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Lu X, Yin Y, Geng W, Liu L, Liu F, Zhang Z. Acute skin toxicity and self-management ability among Chinese breast cancer radiotherapy patients: a qualitative study. Support Care Cancer 2024; 32:394. [PMID: 38814489 PMCID: PMC11139738 DOI: 10.1007/s00520-024-08583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Radiation dermatitis is the most common reaction to radiotherapy, almost all breast cancer patients receive radiotherapy on an outpatient basis. Currently, there are no studies on the experience of radiation dermatitis and the ability to self-manage it. Therefore, we aimed to use qualitative approaches to gain a deeper understanding of the actual experiences and self-management ability in order to provide a reference for further improving the effectiveness of self-management and to optimize symptom management strategies. METHODS A descriptive qualitative study was conducted using purposive sampling to select 17 breast cancer patients undergoing radiotherapy. Semi-structured interviews were conducted from September to November 2023. The Colaizzi seven-step analysis method was used to classify the data into summarized themes. RESULTS Four themes were identified from the interview responses: (1) multiple self-reported skin symptoms in breast cancer patients with radiation dermatitis; (2) the multidimensional impact on patient's quality of life, especially pruritus, ulceration; (3) the ability to self-manage radiation dermatitis: strong mental toughness, positive response, and self-doubt; (4) challenges faced: concerns about radiotherapy side effects and recurrence, targeted symptom management and continuity of care after the radiotherapy. CONCLUSIONS Healthcare professionals should consider patients' self-reported symptoms when assessing radiation dermatitis. For pruritus and pain, we can enhance precision symptom management to improve patients' quality of life. By utilizing information technology tools, we can increase breast cancer patients' ability and confidence in managing radiation dermatitis effectively while enhancing accurate symptom management during radiotherapy.
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Affiliation(s)
- Xiaomeng Lu
- Radiotherapy Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunteng Yin
- Department of Otolaryngology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenhui Geng
- Radiotherapy Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Liu
- Department of Breast Centre, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fengxia Liu
- Department of Nursing, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Zhenye Zhang
- Department of Hospital Management, Shenzhou Hospital, Shenzhou, Hebei Province, China
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Ghaffar A, Xie Y, Antinozzi P, Ryan Wolf J. RISREAC Study: Assessment of Cutaneous Radiation Injury Through Clinical Documentation. Disaster Med Public Health Prep 2023; 17:e486. [PMID: 37680193 DOI: 10.1017/dmp.2023.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Radiation dermatitis (RD) occurs in 95% of patients receiving radiation therapy (RT) for cancer treatment, affecting 800 million patients annually. We aimed to demonstrate the feasibility of developing a historical RD cohort, Radiation Induced Skin Reactions (RISREAC) cohort. METHODS This retrospective study evaluated RD-related clinical documentation for 245 breast cancer patients who received RT at the University of Rochester Medical Center, to understand the RD progression, scoring, and management. All statistical analyses were performed at 0.05 level of significance. RESULTS Clinician-documented RD severity was observed for 169 (69%) patients with a mean severity of 1.57 [1.46, 1.68]. The mean descriptor-based severity score of 2.31 [2.18, 2.45] moderately correlated (r = 0.532, P < 0.0001) with documented RD grade. Most patients (91.8%) received skin care treatment during RT, with 66.7% receiving more than 2 modalities. CONCLUSIONS The RISREAC cohort is the first retrospective cohort established from clinical documentation of radiation-induced skin changes for the study of RD and cutaneous radiation injury (CRI). RD symptom descriptors were more reliably documented and suitable for all skin types compared to Radiation Therapy Oncology Group (RTOG) or Common Toxicity Criteria for Adverse Events (CTCAE) grades. A new descriptor-based scoring tool would be useful for RD and CRI.
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Affiliation(s)
- Aqsa Ghaffar
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Yunna Xie
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Julie Ryan Wolf
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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3
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J Ghadimi D, Looha MA, Akbari ME, Akbari A. Predictors of postoperative pain six months after breast surgery. Sci Rep 2023; 13:8302. [PMID: 37221396 DOI: 10.1038/s41598-023-35426-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 05/25/2023] Open
Abstract
Breast cancer, with a high prevalence and survival rate, leads to long-term complications. A major sequel is acute or chronic postoperative pain, and we investigated the possible relationship with clinical and psychological variables. Patients undergoing breast surgery filled out the loneliness (ULS-8) and depression (HADS) questionnaires. Patients rated their pain intensity with the Numerical Rating Scale (0-10, NRS) two days, seven days, and six months after surgery. Of 124 patients, the mean age was 45.86 years old, and the pain scores on the second and seventh postoperative days were 5.33 and 3.57, respectively. Sixth-month pain was significantly correlated with the acute scores with a mean of 3.27; and in the multivariate analysis, it was significantly associated with preoperative pain (p-value = 0.007), self-reported loneliness (p-value = 0.010), and adjuvant radiotherapy (p-value = 0.004). In conclusion, loneliness may be a risk factor for postoperative pain in breast surgery.
