Educating Breast Cancer Patients Reduces Radiation Dermatitis Severity

Patient education can improve adherence to skin-care plans and reduce radiation dermatitis (RD) among patients undergoing radiotherapy for breast cancer, researchers reported in a poster session at the Oncology Nursing Society (ONS) 42nd Annual Congress, held May 4–7 in Denver.

“Our data suggest that using a highly structured evidence-based multimedia education program with planned reinforcements to teach breast cancer patients about skin care during radiation therapy has a demonstrable positive effect on levels of adherence … and a significant decrease in the severity of RD,” reported lead study author Lena Andriths, BSN, RN, OCN, and colleagues at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Detroit.

More than 95% of patients undergoing cancer radiotherapy experience RD, impairing function and quality of life. The researchers sought to assess the effects on skin-care adherence (use of Aquaphor and wipes twice daily) among women undergoing breast cancer radiotherapy, using an education intervention based on ONS Putting Evidence Into Practice and World Health Organization adherence models.

Oncology nurses were trained to provide verbal instructions.

“Initially, patients received multimethod (verbal, written, video) pretreatment instructions about skin care,” the authors explained. “Planned reinforcement occurred at treatment weeks 1 and 3 using the patient’s preferred method (verbal, written, or video).”

“There was a sharp increase in adherence to the recommended skin-care protocol from week 1 to week 2, moving from 29% to 95%,” they reported.

A second, modest increase occurred by week 4, when adherence reached 100%. However, time to onset of skin toxicity was similar among the intervention group compared to a previous cohort (median time to onset, 17 vs 17.5 days).

The frequency of severe (grade 3/4) RD was significantly lower in the intervention group (chi square = 4.61; P = .03).

“An important finding from the study was that the severity of RD was significantly less among patients using the new protocol compared to those who did not,” the authors reported. “These findings differ substantially from our earlier work with head and neck patients where there was no difference in the severity of RD.”

Scheduled reinforcements in the intervention appeared to have a substantial impact on adherence, they noted.