The efficacy of mechanical protection of skin during radiation therapy: an exploratory study to evaluate the benefits of a retention dressing

Abstract

Radiation therapy is one of the primary cancer treatment modalities that involves passing radioactive beams through the skin. An acute side effect can be radiation-induced damage to the skin overlying the treatment area. Skin reactions can range from mildly uncomfortable pruritus to painful, moist, weeping areas of skin break down which can interrupt and delay treatment thus jeopardising therapeutic outcomes. The management of skin reactions to maximise patient comfort and convenience during and after treatment is a major nursing intervention. Retention dressings have been shown to be effective in a variety of other moist wound situations but have had minimal testing in the radiation therapy setting. Retention dressings work by providing mechanical protection to the skin surface, reducing friction while creating the moist wound environment known to promote comfort and healing. This exploratory study, utilised a randomised control trial (RCT) design to investigate the efficacy of Fixomull TM (Fixomull) as a retention dressing compared with the standard departmental treatment (usual care) of topical application of moisturising and steroid creams in women receiving primary radiation therapy for breast cancer. Eighteen women were randomised to the Fixomull group and 17 to the usual care group. Efficacy was measured in terms of effectiveness of pain and pruritus control, and patient acceptability. Participants scored their skin responses using a Visual Analogue Scale (VAS) from the commencement of treatment until two weeks following completion. Randomisation occurred at the point where a symptomatic skin reaction was reported. Both groups experienced increases in pain and itch. Inferential statistical analysis of scores of the week before and week after randomisation scores for pain, itch, and pain/itch combined, revealed no statistically significant difference between the groups (pain before /after Z= -.038, p=.969, itch before/after Z= -.360, p=.7l9, pain/itch before/after Z= -.491, p=.623). Clinically important information obtained from the women's journal comments and the researcher's observation, found that while Fixomull was not helpful in the moist desquamation stage, it did improve the comfort of the skin reaction in some situations where symptoms were aggravated by friction and movement. Although the Fixomull group reported greater improvement of symptoms (20% versus 12%), no change in symptoms (13% versus 0%) and increased symptoms (68% versus 88%) above the mid point of 5 on the VAS scale, these were not statistically significant. Fixomull may have a limited role to play in the management of radiation induced skin reactions and further study of the role of retention dressings in the radiation therapy setting with a larger sample is warranted.