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Affiliation(s)
- Delaram J Ghadimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Pasalar M, Ahadi B, Mirzaei HR, Buentzel J, Mehri Ardestani M, Kamian S, Heydarirad G. Comparing Dermolina-Henna Cream with Mometasone Cream in Improving Radiodermatitis Among Patients with Breast Cancer: A Randomized Active-Control Double-Blind Clinical Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:895-903. [PMID: 36103288 DOI: 10.1089/jicm.2022.0551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectives: Radiotherapy is one of the treatments used for different types of cancer. Acute radiodermatitis is one of its most common complications. Despite the high prevalence of radiodermatitis, few studies investigated how to prevent or treat this complication. Hence, a standard treatment has not been introduced so far. We sought to evaluate the efficacy of Dermolina-Henna cream, a new polyherbal formulation, compared to Mometasone cream for alleviating acute radiodermatitis among breast cancer patients. Design: Randomized active-control double-blind clinical trial. Setting/Location: The oncology clinic of Shohaday-e Tajrish Hospital (Tehran, Iran). Subjects: Women older than 18 years with breast cancer undergoing radiotherapy. Interventions: Patients were instructed to apply a thin layer of Dermolina-Henna or Mometasone cream once daily on their lesions at least 3 h after radiotherapy for 4 weeks, and if grade I or II radiodermatitis developed, also afterward. Patients were visited weekly until end of study at after 4 weeks. Radiation Therapy Oncology Group standard questionnaires were evaluated and recorded every week as the primary outcome. Outcome measures: Primary outcome was defined as evaluating the efficacy of Dermolina-Henna cream to change the radiodermatitis grade, while the level of patients' satisfaction and the rate of adverse events recorded by patients were secondary outcomes. Results: The trends on decrease in number of lesions, erythema, radiodermatitis grade, burning sensation, pain, and itchiness were statistically significant for each treatment, separately (p < 0.001), except for radiodermatitis grade in Mometasone group (p = 0.4). Dermolina-Henna was significantly better than Mometasone in alleviating burning sensation (p < 0.001) and itchiness (p = 0.041). Approximately 3.7% of patients showed adverse events and 3.7% declared dissatisfaction in both groups. Conclusions: In summary, we showed that Dermolina-Henna cream and Mometasone cream were significantly effective in decreasing severity of radiodermatitis symptoms among patients with breast cancer. Dermolina-Henna cream was significantly superior to Mometasone cream in alleviating burning and itchiness. Clinical Trial Registration Number: IRCT20200115046144N1.
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Affiliation(s)
- Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Ahadi
- School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Reza Mirzaei
- Cancer Research Center, Shohadae Tajrish Hospital, Department of Radiation Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Judith Buentzel
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Mojgan Mehri Ardestani
- Department of Persian Medicine, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Kamian
- Department of Radiation Oncology, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Heydarirad
- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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5
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Maheshwari A, Shankar A, Tyagi K, Verma R. Dermatological Aspects of Nursing Oncology: Meaningful Observations Ensuring Better Quality of Life. Indian J Palliat Care 2022; 28:216-220. [PMID: 35673687 PMCID: PMC9168281 DOI: 10.25259/ijpc_147_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/30/2022] [Indexed: 12/03/2022] Open
Abstract
Modern cancer management has changed over the period of time and now shifted to multidisciplinary care approach to ensure a better quality of life (QOL) of the surfing patients. Every form of cancer treatment has side effects and affects the QOL. Many of the side effects have been discussed in detail because of the need for timely interventions to prevent the consequences of the side effects. Dermatological adverse events due to cancer treatment are important but most commonly ignored in our clinical practice. Nursing staffs have a critical role in the early identification of such events and by briefing and training of the nursing staff in the identification of adverse events which can aid in the prevention of complications. As dermatologists may not be available round the clock, nursing staff are looking after the patients round the clock can prove very vital in screening cutaneous AE and adequately setting up referrals to aid early recognition and treatment of not only mild but also potentially life-threatening complications. The nursing staff, which is a cadre of health caregivers that are intimately involved in cancer care, can be trained to identify timely, skin-related adverse events. A literature search of scientific publications was done using the electronic databases PubMed, Science Direct, Cochrane Library, and Google Scholar. The search included terms 'Adverse events (AEs) post-chemotherapy,' 'AE post-radiotherapy,' 'AE post-immunotherapy,' 'AE post-hormonal therapy for cancer' and 'AE post-cancer surgery.' Data obtained from these studies and case reports were compiled and interpreted to prepare this review. This review focuses on various ways in which skin can be involved adversely as a part of cancer management and their classic and tell-tale signs to help the nurses in their better and quicker identification so that dermatologists are timely intimated and the treatment can be instituted to improve the patient's QOL.
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Affiliation(s)
- Apoorva Maheshwari
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kashish Tyagi
- Department of Dermatology, Medanta Medicity, Gurgaon, Haryana, India
| | - Richa Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Delhi, India
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Bullous Pemphigoid Exacerbated by Radiation Therapy: An Atypical Presentation. Adv Radiat Oncol 2022; 7:100794. [PMID: 34984247 PMCID: PMC8693003 DOI: 10.1016/j.adro.2021.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022] Open
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Córdoba EE, Lacunza E, Güerci AM. Clinical factors affecting the determination of radiotherapy-induced skin toxicity in breast cancer. Radiat Oncol J 2022; 39:315-323. [PMID: 34986553 PMCID: PMC8743461 DOI: 10.3857/roj.2020.00395] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Radiotherapy is essential for the treatment of breast cancer (BC). However, adverse effects may occur in healthy tissue, during treatment and even after several months. Although it is known that this clinical radiosensitivity is multifactorial, the factors involved are unknown yet. In this study, we evaluated the effect of these factors on the development of radiodermatitis in patients undergoing radiotherapy. Materials and Methods Demographic and lifestyle data collected during face-to-face interviews of 122 BC patients and data from clinical records were investigated. Most patients underwent conventional three-dimensional radiotherapy treatment. A total dose of 50 Gy was administered (2 Gy/day), followed by a boost in a tumor bed with a total dose of 18 Gy (2 Gy/day). Radiotoxicity was evaluated weekly using the Radiation Therapy Oncology Group classification system (range, 0 to 4, according to the severity). Results In the present study, 75.4% of patients presented acute skin toxic effects with different degrees of severity. In 25% of cases, these effects manifested at the end of the fourth week at a cumulative dose of 40 Gy. The association of grade ≥2 acute skin reactions with body mass index (BMI) and breast size and between grade 3–4 and age was positive compared with controls. However, the role of the other factors could not be confirmed. Conclusion Analysis of the factors related to individual radiosensitivity suggests that age, BMI and breast size play an important role in the development of acute skin toxicity during treatment. Particular attention to patients who present these characteristics would help to control treatment effectiveness and therefore optimize their quality of life.
