A cancer diagnosis has a significant impact on the emotional health of people and their families. Common experiences include anxiety, distress, and depression. Added to the diagnosis is the additional burden of treatment, which often comes with its own list of physical and emotional challenges. One of those treatments is radiation therapy.
Nearly 50% of all patients with a cancer diagnosis will receive radiation therapy during their illness. Of those, approximately 85% have a moderate to severe radiation burns and 60% of all cancer happens to older adults. This adds physical discomfort and may even delay treatment in older adults who may already have nutritional deficits, poor appetite and frailty.
The burns typically show up in the first two weeks of treatment and as many as 25% of patients will develop an ulceration and moist skin peeling. General symptoms include blistering of the skin, soreness, peeling, itching, pigment changes, and fibrosis.
Prevention is the Best Medicine
While it may not be possible to prevent radiation burns, older adults and their caregivers can take steps to reduce tissue damage. It is important to be gentle with the skin, which should start the first day of treatment, not after skin damage becomes visible.
The area can be washed gently with warm water, but avoid using soap, washcloths, sponges, and loofahs as they can cause microdamage to the skin that is exacerbated by radiation. Also avoid scrubbing off the lines drawn for treatment, avoid shaving the area, and apply moisturizer as directed to help protect the outer layers of the skin.
While it may not be possible to prevent radiation burns, older adults and their caregivers can take steps to reduce tissue damage.
Antiperspirants, talcum powders and fragrances can increase radiation damage to the skin. Irritation to the area must be kept to a minimum. It’s important to wear loose-fitting clothing, and avoiding sun exposure, hot tubs, and tanning beds.
Smoking and alcohol can reduce capillary blood flow and therefore reduce oxygen and nutrients to the skin. This can increase the severity of the reaction as well as significantly reduce the ability to fight infection. Other health conditions and some medications may also impact healing, such as diabetes and steroids.
Steps to Caring for Radiation Burns
When radiation burns do happen, there are five steps that can be taken to help protect the skin and support healing. Tissue damage typically happens after the initial dose of radiation, and all following treatments generate more inflammation. However, it takes from one to four weeks for the first reactions to the skin to become visible and the signs of healing may take up to four to six weeks after therapy is finished.
This five-step process to assess, protect and treat the areas, older adults have a higher potential for reduced pain and a lower risk of infection.
Grade the Burn
The first step in the treatment of any wound is to assess the damage, which helps document the progress of treatment. With radiation burns, clinicians will likely use a common grading system, or guidelines, established by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC).
The guidelines have four stages:
- Grade 1: The skin is discolored with dry peeling of the outer layer of skin and the area continues to turn pale.
- Grade 2: The patient experiences painful redness and swelling with moderate swelling. The moist skin peels at the skin folds. Blisters larger than five millimeters may be visible.
- Grade 3: There may be additional the moist skin peeling beyond the skin folds with edema, or swelling, that “pits” when pressed.
- Grade 4: Patients have full-thickness skin necrosis (death) and ulcerations (open wounds).
After assessing the wound, it is important to protect the area from further damage. Products without adhesives should be used in people who need dressings to protect open areas to help avoid more damage. The dressings must also be absorbent in areas where the wound is leaking fluid and they should be comfortable to enhance patient compliance and reduce pain.
In open wounds, there is a potential complication for local infection. Susceptibility is related to the severity of the skin reaction, the size of the area being treated, and the use of chemotherapy with radiation. Skinfolds are more likely to get a higher dose of radiation and therefore there is a higher risk of bacterial contamination in those areas. Patients with moist ulcerations benefit from hydrocolloid dressings wrapped gauze-to-gauze without adhesive in order to help prevent infection.
Optimal tissue repair requires adequate nutrition. Unfortunately, many who undergo chemotherapy and radiation have a difficult time with their appetite and maintaining adequate calories. It is essential they eat high-quality, nutrient-rich food. Processed foods should be avoided. Foods high in vitamins A and C, and zinc are necessary for wound healing. Consider nutritional supplements if there is significant loss of appetite or disinterest in food.
Skin reactions from radiation can produce a green-yellow fluid within ulcerations. Unless there’s an excessive amount, this can help reduce pain and should not be cleaned off.
Topical nonsteroidal creams, such as aloe vera and calendula, have shown to be effective in reducing pain. Clinicians may consider non-opioid analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). In a review of studies evaluating topical corticosteroid agents, there was no evidence they helped reduce pain or itching from radiation.
Many patients undergoing radiation therapy experience burns and skin irritations of varying degrees. However, by using the five-step process to assess, protect and treat the areas, older adults have a higher potential for reduced pain and a lower risk of infection, which can have disastrous results in people who are immunocompromised.
About the Author
Gayle Morris BSN, MSN, VWCN, is a freelance writer, who has been creating engaging content on health and wellness for more than ten years. She spent over 20 years as a certified nurse and nurse practitioner before hanging up her stethoscope and picking up the pen.
As a nurse, Morris has cared for patients at Cincinnati Children’s Hospital, Riley Children’s Hospital, Chicago Children’s Hospital (now Lurie Children’s Hospital), and at Methodist Hospital in Indianapolis where she assisted with wound care education and treatment. As a PNP, she worked at Mary Free Bed Rehabilitation Hospital in Grand Rapids, MI.