Implementing Evidence Based Practice in the Prevention of Radiodermatitis in an Outpatient Radiation Oncology Department

Abstract

Radiation dermatitis is one of the most frequently observed acute side effects of radiation treatment. It can have a negative impact on quality of life and can cause delays in treatment. The current standard of care varies and is often based on anecdotal evidence. Most departments use a petroleum based gel. Calendula lotion is a less frequently recommended skin product. Is there recent research demonstrating significant effectiveness of calendula cream compared to petroleum based gel in decreasing radiation dermatitis to support a change in practice? A literature synthesis was completed. Picot question: among cancer patients who are undergoing radiation therapy, is treatment with a calendula lotion, as compared to treatment with a petroleum-based gel, less likely to have radiation dermatitis? There is some evidence that calendula is effective in reducing radiation dermatitis. It should be used in combination with skin cleansing, frequent assessments, and consistent education. There are many different calendula products on the market and personal preferences such as cost, availability, and ease of use should be considered with product recommendations. Patients should be informed that petroleum based gel does not cause harm, but there is no data to support any benefit. In addition, the Oncology Nursing Society lists calendula lotion as likely to be effective and petroleum based gel as effectiveness not established. Evidence pointed to a need to a change in practice. A power point presentation for nursing staff in the department of radiation oncology was completed to disseminate the findings of the literature review. Calendula lotions were recommended for use during treatment. Data was collected on patient preference of lotions used during radiation treatment including: effectiveness, ease of purchasing the product, cost, and ease of application. Twenty-one breast cancer patients undergoing daily radiation treatments were evaluated. Data was collected during weekly on treatment visit. The data collected found that all patients thought the calendula products were non-greasy and easy to apply. There was an 85% patient satisfaction with the lotion use on intact skin. A small % found the calendula products difficult to find and expensive. A new recommended skin care handout was completed, which included a list of products of various price ranges and where they could be purchased. Implications for practice: health care professionals can enhance patient care by providing education on evidenced based self-management measures. The change in practice on recommended skin care product resulted in 85% patient satisfaction and also promoted the use of evidence-based practice in radiation dermatitis.