Introduction: Many patients in the United Kingdom having radiotherapy for breast cancer are recommended not to use a deodorant during treatment. The advice is not evidence based, it is solely thought as deodorants contained metals, which would react with radiation and cause an increased skin reaction. Hence this research was undertaken to establish whether patients having a course of radiotherapy for breast cancer could use a deodorant as part of their daily routine.

Method: The research took place between May 2004 and February 2005. A total of 192 breast cancer patients were recruited. This included breast or chest-wall patients with or without axilla involvement. The study was designed with two groups. Group 1 used no deodorant and Group 2 a specific deodorant. The researcher reviewed patients weekly, assessing skin reactions and recording the researcher and patient's observations.

Results: Most patients experienced no reaction or mild erythema and dry desquamation in the axilla. This was observed in both groups. Therefore, findings of this study indicate that future breast cancer patients should be given the choice of using this deodorant.

Further recommendations: Test the reliability of the skin assessment form, extend the research to include other patient groups who have their axilla treated, test different deodorants.

Background: The literature on the evaluation of the management of radiation-induced dermatitis demonstrates the methodological difficulties of studying this subject. Therefore, the feasibility of a methodology whereby the patient acted as their own control was used to study acute cutaneous side effects for head and neck radiotherapy patients using 1% hydrocortisone cream (HC).

Methods: Twenty patients were asked to apply Hyderm (1% hydrocortisone) cream twice daily to one side of the treatment area (either right or left) beginning on day one of radiation therapy and ending 2 weeks post-radiation therapy. The centres standard skin care protocol using mild soap and water and no creams was used on the other side of the neck. Once weekly the patients were assessed and scored using the Radiation-Induced Skin Reaction Scale and Radiotherapy and Oncology Group assessment scales and the patient completed a symptom scoring scale each week was a baseline assessment undertaken before they started treatment. To document compliance with study instructions, patients were asked to keep a calendar indicating when they applied the cream and to which side, and this was collected by clinical staff.

Results: At the conclusion of the study, 12 patients were enrolled. During the course of the study it became increasingly obvious that the side to which patients were applying the Hyderm scored higher on the assessment scale, indicating an increased skin reaction than the control side. This was confirmed with the photographs and patient symptom scale. As a result of these increased reactions, the study ceased accrual earlier than anticipated and all patients were advised to discontinue Hyderm use.

Conclusion: The increase in skin toxicity was unexpected, particularly as the institutional standard of care recommended the use of HC as treatment for radiation dermatitis. The number of patients in the study was too small to make conclusive statements about the efficacy of HC. We were able to confirm the feasibility of using an internal control methodology in these patients. Compliance results indicate the skin care instructions were clearly written and patients were able to follow them.

Background: Radiotherapy skin reactions have been well documented in the past. Until recently, washing of the treated area and the use of perfumed products that contain metals has not been advocated during treatment. The aims of this study were to assess the skin reactions of patients using a non-metallic deodorant and to see whether there were any psychological benefits from being able to use the deodorant.

Method: 41 women attending for radiotherapy to either the breast or breast and axilla were recruited into the trial. They were randomised into one of two groups. Complete data was obtained for 36 patients. 20 patients used the deodorant and 16 did not. Any skin reactions noted were recorded on a weekly basis. Patients were also asked to complete a questionnaire relating to feelings and activities and to comment on the deodorant if they had used it.

Results: Skin reactions did seem to be slightly worse in the patients using deodorant, and it was only in this group of patients that axillary reactions were noted. However, neither of these results were statistically significant. The use of the deodorant did not have any impact on the psychological well being of the patients, but patients using it had found it pleasant to use and the majority said that they would use it again.

Conclusion: Further study is indicated to look at skin reactions using the deodorant with a larger sample of patients.

The aim of this retrospective study is to develop an evidence-based approach to managing radiation induced skin reactions. A Clinical Guideline Development Group was established to undertake a systematic review of literature and a survey of cancer centres with the objectives of highlighting and recommending best practice. Thirty-one papers were reviewed using the United States Health Care Policy and Research and Scottish Intercollegiate Guidelines Network criteria and 42 United Kingdom Cancer Centres responded with a mix of guidelines and information about skin care assessment and advice. The evidence base for the findings is mainly levels II, III and IV.

Although perceived as common, the incidence of skin reactions has not been quantified. There is little evidence of consistent assessment of acute reactions and the survey data shows that the use of a scoring tool such as the Radiation Oncology Group criteria (RTOG/EORTC 1985) is rare. It also demonstrates that advice to patients is variable and sometimes contradictory. Appropriate and timely information is essential to relieve anxiety and reduce problems.

There appears to be a place for the use of creams in the management of early (RTOG/EORTC 0,1, 2a) skin reactions and in delaying the onset of subsequent skin breakdown, however this evidence is not clear and several of the studies identified some allergic reactions to creams. The intervention used varies between departments and individual patients and is ad hoc rather than based on firm evidence.

For reactions graded RTOG/EORTC 2b and 3, evidence from wound care literature suggests the use of hydrocolloids or hydrogels which are founded on moist wound healing principles. No evidence could be found to support the management of RTOG 4.

The study recommends the development of a clinical guideline encompassing factors affecting the onset of reactions, assessment and management principles, and patient information and makes suggestions for much needed further research.