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Affiliation(s)
- Elisa Eugenia Córdoba
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
| | - Ezequiel Lacunza
- Basic and Applied Immunological Research Center, School of Medicine, National University of La Plata, Argentina
| | - Alba Mabel Güerci
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
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8
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A Comprehensive Prospective Comparison of Acute Skin Toxicity after Hypofractionated and Normofractionated Radiation Therapy in Breast Cancer. Cancers (Basel) 2021; 13:cancers13225826. [PMID: 34830981 PMCID: PMC8616262 DOI: 10.3390/cancers13225826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Moderate hypofractionated radiotherapy (HF) has become the standard fractionation scheme for most breast cancer patients. Despite comprehensive data from large, randomized trials, standardized assessment of patient reported outcome (PRO) and physiological changes after HF are largely missing. In this prospective trial focusing on radiodermatitis, HF and conventional normofractionated radiotherapy (CF) were compared using standardized Skindex-16 questionnaire in addition to CTCAE assessment and ultrasound measurement of the skin. The results of the current study complement and confirm existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF. Abstract The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25); p = 0.03; Skindex-16: CF: 20.8 (IQR: 25.8); HF: 8.3 (27.1); p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed.
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Resveratrol mediates its anti-cancer effects by Nrf2 signaling pathway activation. Cancer Cell Int 2021; 21:579. [PMID: 34717625 PMCID: PMC8557610 DOI: 10.1186/s12935-021-02280-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/18/2021] [Indexed: 12/30/2022] Open
Abstract
Aim and background Cancer represents a major health problem with an exceedingly high toll on the patients, their families, and the economy. Cancers are also associated with high mortality rates. Existing therapies for cancer are generally ineffective with many side effects. Method A search was conducted on Pubmed, Google Scholar, Scopus, and web of science databases, and articles related to anticancer effects of resveratrol were collected. Results Resveratrol is a natural compound that can activate the Nrf2 transcription factor. Nfr2 translocates to the nucleus and induces antioxidant gene expression. In different cell lines, resveratrol can increase apoptosis and inhibit the proliferation of cancer cells. Conclusion We found that resveratrol shows efficacy for the treatment of cancer, but due to high controversy on the Nrf2 signaling pathway and mechanisms of resveratrol action, additional studies should be conducted to better characterize its mode-of-action in cancer. Graphical Abstract ![]()
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10
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Management of breast cancer: an overview for therapeutic radiographers. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:The management of breast cancer patients from diagnosis to treatment and beyond can be variable depending on factors including tumour extent and location, histology, genetics, health and wellbeing of the patient as well as personal patient preferences. The therapeutic radiographer’s role is not only vital to ensure safe and accurate radiotherapy delivery but also crucially, as the regular patient interface, they must be fully empowered to engage effectively with all aspects of the patient care pathway. They must be knowledgeable and up to date with evidence-based practices relating to the patient experience including surgery, chemotherapy, endocrine therapy and radiotherapy.Aim:The aim of this paper is to outline the breast cancer management pathway, highlighting the potential side effects that occur as a result of breast radiotherapy treatment and concomitant treatment in order to inform therapeutic radiographers and best practice.Discussion:The treatment pathway for breast cancer patients varies greatly depending on a wide range of factors and is very much individualised for each patient. Each treatment modality has its advantages and disadvantages, and all come with a number of side effects that can affect a patient’s daily living. Toxicities can arise during radiotherapy treatment or months after treatment, and education regarding the management of these is essential for effective patient care. Many technological advances in radiotherapy treatment techniques and regimes have the potential to decrease radiation-induced side effects. Despite attempts to standardise clinical guidelines on the use of topical agents and dressings, historical opinions and ideas are still evident in clinical practice. The use of grading systems in radiotherapy tends to only record patients’ physical symptoms and not their holistic wellbeing and emotional needs.Conclusion:Therapeutic radiographers must ensure that they remain equipped with the skills and knowledge to correctly manage and/or signpost services effectively. This overall outline of the management of patients with breast cancer is designed to help therapeutic radiographers reflect on the current practices and to inspire them, where evidence dictates, to seize opportunities, to explore improvement and to enhance best practice.
