Scott, A. (2014). Polymeric membrane dressings for radiotherapy-induced skin damage. British Journal of Nursing, 23, S24–S31.

DOI Link

Study Purpose

To determine whether a polymeric membrane dressing is effective for radiation skin reactions in patients who scored between 1-2.5 on the Radiation Treatment Oncology Group's (RTOG's) acute radiation morbidity scoring criteria over a four-week period

Intervention Characteristics/Basic Study Process

All patients were provided with aqueous cream to use at the start of treatment prior to application of the Polymem® polymeric dressing. They were also provided with paraffin gauze for moist desquamation. It was unclear when the patients started using Polymem and paraffin gauze. An evaluation form was developed to capture baseline details and weekly assessments for up to four weeks including “patient’s age, gender, radiotherapy dosage, nutritional status, cancer type and location, RTOG rating, wound size, location, and description, wound-pain score, and pain at dressing change.” In addition, dressing wear time, prescribed analgesia, and healing rates were documented. Part of the intervention included patient diaries that captured a daily record of wound-pain scores using the Wong and Baker FACES® scale, a log of whether the pain was related to cancer or dressing change, pain medications, sleep patterns, and free text. It did not report randomization. The four particular performance criteria that were assessed were improving skin integrity, managing dry and moist desquamation, relieving pain and inflammation, and improving quality of life (sleep patterns). Patients and clinicians rated dressing satisfaction and performance.

Sample Characteristics

  • N = 20
  • MEAN AGE = 56.8 years
  • MALES: 17 (85%), FEMALES: 3 (15%)
  • KEY DISEASE CHARACTERISTICS: Primary diagnosis was head and neck cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: 30% were diagnosed with squamous cell carcinoma of the larynx

Setting

  • SITE: Single-site (assumed, not clearly described)
  • SETTING TYPE: Cancer center
  • LOCATION: Mount Vernon Cancer Centre, Middlesex, United Kingdom

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active treatment

Study Design

Observational, quasiexperimental trial

Measurement Instruments/Methods

  • RTOG Morbidity Scoring Scale
  • Wong and Baker FACES® Scale
  • Malnutrition Universal Screening Tool (MUST)
  • World Health Organization's (WHO's) Analgesic Ladder

Results

Sixteen (80%) patients applied either aqueous cream or paraffin gauze prior to applying Polymem dressing.
  • 13 (65%) RTOG = 2
  • 5 (25%) RTOG = 2.5
  • 2 (10%) RTOG = 1
  • 0 (0%) RTOG = 3 or 4
Improving skin integrity
  • Patient response and clinical observation: Within the first week of treatment, skin reactions were reduced in both dry and moist desquamation.
  • First week: Eight patients healed.
  • Second week: Five patients healed.
  • Third week: Two patients healed but stopped using dressing.
  • Fourth week: Two patients were healing but had not completely healed.
  • 15% of patients' skin reactions healed.
Managing dry and moist desquamation
  • Patient response and clinical observation: Within the first week of treatment, skin reactions were reduced in both dry and moist desquamation.
Relieving pain and inflammation
  • Through days 1 to 14, pain levels declined with mean self-reported pain scores being 6–7 (day 1) and 1–2 (day 14)
  • During the first 14 days, patients took a combination of codeine, co-codamol, and paracetamol.
  • Patients reported a significant reduction in wound pain and increased comfort with dressings usage.
Improving quality of life (sleep patterns)
  • No patients were taking sedative medications or practicing relaxation techniques. By the sixth day, patients that kept pain diaries reported sleeping four to eight hours out of a 24 hour day.
  • Journal diaries reported increased sleeping hours.
Patients and clinicians rated dressing satisfaction and performance.
  • Journal diaries reported that patients and their caregivers were able to change the dressings.

Conclusions

In this setting, because of the results of this small study, Polymem dressings have replaced paraffin gauze and aqueous creams for patients with head and neck cancer. Polymem dressings reduced pain and inflammation, improved sleep patterns, and improved healing rates and quality of life. However, there were many limitations.

Limitations

  • Small sample (< 30)
  • Baseline sample/group differences of import
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Risk of bias (no appropriate attentional control condition)
  • Selective outcomes reporting
  • Measurement/methods not well described
  • Measurement validity/reliability questionable
  • Findings not generalizable
  • Intervention expensive, impractical, or training needs
  • Other limitations/explanation: Patients and clinicians should have been trained in assessment as there may have been discordance in reporting. This method was not clearly described.
 

 

Nursing Implications

Polymeric dressings may reduce the severity of radiodermatitis, promote healing, and reduce associated pain. This report had numerous limitations and does not provide strong evidence for the efficacy of these dressings. Additional, well designed research is warranted.