shannon Phillips, R.N. Both are senior nurse specialists at Wilmot.
As a result of Bieck's study, the National Cancer Institute revised its recommendations for patients and rewrote 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.
At the crux of her investigation was whether evidence supports the exclusion of moisturizer or any topical agent on the radiation field within four hours of treatment. Generally, the use of skin lotion is viewed as a way to prevent skin reactions, which are a common and distressing side effect of radiation treatment.
However, one widely held theory is that the presence of lotion can actually increase the risk of a bad skin reaction by inducing a bolus effect, or inadvertently making the skin thicker and thereby boosting the surface dose of radiation.
On the other hand, going without lotion can result in skin damage and dryness. This can lead to infection and pain, resulting in the interruption of treatment and an increased chance that malignant cells will repopulate while the skin heals.
So, until now, the patient was left to wonder: Should I use lotion prior to therapy and worry that my treatment is not as effective as it could be? Or do I skip the lotion and risk a skin reaction, infection, or discomfort?
As a compromise, many institutions, including the NCI and the University of Rochester Medical Center's Wilmot Cancer Center, have been telling patients for years to avoid lotions at least four hours before therapy.