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Peoples AR, Pigeon WR, Li D, Garland SN, Perlis ML, Inglis JE, Vinciguerra V, Anderson T, Evans LS, Wade JL, Ossip DJ, Morrow GR, Wolf JR. Association Between Pretreatment Sleep Disturbance and Radiation Therapy-Induced Pain in 573 Women With Breast Cancer. J Pain Symptom Manage 2021; 61:254-261. [PMID: 32768555 PMCID: PMC7854971 DOI: 10.1016/j.jpainsymman.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Pain can be a debilitating side effect of radiation therapy (RT). Data from the general population have shown that sleep disturbance can influence pain incidence and severity; however, less is known about this relationship in patients with breast cancer receiving RT. OBJECTIVES This secondary analysis examined the association of pretreatment moderate/severe levels of sleep disturbance with subsequent RT-induced pain after adjusting for pre-RT pain. METHODS We report on 573 female patients with breast cancer undergoing RT from a previously completed Phase II clinical trial for radiation dermatitis. Sleep disturbance, total pain, and pain subdomains-sensory pain, affective pain, and perceived pain intensity were assessed at pre-RT and post-RT. At pre-RT, patients were dichotomized into two groups: those with moderate/severe sleep disturbance (N = 85) vs. those with no/mild sleep disturbance (control; N = 488). RESULTS At pre-RT, women with moderate/severe sleep disturbance were younger, less likely to be married, more likely to have had mastectomy and chemotherapy, and more likely to have depression/anxiety disorder and fatigue than the control group (all Ps < 0.05). Generalized estimating equations model, after controlling for pre-RT pain and other covariates (e.g., trial treatment condition and covariates that were significantly correlated with post-RT pain), showed that women with moderate/severe sleep disturbance at pre-RT vs. control group had significantly higher mean post-RT total pain as well as sensory, affective, and perceived pain (effect size = 0.62, 0.60, 0.69, and 0.52, respectively; all Ps < 0.05). CONCLUSION These findings suggest that moderate/severe disturbed sleep before RT is associated with increased pain from pre-to-post-RT in patients with breast cancer.
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Affiliation(s)
- Anita R Peoples
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA.
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia E Inglis
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - Lisa S Evans
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | - James L Wade
- Heartland Cancer Research NCORP, Decatur, Illinois, USA
| | - Deborah J Ossip
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
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Kim H, Kang D, Park W, Cho J, Park H, Kim E, Choi DH, Cho WK, Jeon BJ, Lee KT. Impact of Breast Reconstruction on Biophysical Parameters of Mammary Skin in Patients Receiving Postmastectomy Radiotherapy for Breast Cancer. J Breast Cancer 2021; 24:206-217. [PMID: 33913276 PMCID: PMC8090804 DOI: 10.4048/jbc.2021.24.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In this study, we examined the impact of reconstruction using tissue expander insertion (TEI) on the risk of radiation dermatitis in patients undergoing postmastectomy radiotherapy (PMRT). METHODS Between August 2015 and March 2019, patients with breast cancer who had received systemic chemotherapy and PMRT were prospectively included. Skin parameters, including melanin, erythema, hydration, sebum, and elasticity, were measured using a multi-probe instrument at 6 time points: before the initiation of radiotherapy (pre-RT), at weeks 1, 3, and 5 during radiotherapy (weeks 1-5), and 1 and 3-month after radiotherapy (post-RT-1m and post-RT-3m). Patient-reported outcomes (PROs) were assessed at each time point. Changes in biophysical parameters and PRO were compared between patients with and without TEI (TEI+ vs. TEI-). RESULTS Thirty-eight patients, including 18 with TEI+ and 20 with TEI-, were analyzed. The pattern of time-course changes in biophysical parameters and PRO did not differ between TEI+ and TEI- patients. The melanin index was highest at post-RT-1m, while the erythema index was highest at week 5. At post-RT-3m, TEI+ patients presented higher melanin values than TEI- patients, with no statistical significance (coefficient, 47.9 vs. 14.2%; p = 0.07). In all patients, water content decreased throughout the measurement period. At post-RT-3m, TEI+ patients demonstrated a further decrease in water content, while the TEI- group nearly recovered the water content to pre-RT status (coefficient, -17.1, -2.5; p = 0.11). The sebum and elasticity levels were not altered by TEI. CONCLUSION In patients undergoing PMRT, TEI did not significantly affect the changing patterns of skin biophysical parameters and PRO during radiotherapy.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hyeokgon Park
- Skin Research Institute, Amorepacific Corporation R&D Center, Youngin, Korea
| | - Eunjoo Kim
- Skin Research Institute, Amorepacific Corporation R&D Center, Youngin, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Electronic Patient-reported Outcomes During Breast Cancer Adjuvant Radiotherapy. Clin Breast Cancer 2020; 21:e252-e270. [PMID: 33229222 DOI: 10.1016/j.clbc.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Patient-reported outcomes (PROs) have become extremely important in following patients' health-related quality of life during cancer treatments. The aim of this study was to assess the usefulness of electronic PROs (ePROs) during adjuvant radiotherapy (RT) in patients with early breast cancer. MATERIALS AND METHODS A registry trial was conducted with a total of 253 patients with breast cancer receiving RT. Adverse event data were collected from 9 items on the ePRO questionnaires that were administered before RT (N = 253), at the end of RT (± 3 days; N = 234), 1 month after RT (N = 230), and 3 months (N = 225) after RT. The patient characteristics and treatment details were collected from the medical records. RESULTS The patients have started actively using the ePRO system, and the response rates were high (82.6%). During RT, 39.3% of the ePRO responses were about symptoms, and 60.7% were about treatment-related questions or advice. Patients treated with hypofractionated RT reported fewer local adverse events such as skin symptoms (P = .001) and pain (P = .002) than those who received conventional RT. One of the main findings of this study was that tiredness, fatigue, and anxiety were commonly reported on the patients' ePRO questionnaires, but they were rarely recorded in the medical records. CONCLUSION Patients were motivated to use the ePRO system, and the response rates were high. Additionally, patients seemed to find that the ePRO system was an easy way to contact their own health care professionals. More attention should be paid to mental well-being during visits to the clinic.
