Management of cutaneous symptoms

Wound Dressings During Radiotherapy for Cancer: A Survey of Practice

BACKGROUND

Patients undergoing radiotherapy may experience changes to the skin that require dressings. Recommendations regarding radiating through wound dressings have been variable and relate to the concern regarding surface dose increase or bolus effect.

OBJECTIVES

The purpose of this article is to identify current evidence and practice through literature review and a national environmental scan.

METHODS

Nurses from 18 radiation oncology centers in Canada were surveyed about current practice. In-depth telephone interviews were conducted with four nurse participants to further understand the context of this issue within the nursing practice environment.

FINDINGS

The integrated results of the study were reviewed with five clinical experts to make recommendations for research, practice, leadership, and policy. Implications for clinical practice included the involvement of radiation oncology nurses in the treatment planning team, development of clinical practice tools, and the relevance of the Person-Centered Nursing framework for wound management during radiotherapy.

Maculopapular skin rashes associated with high-dose chemotherapy: prevalence and risk factors

PURPOSE/OBJECTIVES

To determine the prevalence of and risk factors for maculopapular skin rashes associated with high-dose chemotherapy.

DESIGN

Observational pilot study.

SETTING

A bone marrow transplant hematology-oncology unit in a private city hospital.

SAMPLE

Data were collected on 14 patients who developed maculopapular rashes out of 127 patients who received high-dose chemotherapy (purposive sampling).

METHODS

Observation of the distribution and nature of skin rashes in relation to chemotherapy, disease, adjuvant medications, and white blood cell counts.

MAIN RESEARCH VARIABLES

Diseases, chemotherapy protocols and doses, adjuvant medications, and blood counts.

FINDINGS

Skin reactions ranged from mild, scattered macular or maculopapular rashes to severe rashes. Patients newly diagnosed with acute myelogenous leukemia (AML) who received induction protocols containing cytarabine had the most rashes, affecting 6 of 11 patients (55%). No rashes were observed on patients treated with the protocol that included high-dose corticosteroids. Patients rarely had recurrence of the rash with further courses of chemotherapy.

CONCLUSIONS

Cytarabine doses higher than 700 mg/m2 may be a cause of maculopapular skin rashes. Patients most at risk were those newly diagnosed with AML who received induction therapy. Corticosteroids may prevent the development of skin rashes.

IMPLICATIONS FOR NURSING

No useful nursing strategy exists to prevent, lessen the intensity of, or shorten the course of a delayed hypersensitivity rash. Knowing which patients are most at risk is useful to enable close monitoring and patient and staff education.

Dignity-conserving care: application of research findings to practice

A central tenet of palliative care is to help people die with "dignity". The widespread use of this term presupposes that this construct is well understood from the perspective of the terminally ill, and that the factors that bolster or erode dignity are known. However, the paucity of research related to these issues suggests otherwise. Over the past 5 years, this research team, headed by Dr Chochinov, has undertaken a programme of research aimed at explicating what dignity means to those who are terminally ill, and identifying those factors that support and undermine dignity in this patient population. This article will provide a synopsis of that work, with an emphasis on the application of research findings for practice.

Malignant cutaneous wounds

Very little literature is available about malignant cutaneous fungating wounds, and most of the research has been conducted in England. Although only a small number of patients with cancer develop the traumatic and devastating complication of a malignant cutaneous wound, it can be a very distressing occurrence. These patients usually are in the last few months of their lives, and the presence of a wound may be a constant reminder of their disease (Naylor, 2002). In addition, patients may need to cope with bleeding, exudates, odor, or infection. Caring for these patients may be challenging but it can be rewarding if the patients are able to maintain or improve their quality of life.

Management of acute radiotherapy induced skin reactions: a literature review

Up to 60% of patients with cancer will receive radiotherapy treatment at some stage during their illness. One of the main side effects of this treatment is an acute skin reaction, which may range in severity from a mild erythema to moist sloughing off of the epidermis. The management of these skin reactions varies between cancer centres and is often based on personal preference and historical practices rather than clinical evidence. This paper presents a literature review that was conducted to discover the most commonly recommended treatments and the research evidence to support them. The review was conducted in two parts and looked at both clinical papers and research studies. A multitude of treatments were recommended in the clinical papers, but few were supported by high quality research. As a result of combining the evidence from both sources, preliminary guidelines for acute skin reaction management can be produced, but these should be implemented in clinical practice and their clinical performance evaluated. There is a need for further research to review treatments that have produced promising results in the reviewed research studies and to evaluate other commonly recommended topical treatments.

Using a new foam dressing in the care of fungating wounds

Fungating wounds may present with a number of unpleasant symptoms such as malodour, high levels of exudate and pain. The cosmetic appearance of the wound, along with these associated symptoms, can be a significant cause of distress to patients. As a result of the fact that fungating wounds rarely heal, their management is based on symptom control, promoting comfort and maintaining or improving the patient's quality of life. The treatment of these wounds is generally palliative in nature and often involves the use of dressings or other topical products to control symptoms. This case study details the use of a new hydropolymer foam dressing (Tielle Plus) in the management of a large fungating breast wound. The dressing was clinically and cost effective, nursing staff found it easy to use, and the patient found it very comfortable and less noticeable under her clothing.

Mucocutaneous reactions to chemotherapy

Chemotherapeutic agents are a widely used treatment modality. Side effects range from common to unusual and may be confused with other cutaneous sequelae of oncologic treatment. The goal of this communication is to elaborate on previous descriptions of the cutaneous manifestations of chemotherapeutic treatment and to discuss more recent findings.

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be able to generate a differential diagnosis of possible etiologies for varying patterns of cutaneous involvement in patients receiving chemotherapy and identify the various cutaneous side effects of chemotherapeutic treatment. In addition, they should be able to distinguish life-threatening side effects that require immediate management from more benign manifestations of chemotherapeutic treatment.

Metastasis to skin

OBJECTIVES

To provide a review of the incidence, presentation, and nursing care of people with cutaneous metastatic disease.

DATA SOURCES

Published articles and book chapters that describe incidence, presentation, and nursing care.

CONCLUSIONS

The dermatologic literature provides the best descriptions of cutaneous metastasis. Limited material is published on treatment methods. Nursing care is best abstracted from wound care publications, although these do not directly address the complexity of the issues involved in cutaneous metastatic disease.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are challenged with pain management, infection control, choice of appropriate dressings, and odor elimination. Skilled assessment of skin problems can lead to earlier detection and prompt intervention with treatment before the tumor has ulcerated and created the emotional challenge that patients and their families then must face.