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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Provincial Radiation Therapy Skin Care Working Group

11. 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

12. 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

13. 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., Sperduti , 2008.
Provincial Radiation Therapy Skin Care Working Group

14. 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

15. 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

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

17. 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 indefinite use
Promote General Sun Safety:
Large rim hats, clothing to cover skin, sun glasses
Provincial Radiation Therapy Skin Care Working Group

18. 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

19. Thank You!
Provincial Radiation Therapy Skin Care Working Group