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14
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Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna VA, Gentili M, Giacomelli L, Sacerdote P. Topical treatment of radiation-induced dermatitis: current issues and potential solutions. Drugs Context 2020; 9:dic-2020-4-7. [PMID: 32587626 PMCID: PMC7295106 DOI: 10.7573/dic.2020-4-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.
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Affiliation(s)
| | - Yvan Torrente
- Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Milan, Italy.,Unit of Neurology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, Milan, Italy
| | - Adriana Ciuffreda
- Medico Chirurgo, Specialista in Dermatologia e Venereologia, Dermatologia Pediatrica, Milan, Italy
| | - Vittorio A Guardamagna
- Division of Palliative Care and Pain Therapy, IRCCS Istituto Europeo di Oncologia IEO, Milan, Italy.,Director of ESMO, Designated Center of Integrated Oncology and Palliative Care, Milan, Italy
| | | | - Luca Giacomelli
- Polistudium SRL, Milan, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Science, University of Milano, Milan, Italy
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15
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Koukourakis G, Pissakas G, Ganos CG, Sivolapenko G, Kardamakis D. Effectiveness and Tolerability of Natural Herbal Formulations in the Prevention of Radiation-Induced Skin Toxicity in Patients Undergoing Radiotherapy. INT J LOW EXTR WOUND 2020; 21:75-86. [PMID: 32525718 DOI: 10.1177/1534734620923912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to investigate the preventive role of 3 herbal formulation products on reducing the incidence of radiation-induced dermatitis in patients undergoing radiotherapy for either breast or head and neck cancer. A total of 59 patients participated in the study. The novel herbal products, a combination of beeswax, olive oil, Calendula and Hypericum oils and Aloe gel, were daily and regularly being used by the patients during radiotherapy and 2 weeks after treatment end. Acute skin toxicity was scored weekly during radiotherapy and after treatment for a further 4-week follow-up period. Demographic data were analyzed by descriptive statistics. Statistical analyses of the study objectives were based on an intent-to-treat principle. Most of the patients presented with grade I (RTOG/EORTC) toxicity in the first weeks of radiotherapy, progressed to grade II but reverted to grade I toxicity up until the study end. A total of 94.9% of the patients had Dermatology Life Quality Index up to 1, and 66.1% remained in this scale. The application of the novel natural product combinations proved to be statistically significantly effective in reducing the intensity of radiation dermatitis, positively affecting the quality of life of the patients.
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16
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Non-invasive quantitative measures of qualitative grading effectiveness as the indices of acute radiation dermatitis in breast cancer patients. Breast Cancer 2020; 27:861-870. [PMID: 32363524 PMCID: PMC7438338 DOI: 10.1007/s12282-020-01082-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/20/2020] [Indexed: 11/15/2022]
Abstract
Background Recent improvement of machinery evaluation for the skin changes in various therapies enabled us to evaluate fine changes quantitatively. In this study, we performed evaluation of the changes in radiation dermatitis (RD) using quantitative and qualitative methods, and verified the validity of the conventional qualitative assessment for clinical use. Methods Forty-three breast cancer patients received conventional fractionated radiotherapy to whole breast after breast-conserving surgery. Erythema, pigmentation and skin dryness were evaluated qualitatively, and biophysical parameters of RD were measured using a Multi-Display Device MDD4 with a Corneometer for capacitance, a Tewameter for transepidermal water loss (TEWL), a Mexameter for erythema index and melanin index. Measurements were performed periodically until 1 year. Results The quantitative manifestations developed serially from skin erythema followed by dryness and pigmentation. Quantitative measurements detected the effects of irradiation earlier than that of qualitative indices. However, the grades of the domains in RD by qualitative and quantitative assessment showed similar time courses and peak periods. However, no significant correlation was observed between the skin dryness grade and skin barrier function. In contrast to serial increase in pigmentation grades, melanin index showed initial decrease followed by marked increase with significant correlation with pigmentation grades. Conclusion Subjectively and objectively measured results of RD were almost similar course and peak points through the study. Therefore, validity of the conventional qualitative scoring for RD is confirmed by the present quantitative assessments. Instrumental evaluations revealed the presence of modest inflammatory changes before radiotherapy and long-lasting skin dryness, suggesting indication of intervention for RD.
