Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T21:23:12.898Z Has data issue: false hasContentIssue false
  • English
  • Français

Colloidal oatmeal emollient as an alternative skincare approach in radiotherapy: a feasibility study

Published online by Cambridge University Press:  17 August 2016

Rosemary Rudge
Rosemary Rudge*
Affiliation:
Bristol Cancer Institute, Horfield Road, Avon, Bristol, UK
*
Correspondence to: Bristol Cancer Institute, Horfield Road, Avon, Bristol, UK. E-mail: roseyrudge@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

To assess the feasibility of a randomised controlled trial (RCT) on patients receiving radical radiotherapy for carcinoma of the anus in order to compare the present skincare advice at the time of the study with an alternative product, Aveeno, used primarily for dermatological and chemotherapeutic-induced skin conditions.

Materials and method

Standardised Radiation Therapy Oncology Group (RTOG) grading and skincare assessments were used primarily to inform on physical reactions within a RCT. A pre-existing morbidity/quality-of-life instrument ‘the Head and Neck Radiotherapy Questionnaire’, which was validated for use with radiotherapy patients in preceding studies, was adapted for anus patients and formed the secondary basis for data collection. In all, 24 participants undergoing radical radiotherapy for anal cancer were randomised into two arms, Aveeno cream versus Aqueous Cream BP, and reviewed weekly to collect data and perform analysis and Mann–Whitney U non-parametric statistical tests.

Results

RTOG gradings for skin reactions were comparable week by week across the cohorts, with a baseline 100% of participants exhibiting RTOG 0 at week 1 in all areas, through to week 6 where both cohorts had progressed to higher RTOG grades. The Aveeno cohort, however, indicated a p-value approaching significance in regards to epidermal regeneration at follow-up 1 (p=0·0543). Questionnaires yielded diminishing responses as treatment progressed correlating with advancing RTOG grades, and exhibited increasing negativity in responses in correlation with advancing RTOG grade exhibited.

Conclusion

The study was the first to recognise colloidal oatmeal as a skincare approach in the radiotherapy setting and recognises the potential benefits of Aveeno in radiation-induced skin reactions. The study determined the RTOG grading system to be robust as a method of evaluation of skin reactions and the questionnaires deemed the quality-of-life assessment to be a necessity in order to address patients’ psychological needs in addition to the physical needs.

