Consensus on Provincial Skin Care Guidelines Provincial Radiation Therapy Skin Care Working Group Initiative Danielle Carroll, BSC, MRT(T)

Provincial Approach Establishment of a provincial working group Clinical representation/ stakeholders per site RT & RN initially Pharmacist Meetings 6-7 meetings to date Provincial Radiation Therapy Skin Care Working Group

Objectives of Provincial Skin Care Committee Increase knowledge, share information, collaboration Develop an evidence based clinical guide to help standardize management of skin reactions for radiation therapy patients in each cancer center Look for gaps in evidence and research opportunities that could be done provincially Provincial Radiation Therapy Skin Care Working Group

Advocate for patients in terms of comfort and minimizing onset of symptoms rather than doing what we have always done Provincial Radiation Therapy Skin Care Working Group

Evaluation: Survey of Current Practices Survey of practices across Ontario Survey Included: Use of measurement tools Basic skin care Prophylactic products Prevention Management Roles involved in care and decision making Provincial Radiation Therapy Skin Care Working Group

Survey= Variation in Practice N= 17 centers Clinical guidelines Patient Education pamphlets Measurement tools Individual RO practice RN/RT/RO patient instructions vary Difficult to change culture Provincial Radiation Therapy Skin Care Working Group

General Hygiene Gentle cleansing with unscented soap (Dove or baby soap) Hair washing with gentle baby shampoo Exposing the treated area to air when possible Sitz baths for perianal areas Rationale: Promotes comfort and quality of life Reduces opportunistic organisms Provincial Radiation Therapy Skin Care Working Group

General Skin Care Wear soft loose fitting clothing in treatment areas Use electric shavers Swimming is okay provided skin is intact NO hot tubs NO extreme temperature(s); such as, heating pads, ice packs Do not use aftershave or perfume in treatment areas Provincial Radiation Therapy Skin Care Working Group

Lotions and Creams Hydrophilic, scent free, lanolin free lotions or creams to moisturize the skin Start before treatment if possible Apply topically as frequently as possible Recommend easily accessible and cost effective products Lubriderm and Glaxal Base Cream NO restrictions on timing of application prior to treatment Bieck, et. Al., 2010; Burch, et. Al., 1997; Fenig, et. Al., 2001; Feight, et. Al., 2011; Morley, et.al, 2013; Rizza, et. Al., 2010; Morley et al 2013 Provincial Radiation Therapy Skin Care Working Group

Provincial Radiation Therapy Skin Care Working Group

Deodorant/Antiperspirant May use either deodorant or antiperspirant– on intact skin Deodorants reduce smell by having antibacterial components which reduce odor causing bacteria Antiperspirants reduce both sweating and odor Use promotes patient comfort and quality of life Burch, et. Al., 1997, Gee, et. Al., 2000; Theberge, et. Al., 2008; Watson, et. al., 2012 Provincial Radiation Therapy Skin Care Working Group

Baby Powder/Cornstarch Not recommended Promotes bacterial & yeast migration Causes increasing dryness to skin Aerosol inhalation concerns Farley, (1991); Maienza, J. (1988) Provincial Radiation Therapy Skin Care Working Group

Aloe Vera Not recommended Increases drying effect to skin Known sensitizer Dudek. et. al., 2000; Heggie, et. al., 2002; Olsen, et. al., 2001; Williams, et. al., 1996. Sperduti , 2008. Provincial Radiation Therapy Skin Care Working Group

Vitamin E Cream Level of absorption of vitamin E is minimal No concern from an antioxidant prospective Most centers are recommending to use on scar post treatment once skin has healed from radiation reaction Provincial Radiation Therapy Skin Care Working Group

Topical Steroids Not for basic hygiene or prophylactic use To be determined by each facility, on a patient needs basis, as a possible intervention Bostrom, et. al. 2001; Miller, et. al., 2011; Omidvari, et. al., 2007; Schmuth, et. al. 2002; Roper, et. al., 2004; Wong, et. al. 2013 Provincial Radiation Therapy Skin Care Working Group

Saline Soaks/Sitz Bath Management for moist desquamation in conjunction with prescribed cream Provincial Radiation Therapy Skin Care Working Group

Sunscreen For the treatment area: Do not use sunscreen during treatment on the treated area Resume use of sunscreen post treatment once skin is intact SPF 30+ - indefinite use Promote General Sun Safety: Large rim hats, clothing to cover skin, sun glasses Provincial Radiation Therapy Skin Care Working Group

Next Steps Standardizing skin care instructions given to MRS students Studies involving barrier films (Mepitel, Cavilon, and Mepilex) Radiation Toxicity Product Selection Update education material and my cancer guide Provincial Radiation Therapy Skin Care Working Group

Thank You! Provincial Radiation Therapy Skin Care Working Group