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Fuzissaki MDA, Paiva CE, Gozzo TDO, Maia MDA, Canto PPL, Maia YCDP. Is there agreement between evaluators that used two scoring systems to measure acute radiation dermatitis? Medicine (Baltimore) 2019; 98:e14917. [PMID: 30985641 PMCID: PMC6485857 DOI: 10.1097/md.0000000000014917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze the agreement between the nurses evaluating radiodermatitis that used the Radiation Therapy Oncology Group (RTOG) and the World Health Organization (WHO) scales.A prospective and longitudinal study conducted in 2016 to 2017, in a university hospital. We analyzed 855 images of irradiated sites of 100 breast cancer women during radiotherapy. In order to evaluate the agreement between 3 observers that evaluated theses irradiated sites Krippendorff's alpha and weighted kappa were obtained and analyzed.The pairwise agreement among the evaluators was fair and moderate (RTOG scale: 0.408, 95% confidence interval, CI 0.370-0.431; WHO scale: 0.559, 95% CI 0.529-0.590). In addition, the general agreement rates were 10.2% and 29.2%, respectively. When assessing the overall absolute agreement between the evaluators according with different phototypes and types of surgery, there was a fair agreement according to the RTOG scale when evaluating patients with phototype V or VI and mastectomy (3.7% and 8.8%, respectively).The RTOG and WHO scales should be used with caution in clinical practice to identify the prevalence of radiodermatitis and the severity. Another point of caution is that skin phototype and the type of surgery may influence the analysis outcome. An illustrative scale was designed and proposed, by our group, aiming to improve accuracy and agreement between evaluators that will be tested in subsequent clinical studies.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology, Division of Breast and Gynecology, Barretos Cancer Hospital, Barretos-SP
| | - Thais de Oliveira Gozzo
- Department of Maternal-Child Nursing and Public Health, Ribeirão Preto College of Nursing, University of São Paulo
| | | | - Paula Philbert Lajolo Canto
- Department of Clinical Oncology, Clinic's Hospital, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Yara Cristina de Paiva Maia
- Graduate Program in Health Sciences, Medicine School, Federal University of Uberlandia, Uberlandia, Minas Gerais
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18
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Møller PK, Olling K, Berg M, Habæk I, Haislund B, Iversen AM, Ewertz M, Lorenzen EL, Brink C. Breast cancer patients report reduced sensitivity and pain using a barrier film during radiotherapy - A Danish intra-patient randomized multicentre study. Tech Innov Patient Support Radiat Oncol 2018; 7:20-25. [PMID: 32095578 PMCID: PMC7033759 DOI: 10.1016/j.tipsro.2018.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/22/2018] [Accepted: 05/10/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Radiodermatitis is a well-known toxicity of radiotherapy and barrier film has been shown to reduce the severity of radiodermatitis. We have validated prior findings in a Danish cohort, using a similar barrier film and patient reported outcomes. MATERIALS AND METHODS 101 Danish breast cancer patients were included at three radiotherapy centres. Based on randomization either the lateral or medial part of their chest was covered by Mepitel film; making the patients their own control. The primary endpoint was patient reported symptoms and experience. A secondary endpoint was radiotherapy staff evaluation of dermatitis. RESULTS Within the skin area covered by film, the patients reported a statistical significant lower level of pain (p < .001), itching (p = 0.005), burning sensation (p = 0.005) as well as edema (p = 0.017) and reduced sensitivity (p < .001). Most patients (76%) would have preferred film on the entire treatment area (p < 0.001) and Mepitel Film as a standard treatment option (84%) (p < 0.001). Patients treated after mastectomy had a significantly lower severity of radiation-induced dermatitis with film at the end of RT compared to standard care (p = 0.005). However, in the blinded staff evaluation, no significant differences were found at follow-up. CONCLUSIONS Patients reported reduced symptoms from the skin with Mepitel Film and the majority would have preferred film as a standard offer to cover their entire treatment area. Especially women treated after mastectomy had a significantly lower level of radiodermatitis and preferred the film over standard care.
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Affiliation(s)
- Pia Krause Møller
- Department of Oncology, Odense University Hospital, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Martin Berg
- Department of Medical Physics, Vejle Hospital, Denmark
| | - Inger Habæk
- Department of Oncology, Odense University Hospital, Denmark
| | | | | | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Denmark
- Institute of Clinical Research, University of Southern Denmark, Denmark
| | | | - Carsten Brink
- Department of Oncology, Odense University Hospital, Denmark
- Institute of Clinical Research, University of Southern Denmark, Denmark
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Andersen ER, Eilertsen G, Myklebust AM, Eriksen S. Women's experience of acute skin toxicity following radiation therapy in breast cancer. J Multidiscip Healthc 2018; 11:139-148. [PMID: 29503562 PMCID: PMC5826296 DOI: 10.2147/jmdh.s155538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Acute skin toxicity is experienced by 70%–100% of patients receiving radiation therapy following breast cancer. Most studies focus on skin appearances and treatment of such reactions, not the experience. Increased knowledge about patients’ experience will contribute to provide tailored patient care. Thus, the purpose was to investigate patients’ experiences of acute skin toxicity following radiation therapy for breast cancer. Patients and methods Semi-structured in-depth interviews were conducted with seven women, 2–3 weeks post-treatment. Five broad areas of inquiry were investigated: 1) experiences from the development of skin reactions; 2) experiences in day-to-day life; 3) coping strategies; 4) experiences of information; and 5) experiences from the aftercare. The interviews were analyzed in line with qualitative content analysis. Results The main theme “Not so bad itself, but it comes on top of everything else” was identified, based upon three categories: 1) unique experience of the skin; 2) it is something about the psychological aspect; and 3) experience of information. Conclusion Acute skin toxicity following breast cancer treatment may affect many dimensions of patients’ lives. Experiences are complex, individual, and not necessarily consistent with visible changes of the skin. A holistic approach is necessary to provide treatment and support according to patients’ individual needs.