Keywords

anal cancerradiotherapyskincareskin reactions
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 4 , December 2016 , pp. 322 - 333
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Harsolia, A R, Kestin, L L, Grills, I et al. Intensity modulated radiation therapy results in a significant decrease in clinical toxicities when compared to conventional wedge based radiation therapy. Int J Radiat Oncol Biol Phys 2007; 68 (5): 1375–1380.Google Scholar
2. Naylor, W, Mallett, J. Management of acute radiotherapy induced skin reactions: a literature review. Eur J Oncol Nurs 2001; 5 (4): 221–233.Google Scholar
3. Barkham, A M. Radiotherapy skin reactions and treatments. Prof Nurs 1993; 8 (11): 732–736.Google Scholar
4. McQuestion, M. Evidence-based skin care management in radiation therapy. Semin Oncol Nurs 2006; 22 (3): 163–173.Google Scholar
5. Aistars, J. The validity of skin care protocols followed by women with breast cancer receiving external radiation. Clin J Oncol Nurs 2006; 10 (4): 487–492.CrossRefGoogle ScholarPubMed
6. Harris, R. Skin Care in Radiation Therapy. New Orleans, LA: ASRT, 2002.Google Scholar
7. Bernier, J, Bonner, J, Vermorken, J et al. Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol 2008; 19 (1): 142–149.CrossRefGoogle ScholarPubMed
8. Byun, H J, Lee, H J, Yang, J I et al. Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients. Ann Oncol 2012; 23 (8): 1992–1998.Google Scholar
9. Denham, J, Hauer-Jensen, M. The radiotherapeutic injury–a complex ‘wound’. Radiother Oncol 2002; 63: 129–145.Google Scholar
10. Bolderston, A, Lloyd, N S, Wong, R K et al. The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline. Support Care Cancer 2006; 14 (8): 802–817.Google Scholar
11. Kim, S, Jary, M, Mansi, L et al. DCF (docetaxel, cisplatin and 5-fluorouracil) chemotherapy is a promising treatment for recurrent advanced squamous cell anal carcinoma. Ann Oncol 2013; 24 (12): 3045–3050.Google Scholar
12. Hymes, S R, Strom, E A, Fife, C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment. J Am Acad Dermatol 2006; 54 (1): 28–46.Google Scholar
13. Kumar, S, Juresic, E, Barton, M, Shafiq, J. Management of skin toxicity during radiation therapy: a review of the evidence. J Med Imaging Radiat Oncol 2010; 54 (3): 264–279.Google Scholar
14. Wickline, M M. Prevention and treatment of acute radiation dermatitis: a literature review. Oncol Nurs Forum 2004; 31 (2): 237–247.Google Scholar
15. Glean, E, Edwards, S, Faithfull, S et al. Intervention for acute radiotherapy induced skin reactions in cancer patients: the development of a clinical guideline recommended for use by the College of Radiographers. J Radiother Pract 2001; 2: 75–84.Google Scholar
16. Harris, R. Guidelines for grade iii radiotherapy skin reactions. Prague: ESTRO, 2002.Google Scholar
17. Harris, R, Probst, H, Beardmore, C et al. Radiotherapy skin care: a survey of practice in the UK. Radiography 2012; 18 (1): 21–27.Google Scholar
18. Salvo, N. Prophylaxis and management of acute radiation-induced skin reactions: a systematic review of the literature. Curr Oncol 2010; 14 (4): 94–112.Google Scholar
19. Cumming, J, Routsis, D. Are improvements needed in the management of severe acute skin reactions following completion of breast radiotherapy? A discussion of some possible service options. J Radiother Pract 2009; 8: 11–16.Google Scholar
20. Alexandrescu, D T, Vaillant, J G, Dasanu, C A. Effect of treatment with a colloidal oatmeal lotion on the acneiform eruption induced by epidermal growth factor receptor and multiple tyrosine-kinase inhibitors. Clin Exp Dermatol 2007; 32: 71–74.Google Scholar
21. Sur, R, Nigam, A, Grote, D et al. Avenanthramides, polyphenols from oats exhibit ant-inflammatory and anti-itch activity. Arch Dermatol Res 2008; 300 (10): 569–574.CrossRefGoogle Scholar
22. Kurtz, E S, Wallo, W. Colloidal oatmeal: history, chemistry and clinical properties. J Drugs Dermatol 2007; 6: 167–170.Google Scholar
23. Talsania, N, Coffild, A, Orpin, S D. Colloidal oatmeal lotion is an effective treatment for pruritus caused by erlotinib. Clin Exp Dermatol 2008; 33 (1): 108.Google Scholar
24. Cerio, R, Dohil, M, Jeanine, D, Magina, S, Mahé, E, Stratigos, A J. Mechanism of action and clinical benefits of colloidal oatmeal for dermatologic practice. J Drugs Dermatol 2010; 9: 1116–1120.Google Scholar
25. Kedge, E. A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography 2009; 15 (3): 247–257.Google Scholar
26. Cox, J, Stetz, J, Pajak, T. Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organisation for Research and Treatment of Cancer (EORTC). Int J Rad Oncol Biol Phys 1995; 31: 1341–1346.Google Scholar
27. Russell, N. A Review of the Management of Skin Reactions. Barcelona: ESTRO, 2010.Google Scholar
28. Russell, N S, Knaken, H, Bruinvis, I A et al. Quantification of patient to patient variation of skin erythema developing as a response to radiotherapy. Radiother Oncol 1994; 30 (3): 213–221.Google Scholar
29. Hopewell, J W, Van Der Kogel, A J. Pathophysiological mechanisms leading to the development of late radiation-induced damage to the central nervous system. Front Radiat Ther Oncol 1999; 33: 265–275.Google Scholar
30. Wells, M, MacBride, S. Radiation skin reactions. Support Care Radiother 2003; 8: 135–157.Google Scholar
31. Creswell, J W. Educational Research Planning, Conducting and Evaluating Quantitative and Qualitative Research, 2nd edition. Upper Saddle River, NJ: Pearson Education, 2005.Google Scholar
32. Hek, G, Moule, P. Making Sense of Research: An Introduction for Health and Social Care Practitioners, 3rd edition. Sage Publications, 2007.Google Scholar
33. Browman, G P, Levine, M N, Hodson, D I et al. The head and neck radiotherapy questionnaire: a morbidity/quality-of-life instrument for clinical trials of radiation therapy in locally advanced head and neck cancer. J Clin Oncol 1993; 11 (5): 863–872.Google Scholar
34. Baker, T L. Doing Social Research, 2nd edition. New York: McGraw-Hill Inc., 1994.Google Scholar
35. Kunz, R, Vist, G E, Oxman, A D. Randomization to protect against selection bias in healthcare trials. Cochrane Database Sys Rev 2007; 2: 1–33.Google Scholar
36. Royal College of Radiographers. Summary of Intervention for Acute Radiotherapy Induced Skin Reactions in Cancer Patients. London: CoR, 2000.Google Scholar
37. Wells, M, Raab, G, MacBride, S, Bell, N, Mackinnon, K, Munro, A. Prevention and management of radiation skin reactions: a randomised controlled trial of skin care approaches in patients with breast, head and neck and anorectal cancer. EJC Suppl 2003; 1 (5): S207.Google Scholar
38. Medicines and Healthcare Products Regulatory Agency. Drug safety update. Aqueous cream: may cause skin irritation. https://www.gov.uk/drug-safety-update/aqueous-cream-may-cause-skin-irritation. Accessed on 25th March 2012.Google Scholar
39. Gosselin, T, Schneider, S, Plambeck, M A et al. A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 2010; 37 (5): 619–626.Google Scholar
40. Heggie, S, Bryant, G P, Tripcony, L et al. A phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs 2002; 25 (6): 442–451.Google Scholar
41. Society of Radiographers. Skin care advice for patients undergoing radical external beam megavoltage radiotherapy. http://www.sor.org/learning/document-library/skin-care-advice-patients-undergoing-radical-external-beam-megavoltage-radiotherapy-0. Accessed on 10th February 2015.Google Scholar
42. Greene, J C. Mixed Methods in Social Enquiry. San Francisco, CA: Jossey-Bass, 2007.Google Scholar
43. Everest, T. Resolving the qualitative/quantitative debate in healthcare research. Med Pract Rev 2014; 5 (1): 6–15.Google Scholar
44. Gosselin, T, Schneider, S et al. A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy. Oncol Nurs Forum 2010; 37 (5): 619–626.Google Scholar
45. Miller, R. Implementing a survivorship care plan for patients with breast cancer. Clin J Oncol Nurs 2008; 12 (3): 479–487.Google Scholar
46. Wells, M, Macmillan, M, Raab, G et al. Does aqueous or sucralfate cream affect the severity of erythematous radiation skin reactions? A randomised controlled trial. Radiother Oncol 2004; 73 (2): 153–162.CrossRefGoogle ScholarPubMed