Breast Cancer

Lifting the Ban on Skin Creams Before Radiation Treatment

Most cancer patients who get radiation may now be able to use creams prior to treatment. A new study challenges the recommendation made by most doctors that cream should not be used the day of radiation treatment. The ban on creams is based on decades-old practices, with radiation machines that were much less sophisticated than today. The fear has been that creams add thickness to the skin that would keep the full dose from reaching the tumor.

One of the side effects of radiation is irritation to the skin. The effect has been described as skin becoming “bright red, or very dark, and may become swollen…may also feel dry, feel tight, be itchy, and look flaky. Some people develop a rash or blisters in the area where they are getting radiation therapy. These blisters may open and peel. ” The recommended treatment is moisturizing creams.

Ten years ago two nurses set out to prove that the ban on creams the day of radiation was not based on evidence. Trish Bieck, RN, and Shannon Phillips, RN, from the James P. Wilmot Cancer Center, University of Rochester Medical Center, noticed that skin issues were a constant source of irritation for patients getting radiation. “It always bothered me that there didn’t seem to be any rationale behind restricting lotions during that particular timeframe,” Bieck said.

So they reviewed studies, interviewed experts, looked at guidelines used at international cancer centers and consulted professional nursing organizations. In 2010 they published a study which concluded that there was little scientific evidence to support the ban on creams the day of radiation. But this study was published in the “Clinical Journal of Oncology Nursing,” which means it would not have much of an impact. The ban on creams continued.

But today in a journal with high impact (JAMA Oncology), doctors at the University of Pennsylvania and Washington University St. Louis published results of an ambitious study which went far beyond the one done in 2010 in exploring what one author called an “oncomyth.” With three separate studies in one the researchers established that the same day skin cream ban was widely practiced and then proved in two ways that that the ban was a mistake.

The first phase of the study was surveying doctors and patients. They posted a short survey on an educational website providing free cancer information to patients doctors and nurses. The results:

  • 73% of patients “were advised to avoid applying topical agents prior to radiation therapy”
  • 54% of patients were told to wipe off any residual creams prior to therapy
  • 62% of patients reported moderate or severe skin irritation during radiation therapy
  • 91% of doctors and nurses reported advising their patients to avoid creams before radiation
  • 59% of doctors and nurses said the reason for the advice was routine clinical practice

In addition to the survey, the researchers did other tests. They used blocks of material that they subjected to radiation. Dr. Brian Baumann, adjunct assistant professor of Radiation Oncology at the University of Pennsylvania said they used this material to “measure actual dose received under creams of varying thicknesses.” Tests showed no differences in dose when the radiation went through the cream. They also did studies in mice, which gave the same result. The one caveat was when they applied an excessive amount of cream, what Baumann described as “pouring out the whole bottle,” there was an effect on the dose of radiation.

But Baumann thinks the message is clear. Patients should talk with their doctor prior to radiation treatment about using cream.”I no longer tell patients not to apply creams,” Baumann says. He also notes that this is a lot of patients who will be impacted. There are 1.6 million new cancer diagnoses each year. Three fourths get radiation. Baumann  says these findings apply to the majority of those radiation patients.

“This is huge. I’m really excited,” Bieck said of the new study. “We now have concrete evidence and we don’t need to be so restrictive in the use of creams.”  She said to patients: “Don’t worry when you put on creams.”

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