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Affiliation(s)
- Eivind Richter Andersen
- Department of Radiotherapy, Division of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway.,Department of Optometry, Radiography and Lighting Design, University College of Southeast Norway, Drammen, Norway
| | - Grethe Eilertsen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway
| | - Aud Mette Myklebust
- Department of Optometry, Radiography and Lighting Design, University College of Southeast Norway, Drammen, Norway
| | - Siren Eriksen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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20
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Evaluation of acute skin toxicity in breast radiotherapy with a new quantitative approach. Radiother Oncol 2017; 122:54-59. [DOI: 10.1016/j.radonc.2016.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
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21
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Aysan E, Idiz UO, Elmas L, Saglam EK, Akgun Z, Yucel SB. Effects of Boron-Based Gel on Radiation-Induced Dermatitis in Breast Cancer: A Double-Blind, Placebo-Controlled Trial. J INVEST SURG 2016; 30:187-192. [DOI: 10.1080/08941939.2016.1232449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Erhan Aysan
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Leyla Elmas
- Department of General Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Department of Radiation Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zuleyha Akgun
- Department of Radiation Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Serap Baskaya Yucel
- Department of Radiation Oncology, Bezmialem Vakif University, Istanbul, Turkey
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22
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Córdoba EE, Abba MC, Lacunza E, Fernánde E, Güerci AM. Polymorphic Variants in Oxidative Stress Genes and Acute Toxicity in Breast Cancer Patients Receiving Radiotherapy. Cancer Res Treat 2016; 48:948-54. [PMID: 26790968 PMCID: PMC4946367 DOI: 10.4143/crt.2015.360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose Reactive oxygen species (ROS) are generated as an indirect product of radiation therapy (RT). Genetic variation in genes related to ROS metabolism may influence the level of RT-induced adverse effects. We evaluated the potential association of single nucleotide polymorphism (SNP)–related response to radiotherapy injury in breast cancer patients undergoing RT. Materials and Methods Eighty patients receiving conventional RT were included. Acute effects were evaluated according to the Radiation Therapy Oncology Group (RTOG) scores. DNA was extracted from blood and buccal swab samples. SNPs were genotyped for GSTP1, GSTA1, SOD2, and NOS3 genes by polymerase chain reaction–based restriction fragment length polymorphism. Univariate analysis (odds ratios [ORs] and 95% confidence interval [CI]) and principal component analysis were used for correlation of SNPs and factors related to risk of developing ≥ grade 2 acute effects. Results Sixty-five patients (81.2%) showed side effects, 32 (40%) presented moderate to severe acute skin toxicity, and 33 (41.2%) manifested minimal acute skin reactions by the end of treatment. In both univariate and multivariate analyses, nominally significant associations were found among body mass index (OR, 3.14; 95% CI, 8.5338 to 1.1274; p=0.022), breast size (OR, 5.11; 95% CI, 17.04 to 1.54; p=0.004), and grade ≥ 2 acute radiation skin toxicity. A significant association was also observed between NOS3 G894T polymorphism (OR, 9.8; 95% CI, 211.6 to 0.45; p=0.041) and grade ≥ 2 acute radiation skin toxicity in patients with neo-adjuvant chemotherapy treatment. Conclusion The analysis of the factors involved in individual radiosensitivity contributed to the understanding of the mechanisms underlying this trait.
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Affiliation(s)
- Elisa Eugenia Córdoba
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,IGEVET-Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
| | - Martín Carlos Abba
- Basic and Applied Immunological Research Center, School of Medicine, National University of La Plata, Argentina
| | - Ezequiel Lacunza
- Basic and Applied Immunological Research Center, School of Medicine, National University of La Plata, Argentina
| | | | - Alba Mabel Güerci
- Department of Physics, School of Exact Sciences, National University of La Plata, Argentina.,IGEVET-Veterinary Genetics Institute (National Scientific and Technical Research Council-National University of La Plata) School of Veterinary Sciences, La Plata, Argentina
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Zhou J, Fang L, Xie H, Yao WX, Zhou X, Xiong ZJ. A pilot study using the Chinese herbal paste Liu-He-Dan to manage radiodermatitis associated with breast cancer radiotherapy. ACTA ACUST UNITED AC 2015; 22:e453-6. [PMID: 26715882 DOI: 10.3747/co.22.2725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND During radiotherapy for breast cancer, patients are greatly affected by pain, infection, and delayed healing of wounds caused by radiodermatitis. In the present study, we aimed to determine the efficacy of Liu-He-Dan in treating radiodermatitis. METHODS In 26 breast cancer patients who experienced moist decrustation while receiving radiotherapy, 5 g Liu-He-Dan was applied externally once daily after the wound surface had been cleaned and dried. The healing time was recorded, and a Kaplan-Meier survival curve was applied to analyze the treatment course. Meanwhile, a pain assessment using the Numeric Rating Scale (nrs) recorded the pain level experienced by patients after application of the Liu-He-Dan. RESULTS After application of Liu-He-Dan, the average healing time for the surface of the moist decrustation wounds was 14.17 ± 2.03 days (range: 5-22 days). Inflammatory seepage decreased significantly and exudation almost disappeared in 3 days. The pain trend line indicated that the average nrs score declined with treatment in all patients. The average nrs scores at days 1, 4, and 7 were 6.13, 3.62, and 2.58 respectively. After 3 days of treatment, pain was remarkably alleviated in 80.76% of patients. After treatment for 1 week, the pain remission rate was 96.15%, without any obvious adverse reactions. CONCLUSIONS Liu-He-Dan was efficacious in treating radiation skin injury with little toxicity and few side effects; the economic efficiency of the treatment was also favourable. The Liu-He-Dan was generally well tolerated by patients. In future, randomized control trials will be established for further observation of the value of Liu-He-Dan in treating radiodermatitis in breast cancer.
