Sherman Deborah Witt
Graduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA.
Transl Breast Cancer Res. 2024 Mar 8;5:17. doi: 10.21037/tbcr-23-52. eCollection 2024.
Radiation therapy (RT) is often indicated in the treatment of breast cancer following breast conserving surgery or mastectomy, yet carries a 95% risk of radiation dermatitis (RD) of varying severity within 1 to 4 weeks of treatment. The burdens of RT include skin breakdown, pain, psychological distress, and functional challenges. Given limited patient education regarding the prevention and management of RD, a Clinician Guide and Evidence-based Skin Care Plan were developed to offer a holistic, patient-centered approach to care, with optimal RD prevention and management strategies to enhance patients' quality of life and survival.
M.R. (a pseudonym) was a 64-year-old Caucasian woman, diagnosed with invasive adenocarcinoma of the left breast, underwent a lumpectomy with a positive sentinel node biopsy. Within 4 weeks of surgery, she received RT, 5 days a week for 6 weeks. Within 1 week, the skin of her breast and axilla was red and hyperpigmented with skin damage progressing to dryness, itching and flaking. At this point, she asked the Radiology team for a skin care protocol to prevent or reduce RD, but limited information was provided. Ultimately, her skin cracked, blistered and crusted, with the development of a skin infection. She expressed the significant impact on her physical, emotional and functional well-being, and lamented about the shortfalls in her care, specifically the limited availability of information to prevent and reduce RD.
In order to prevent and minimize RD and to promote health, this case study highlights the need for an all-encompassing, patient-centered approach to care, which may be achievable by implementation of a Clinician Guide and an Evidence-based Skin Care Plan. Highlighted in the Clinician Guide are the importance of developing a trustworthy patient-clinician relationship, emotional support, social support, education, weekly physical assessments, assessment of overall adjustment to a cancer diagnosis and treatment, promotion of patient engagement and self-care, reinforcement of healthy lifestyles, and patient adherence to the Evidence-based Skin Care Plan during RT. These strategies are expected to decrease the physical, mental, and functional difficulties associated with RT, avoid treatment delays or discontinuation, and increase the likelihood of disease-free survival and quality of life.
保乳手术或乳房切除术后的乳腺癌治疗通常需要进行放射治疗（RT），然而在治疗的1至4周内，发生不同严重程度放射性皮炎（RD）的风险为95%。放射治疗的负担包括皮肤破损、疼痛、心理困扰和功能挑战。鉴于患者在放射性皮炎预防和管理方面的教育有限，制定了一份临床医生指南和循证皮肤护理计划，以提供一种全面的、以患者为中心的护理方法，采用最佳的放射性皮炎预防和管理策略来提高患者的生活质量和生存率。
M.R.（化名）是一名64岁的白人女性，被诊断为左乳浸润性腺癌，接受了前哨淋巴结活检阳性的肿块切除术。术后4周内，她接受了放射治疗，每周5天，共6周。1周内，她的乳房和腋窝皮肤发红、色素沉着，皮肤损伤发展为干燥、瘙痒和脱屑。此时，她向放射科团队询问预防或减轻放射性皮炎的皮肤护理方案，但得到的信息有限。最终，她的皮肤出现破裂、水泡和结痂，并发生了皮肤感染。她表示这对她的身体、情感和功能健康产生了重大影响，并对护理中的不足表示遗憾，特别是预防和减轻放射性皮炎的信息有限。
为了预防和最小化放射性皮炎并促进健康，本案例研究强调需要一种全面的、以患者为中心的护理方法，通过实施临床医生指南和循证皮肤护理计划可能实现这一目标。临床医生指南强调了建立可信赖的医患关系、情感支持、社会支持、教育、每周身体评估、评估对癌症诊断和治疗的总体适应情况、促进患者参与和自我护理、强化健康生活方式以及患者在放射治疗期间遵守循证皮肤护理计划的重要性。这些策略预计将减少与放射治疗相关的身体、心理和功能困难，避免治疗延迟或中断，并增加无病生存和生活质量的可能性。
