ONS Releases Guidelines on the Management of Cancer Treatment-Related Radiodermatitis

Evidence-based recommendations for the management and treatment of radiodermatitis were summarized in Oncology Nursing Society guidelines published in the Oncology Nursing Forum.

Radiodermatitis, skin reactions occurring following exposure to ionizing radiation, is a very common adverse effect of radiation therapy (RT) used in the setting of cancer treatment. Its severity can vary from mild erythema to desquamation, ulceration, and necrosis, and involve symptoms of discomfort and pain.

“The panel noted that prevention of radiodermatitis is unlikely and, therefore, focused questions on minimizing the development of radiodermatitis,” the authors stated.

For each recommendation related to radiodermatitis in patients with cancer undergoing RT, both its strength (strong, conditional, knowledge gap) and the quality of the associated evidence (high, moderate, low, very low) were listed.

Most notably, standard washing and skincare, as opposed to topical nonsteroidal products, was recommended to minimize development/treat radiodermatitis for those who have not yet exhibited symptoms (strength of recommendation: Strong; quality of evidence: Moderate).

Other recommendations/suggestions related to minimizing the development of cancer-related radiodermatitis included the following:

• Semipermeable dressings were suggested in conjunction with standard washing and skincare, as opposed to standard washing and skincare alone (strength of recommendation: Conditional; quality of evidence: Low)
• Topical steroids were suggested in conjunction with standard washing and skincare, as opposed to standard washing and skincare alone (strength of recommendation: Conditional; quality of evidence: Low)
• Either deodorant/antiperspirant use in conjunction with standard washing and skincare regimen or standard washing/skincare regimen alone was suggested for patients with cancer undergoing RT to the chest or breast (strength of recommendation: Conditional; quality of evidence: Very Low)
• Emu oil (strength of recommendation: Conditional; quality of evidence: Very Low) and calendula (strength of recommendation: Conditional; quality of evidence: Low) were not considered useful in conjunction with standard washing and skincare
• Oral curcumin or aloe vera/aloe vera formulations were recommended only within the context of a clinical trial (strength of recommendation: Knowledge gap)

Regarding treatment of symptoms of cancer-related radiodermatitis, such as pain and itching, topical steroids in conjunction with standard washing and skincare were suggested for those patients with intact skin, as opposed to standard washing and skincare alone (strength of recommendation: Conditional; quality of evidence: Low).

The guidelines panel note that future research priorities need to build on evidence-based interventions vs past strategies that have not demonstrated efficacy.

They further added that “patient-reported outcomes, including pruritus, pain, and other symptomology, are important to quantify, as well as cost impact to the patient and/or institution.”

Reference

Gosselin T, Ginex PK, Backler C, et al. ONS guidelines for cancer treatment-related dermatitis.Oncol Nurs Forum. 2020;47(6):654-670. doi:10.1188/20.ONF.654-670