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Affiliation(s)
- J Zhou
- Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R.C
| | - L Fang
- Department of Gastroenterology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, P.R.C
| | - H Xie
- Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R.C
| | - W X Yao
- Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R.C
| | - X Zhou
- Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R.C
| | - Z J Xiong
- Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan, P.R.C
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Manas A, Santolaya M, Ciapa VM, Belinchón B, Tully F. Topical R1 and R2 Prophylactic Treatment of Acute Radiation Dermatitis in Squamous Cell Carcinoma of the Head and Neck and Breast Cancer Patients Treated With Chemoradiotherapy. EPLASTY 2015; 15:e25. [PMID: 26171097 PMCID: PMC4485614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A clinical study was conducted on the use of the topical Lactokine-based R1 and R2 system as a prophylactic treatment of acute radiation dermatitis in patients with squamous cell cancer of the head and neck and breast cancer treated with chemoradiotherapy. METHODS Ninety-eight patients were studied who attended the Radiation Oncology Services, La Paz University Hospital, Madrid, for treatment with chemoradiotherapy for head and neck cancer (n = 19) and breast cancer (n = 79). The treatment group (R1 and R2) included 51 patients; 47 control patients were given the local standard topical treatment (5% wt/wt urea lotion). At 3 postradiotherapy follow-up clinics, radiation dermatitis was graded, if present. All patients were administered with "quality-of-life" questionnaires. RESULTS Treatment with R1 and R2 significantly reduced the grade of radiation dermatitis in patients treated with chemoradiotherapy. At the fourth (last) clinic visit, at 2 weeks following the end of radiation treatment, 66.7% of patients in the treated group (R1 and R2) were free from radiation dermatitis compared with 34% in those given the center's usual skin care (topical urea lotion). There were no reported side effects, and quality of life improved for patients treated with R1 and R2. CONCLUSION Topical skin treatment with the R1 and R2 system has been shown to be effective in preventing, reducing the onset, and reducing the degree (grade) of radiation dermatitis in head and neck and breast cancer patients treated with chemoradiation.
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Affiliation(s)
- Ana Manas
- aRadiation Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Miguel Santolaya
- bFoundation for Biomedical Research, Radiation Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | - Belén Belinchón
- aRadiation Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Frances Tully
- dWater-Jel Europe LLP, Unit 3&4, The Mead Business Centre, Hertford, United Kingdom.,Correspondence:, https://twitter.com/WATERJELR1R2
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25
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Looking for complementary alternatives to CTCAE for skin toxicity in radiotherapy: quantitative determinations. Clin Transl Oncol 2014; 16:892-7. [PMID: 24643699 DOI: 10.1007/s12094-014-1163-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Radiotherapy (RT) is an essential part of the patient's treatment diagnosed with cancer. Determination of the most common RT secondary effect, the cutaneous toxicity, is usually based on visual rating scales, like Common Terminology Criteria for Adverse Events with an inherent subjectivity. The aim of this work is to perform an objective method to evaluate the radiodermatitis using a non-invasive imaging technique based on laser Doppler flowmetry (LDF). MATERIALS AND METHODS A prospective study was performed analysing 1,824 measurements. A LDF was used to measure the cutaneous microcirculation in real time. A basal measurement was taken prior to radiotherapy treatment. To be able to observe the microcirculation changes related to the delivered dose, several sets of measurements were taken in the irradiated area along the RT treatment and in the contralateral non-irradiated area. RESULTS A relative increase in blood flow at all measured points was found in the irradiated area. This relative increase in blood flow increases with the dose administered. In the non-irradiated contralateral area, the relative increase in blood flow is not significant and is independent of the dose administered. After treatment, a decrease in blood flow was detected with a trend towards returning to the baseline measurements. CONCLUSIONS LDF is an objective technique that assesses early radiodermatitis. This method is useful to develop strategies to prevent onset of radiation dermatitis in patients irradiated, such as the modification and individualization of fractionation parameters of the RT. This allows the reduction of radiation morbidities and maintains patient quality of life.
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26
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Upper Body Pain and Functional Disorders in Patients With Breast Cancer. PM R 2013; 6:170-83. [DOI: 10.1016/j.pmrj.2013.08.605] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/22/2022]
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27
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Buedo J, González Sanchis A, Iñigo R, Gordo Partearrollo J, Martinez R, Brualla L, López Torrecilla J. Cutaneous toxicity and quality of life in breast irradiation. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buedo García J, González Sanchís A, Iñigo Valdenebro R, Martínez San Juan R, Brualla González L, Gordo Partearroyo J, López Torrecilla J. Impact of breast radiodermatitis in the quality of life. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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29
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Foray N, Colin C, Bourguignon M. 100 Years of Individual Radiosensitivity: How We Have Forgotten the Evidence. Radiology 2012; 264:627-31. [DOI: 10.1148/radiol.12112560] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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A Systematic Review of Patient-rated Measures of Radiodermatitis in Breast Cancer Radiotherapy. Am J Clin Oncol 2012. [DOI: 10.1097/coc.0b013e31824dd3e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study. Support Care Cancer 2012; 20:3105-13. [PMID: 22426538 DOI: 10.1007/s00520-012-1435-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/27/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures. METHODS A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment. RESULTS Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need. CONCLUSIONS Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs. RELEVANCE In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.
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