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Issues for consideration

As noted by Russell35, if the underlying cause of a radiation reaction is physiological and the extent is genetically predisposed, there will be inter-patient variation which may make conducting clinical trials in this area statistically compromised. It would appear that topical agents are unlikely to realistically affect the above as noted by Russell35, 37 although as a few studies have shown statistically significant results,104 perhaps we should be focussing on symptomatic amelioration. The type of regime applied preventatively and to erythema appears to have no influence in a skin reaction occurring.

Comparing radiotherapy skin care study data is difficult as there is often unclear methodology, differing patient allocation, and different skin assessment scales and follow-up data.55 Overall study data shows no significant difference between cheaper aqueous cream and more expensive alternatives.39, 105 Gosselin44 also notes that there is no evidence to suggest using products prophylactically as we do not know who will get skin reactions and what type of reaction they will get.

Are we actually providing skin care advice to patients based on traditional knowledge and a paternalistic approach to healthcare? Currently, some of the skin care provided may not actually alleviate the problem and indeed may even compound the effect. This area of patient care is time consuming and expensive therefore, as health professionals, we need to understand what we are doing and more importantly why.20 Urgent research is required to enable a more consistent approach to patients receiving radiotherapy and to inform a review of available guidelines.

An effective skin care protocol16 will:

  • aid continuity and consistency of care
  • promote skin assessment
  • encourage evidence-based practice
  • simplify documentation and recording
  • educate both patients and staff.

D’haese et al56 reflect that the variation in product utilisation could be reduced if evidence-based recommendations were adopted. They note that changing practice is a ‘long-term process’ and that in order to change outdated traditional practice, good translation of research findings into the clinical setting is a necessity, which will be an on-going process that requires monitoring.

Kedge55 notes that the College of Radiographers’ (CoR) guidelines1 are out of date. Indeed they are ten years old and require urgent review. In light of updated evidence, particular attention needs to be paid to the recommendations of those guidelines:

  • not to use deodorant
  • the use of aqueous cream for erythema
  • the use of hydrocortisone 1 % for dry desquamation
  • the use of hydrogels and hydrocolloids for moist desquamation.

This survey illustrates that the CoR 2000 guidelines1 are still followed by the majority of departments, therefore if updated guidelines are issued, this will provide a good base to afford the critique and evaluation of skin care practices. With a wide variety of products currently available to both primary and secondary care markets, there are bound to be variations in product utilisation and availability; therefore, careful assessment and justification is paramount with considerations such as:

  • what is the variation of ingredients in products that use the same generic name eg Aloe vera, aqueous cream?
  • is a product actually worth the cost?
  • how available and reliable is the supplier?
  • how often does a product need to be applied?
  • how easily is the product applied?

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