Radiotherapy-induced skin changes and quality of life

Abstract

Quality of life is broadly recognised within oncology as an essential component of cancer care and has been studied extensively in patients with breast cancer. 1 Yet, among the three pillars of breast cancer treatment (surgery, chemotherapy, and radiotherapy), research on radiotherapy-related quality of life has lagged behind. Specifi cally, the study of quality of life as it relates to normal tissue eff ects in patients with breast cancer is woefully understudied. The reasons for this relative lack of attention are unclear, but the results are worrying. Insuffi cient understanding of the eff ects of radiotherapy on quality of life can impair doctor– patient communication, inhibit therapeutic progress, and limit a patient’s understanding of radiotherapy and its outcomes. Therefore, the report of the START trials today in The Lancet Oncology, by Hopwood and colleagues, is much needed. 2 It makes an important contribution to the area of radiotherapy by looking at several aspects of quality of life (breast, arm, and shoulder eff ects, and body image). In doing so, these researchers show a consideration of the patient’s point of view that is too often absent. The study’s fi ndings provide a strong foundation for further pursuit of understanding of the patient’s experience of adverse skin changes after radiotherapy. Indeed, at least fi ve areas of future research are readily apparent. 40% of women reported moderate or striking concerns for at least one body image item up to 5 years after treatment, and body image concerns did not diff er between radiotherapy regimens. This combination of results suggests the fi rst two directions for future research: scale development and interventions. First, with regard to scale development, the body image scale used in the study was designed to measure overall body image, rather than breast satisfaction per se. Therefore, development of a scale specifi cally to assess breast body image is needed to understand better the clinical eff ects. Second, with respect to interventions, the fi nding that body image scores did not diff er between radiotherapy regimens suggests that, at this time, a purely medical intervention strategy (eg, variation of radiotherapy regimens) might not be suffi cient to improve body image. A more comprehensive approach might be needed. For example, in broader scientifi c published work, behavioural medicine approaches (eg, cognitive behavioural therapy) have been shown to be eff ective for enhancement of body image. 3