Managing radiotherapy induced skin reactions – an educational toolkit for healthcare professionals

Summary

An educational toolkit was developed to support healthcare professionals in assessing and managing radiotherapy-induced skin reactions. These unwanted effects can range from mild erythema to confluent moist desquamation – and may affect 85-90 per cent of patients in a moderate to severe form. 

Correctly assessing and managing these skin reactions increases patient comfort, treatment compliance and offers an enhanced quality of life. The toolkit offers a knowledge base and practical guidance for all healthcare professionals, with and without specialist knowledge, in a variety of healthcare settings. It can be used as a framework to inform local guidelines, and has also been implemented in national and international centres.

It is available as a printed booklet, an e-document and a ‘web app’. There have been over 1,100 electronic downloads from the Yorkshire Cancer Network website and requests for copies from around the world.

Challenge

Radiotherapy can cause a range of side effects, one of the most common being a skin reaction, ranging from mild erythema to confluent moist desquamation, a debilitating symptom often associated with a decreased quality of life. Approximately 85-90 per cent of those receiving radical radiotherapy will experience a moderate to severe skin reaction.

The care of radiotherapy patients involves specialist health professionals but frequently also includes primary care staff, many of whom will have little or no knowledge of the effect of radiotherapy on tissue viability, and the management of radiation induced reactions. Inappropriate dressings frequently cause further damage to the skin. The severity of these skin reactions can peak around 7-10 days after treatment, when primary care staff have the lead role.

A common misconception is that radiation induced skin reactions are burns and understanding the difference between burns and skin reactions is essential for correct assessment and management. ‘Burn’ implies an accidental occurrence but acute and delayed skin reactions are a known side effect. Also, a lack of knowledge about confluent moist desquamation leads to inappropriate prescribing of antibiotics when the area is perceived to be infected. 

Disseminating knowledge and skills was difficult. Educational sessions and clinical workshops were unsuccessful as staff shortages resulted in poor uptake and cancellations. A more innovative and resourceful way of delivering education and training was needed, particularly outside of specialist centres.

Objectives

To develop an educational resource for the management of radiotherapy induced skin reactions in the form of a toolkit that was user-friendly, appropriate for a multi-professional audience, applicable in a variety of settings and adaptable to local needs.

The toolkit would include information on the effect of radiotherapy on skin cells; how a skin reaction develops and the cycle of changes; factors that can affect and exacerbate a reaction; how a skin reaction differs from a burn; the goals of care; an assessment framework; treatment options and rationale for interventions; appropriate product selection; a self assessment test; and a CD ROM containing an electronic version and downloadable PDF files of the materials.

We wanted the toolkit to increase awareness of radiotherapy induced skin reactions and thereby improve patient care and treatment. This was to be achieved through a practical framework to guide clinical practice in a systematic way, ensuring that assessment and management are consistent, effective and safe. It would also be cost-effective by ensuring that only suitable wound care products were used.

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QiC Oncology Winner 2013
Best practice in dissemination – sharing patient excellence across the pathway
Managing radiotherapy induced skin reactions – an educational toolkit for healthcare professionals
by St. James’s Institute of Oncology, Leeds Teaching Hospitals NHS Trust

Contacts

Ellen Trueman

Job title:
Senior Sister, Radiotherapy
Place of work:
St James’ Institute of Oncology
Email:
ellen.trueman@leedsth.nhs.uk

Resources

Assessment chart - 783.2 KB
QiC Oncology 2016 partner:
Bristol-Myers Squibb
Supported by: