Impacto da Radiodermatite na estética corporal de pacientes com câncer de cabeça e pescoço / Impact of Radiodermatitis on body aesthetics in head and neck cancer patients / Impacto de la Radiodermatitis en la estética corporal de pacientes con cáncer de cabeza y cuello

Objetivo: descrever o impacto da radiodermatite na estética corporal em pacientes com câncer de cabeça e pescoço submetidos à radioterapia. Método: estudo exploratório descritivo, do tipo série de casos, realizado no ambulatório de radioterapia de um hospital de ensino. Foram incluídos dez pacientes com câncer de cabeça e pescoço que foram submetidos à radioterapia no período de 2015 a 2017. A coleta dos dados foi realizada com instrumento construído para esse fim e por meio de registro fotográfico. Os dados foram analisados de forma descritiva, apresentando-se o cálculo da frequência. Resultados: todos os pacientes apresentaram sinais característicos de radiodermatite, principalmente os sinais clínicos de epilação (nos homens), hiperpigmentação e descamação seca, que afetam a estética corporal. Conclusão: a estética corporal dos pacientes acompanhados foi alterada em decorrência dos sinais clínicos da radiodermatite. Destaca-se a importância de avaliar essas alterações em pacientes com câncer de cabeça e pescoço submetidos à radioterapia.

Objective: to describe the impact of radiodermatitis on body aesthetics in patients with head and neck cancer undergoing radiotherapy. Method: this is an exploratory descriptive case series study conducted at the radiotherapy outpatient clinic of a teaching hospital. Ten patients with head and neck cancer who underwent radiotherapy from 2015 to 2017 were included. Data collection was performed with an instrument designed for this purpose and through photographic record. Data was analyzed descriptively, presenting the calculation of frequency. Results: all patients presented characteristic signs of radiodermatitis, mainly the clinical signs of epilation (in men), hyperpigmentation and dry scaling, which affect body aesthetics. Conclusion: the body aesthetics of the followed patients was altered as a result of the clinical signs of radiodermatitis. It is important to evaluate these changes in patients with head and neck cancer undergoing radiotherapy.

Objetivo: describir impacto de la radiodermatitis en la estética corporal en pacientes con cáncer de cabeza y cuello sometidos a radioterapia. Método: estudio exploratorio descriptivo, del tipo serie de casos, realizado en ambulatorio de radioterapia de un hospital de enseñanza. Incluidos diez pacientes con cáncer de cabeza y cuello que fueron sometidos a radioterapia entre 2015 y 2017. Recolecta de datos fue realizada con instrumento construido para ese fin y mediante registro fotográfico. Los datos fueron analizados de manera descriptiva, presentándose el cálculo de la frecuencia. Resultados: todos los pacientes presentaron síntomas característicos de radiodermatitis, principalmente síntomas clínicos de epilación (en los hombres), hiperpigmentación y descamación seca, que afectan la estética corporal. Conclusión: la estética corporal de los pacientes acompañados fue alterada en decurso de los síntomas clínicos de la radiodermatitis. Se destaca la importancia de evaluar esas alteraciones en pacientes con cáncer de cabeza y cuello sometidos a radioterapia.

The Impact of Radiodermatitis on Breast Cancer Patients' Quality of Life During Radiotherapy: A Prospective Cohort Study.

CONTEXT: In the oncology field, quality of life (QoL) is recognized as an essential component. However, few studies have evaluated radiotherapy (RT) and its adverse events, specifically radiodermatitis. OBJECTIVES: The objective of this study was to investigate the influence of radiodermatitis severity on QoL of women with breast cancer (BC) throughout RT. METHODS: A prospective cohort study was conducted with 100 BC patients evaluated weekly during RT. The Dermatology Life Quality Index questionnaire and the Radiation Therapy Oncology Group scale were used. The generalized estimated equations were used to examine the association between the total score of QoL and their domains, time of RT, and the radiodermatitis score, controlled by confounding factors. Estimated marginal means and 95% CIs were compared pairwise by applying Sequential Sidak. RESULTS: The total QoL score and their domains (work/school, leisure, daily activities, symptoms, and feelings) were significantly associated with the evaluation times of RT (P < 0.001), the radiodermatitis score (P ≤ 0.002), and the interaction between timing (T) of treatment and radiodermatitis score (P < 0.001). When assessing post hoc, it was identified that the worst QoL scores were in the presence of Grade 3 (mean = 6.00) in T3 and Grade 4 (6.50; 7.00) in T5 and T6, respectively, and this difference was statistically significant. CONCLUSIONS: RT negatively influenced the QoL of women with BC, with the greatest impact resulting from severe radiodermatitis. Actions aimed at minimizing the impairment on QoL need to be adopted to make this exhausting process less traumatic and easier to complete.

Effect of laser therapy on quality of life in patients with radiation-induced breast telangiectasias.

OBJECTIVE: To evaluate the effects of laser monotherapy on quality of life in breast cancer patients with chronic radiation dermatitis. STUDY DESIGN: A prospective, IRB-approved study was conducted at Memorial Sloan Kettering Cancer Center. Breast cancer patients with chronic radiation dermatitis completed health-related quality of life (HR-QOL) questionnaires before and after laser monotherapy for radiation-induced breast telangiectasias (RIBT). METHODS: After informed consent, all patients were issued the Skindex-16 and Breast-Q Adverse Effects of Radiation HR-QOL questionnaires prior to receiving laser treatment. Patients were treated with a 595 nm pulsed dye laser at 4- to 6-week intervals, with percent telangiectasia clearance and adverse events recorded at each visit. Post-treatment HR-QOL questionnaires were collected after clinician-assessed telangiectasia clearance of >50%. Median HR-QOL scores before and after therapy were reported for individual HR-QOL domains (Skindex-16) and HR-QOL totals (Skindex-16 and Breast-Q Adverse Effects of Radiation). Before- and after-differences were calculated using the Wilcoxon Signed-Rank Test. RESULTS: Twenty-two female patients (average age 56 years) enrolled in this study. A majority (13/22, 59%) exhibited telangiectasias across the décolletage and axilla in addition to the breast. Sixteen patients reached the 50% RIBT clearance threshold during the study period, and 11 of these patients (69%) completed follow-up HR-QOL questionnaires. Patients showed statistically significant improvements in emotional and functional Skindex-16 HR-QOL domains and in overall Skindex-16 HR-QOL score. Breast-Q scores also improved significantly, illustrating a decrease in specific physical and cosmetic concerns common to radiated breast skin. Common adverse events were transient post-treatment pain and redness. CONCLUSION: Breast cancer patients with RIBT presented with substantial deficits in several HR-QOL arenas. Laser monotherapy effectively treated the appearance of radiation dermatitis in these patients and also significantly improved HR-QOL. Lasers Surg. Med. 50:284-290, 2018. © 2017 Wiley Periodicals, Inc.

Psychological stress affects the severity of radiation-induced acute skin reactions in breast cancer patients.

Psychological stress exacerbates many pathological conditions including inflammatory skin conditions. The effect of psychological stress on acute radiation-induced skin reactions has not been documented before. Here, we aimed to explore if psychological stress could aggravate skin reaction severity in breast cancer patients. We conducted a secondary analysis of patient data obtained during a randomised, controlled clinical trial for acute radiation-induced skin reaction severity in 78 breast cancer patients. Patients were assessed three times a week during treatment. Skin reaction severity was measured using the modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) and Radiation Therapy Oncology Group grades. Stress levels were determined using a 5-point LIKERT scale to rate physical well-being, managing stress levels, house, family, work and other commitments. A total of 20 patients (26%) of the 78-patient cohort were considered stressed. Skin reaction severity in stressed patients was twice that of non-stressed patients (p < 0.001) and stressed patients were five times more likely to develop moist desquamation. Our results show that psychological stress aggravates skin reaction severity during radiation therapy. This research needs to be validated in a more rigorous manner by incorporating a validated scale such as the Distress Thermometer and Impact Thermometer in future skin trials.

Use of 4MAT Learning Theory to Promote Better Skin Care During Radiation Therapy: An Evidence-Based Quality Improvement Project.

Radiation therapy is a key treatment modality for cancer patients, but it is associated with adverse side effects such as radiation dermatitis. To mitigate the adverse effects of radiation on the skin, patients must participate in skin-related self-care. However, even with self-care instruction, adherence can be poor. This quality improvement project used best available evidence for skin care in patients undergoing radiation therapy and a theoretical framework, 4MATing, to provide a structured approach to patient education designed to enhance adherence to skin care recommendations. Implementation of this approach resulted in increased adherence to a topical skin care protocol in our facility. Patients were highly satisfied with their education. While there was a 4-day delay in the onset of radiation dermatitis, this difference was not statistically significant.

A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients.

OBJECTIVES: One of the most common acute side effects of breast cancer radiotherapy is treatment-induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on QOL. METHODS: Semistructured interviews were conducted with 20 women (Stage 0-III breast cancer), during their last week of external beam radiotherapy. Each interview was transcribed verbatim, and thematic analysis was performed. RESULTS: Three themes were identified based on the interview responses: First, skin changes affect multiple dimensions of QOL. They cause physical discomfort, body image disturbance, emotional distress, and impair both day-to-day functioning and satisfaction with radiation treatment. Second, individual differences affect women's experiences. Generally African American women, younger women, women who are not currently in a relationship, women who are being treated during the summer, and women who are more invested in their appearance are more distressed by skin toxicity. Third, women use a variety of symptom management strategies including self-medication, complementary/alternative medicine approaches, and psychological strategies. CONCLUSIONS: Implications of results are as follows: (1) skin toxicity affects numerous dimensions of QOL, and assessment approaches and psychosocial interventions should address this; (2) individual differences may affect the experience of skin toxicity and should be considered in treatment and education approaches; and (3) participants' own creativity and problem-solving should be used to improve the treatment experience.

Relationships among optimism, well-being, self-transcendence, coping, and social support in women during treatment for breast cancer.

OBJECTIVE: The impact of diagnosis and treatment for breast cancer, stressors that affect emotional well-being, is influenced by several psychosocial factors and the relationships among them. The purpose of this study was to investigate the relationship between optimism and emotional well-being (EWB) and the individual and combined mediation of this relationship by perceived social support (SS), problem focused coping (PFC), and self-transcendence in women with breast cancer during radiation therapy. METHODS: Ninety-three women receiving radiation treatment for breast cancer completed questionnaires that measured EWB, optimism, SS, PFC, and self-transcendence. RESULTS: Correlational and multiple regression analysis revealed that optimism was positively related to EWB. Of the three mediators, self-transcendence alone was found to partially mediate the relationship between optimism and EWB. The relationship between optimism and PFC was not significant. Optimism was related to SS, but its indirect effect on EWB through SS did not reach significance. CONCLUSIONS AND IMPLICATIONS: During breast cancer treatment, the positive effects of optimism on EWB are partially mediated by a woman's level of self-transcendence. Brief screening of women's optimism may help identify women at risk for psychological distress. Early detection and interventions to promote psychological adjustment throughout the cancer trajectory (e.g. enhancing self-transcendence) should receive attention in future research.

Hypnosis and cognitive-behavioral therapy during breast cancer radiotherapy: a case report.

This case report describes an effort to control two primary side-effects of breast cancer radiotherapy (fatigue and skin discomfort) that used a combination of cognitive-behavioral therapy with hypnosis (CBTH). Two patients, matched on demographic and medical variables (marital status, employment status, number of children, cancer diagnosis, surgical history, radiation dose), were compared: one who received a CBTH intervention and one who received standard care. Results were consistent with the view that CBTH was effective in managing fatigue and skin discomfort, and increasing relaxation.

'If we get too close to your bones they'll go brittle': women's initial fears about radiotherapy for early breast cancer.

INTRODUCTION: Radiotherapy is a common treatment for breast cancer. However, previous studies have shown that women who present for radiotherapy fear its use and associated side effects. The aims of this study were to develop further understanding of breast cancer patients' fears of radiotherapy, ascertain how patients deal with these fears and determine the best time in the treatment planning trajectory for health professionals to address these concerns. METHODS: Semi-structured interviews were conducted with early breast cancer patients at four time points during their experiences of radiotherapy. Grounded theory was used to analyse the data. Symbolic interactionism informed data interpretation. RESULTS: Thirty-four participants were interviewed. The two main themes that emerged prior to treatment commencement were 'fears about receiving radiotherapy' and 'ways of coping with the fear of radiotherapy'. Sub-themes that emerged as components of the theme 'fears about receiving radiotherapy' were: 'fearing the unknown', 'getting burnt', 'damaging internal parts' and 'anticipating tiredness'. Patients were able to cope with their fears by trying not to worry about their fears and by seeking information. Many patients found that their fears about radiotherapy were much worse than their actual experiences of receiving treatment and the side effects they experienced. DISCUSSION/CONCLUSION: In discussing radiotherapy with patients, health professionals have a window of opportunity at the planning appointment, prior to the commencement of radiotherapy, to assess patients' understanding and concerns about radiotherapy, listen to their fears, address meanings they assign to radiotherapy and provide reassurance about radiotherapy and the management of side effects.