Management of responses to radiotherapy Radiotherapy effects can have a debilitating impact on an individual's quality of life, and the severity and frequency of adverse effects can affect treatment delivery. The effect of radiation is a complex series of interactions that can occur within a fraction of a second or several years after treatment. While radiotherapy affects all body tissues in the path of the radiation treatment beam, every person will react differently to the radiotherapy due to a range of treatment factors and individual characteristics. Factors influencing responses to ionising radiation include: body site treatment intent (curative/palliative) dose treatment volume machine energy neoadjuvant therapy. The individual's emotional responses to radiotherapy are influenced by: the severity of symptoms and specific side effects of treatment, the need to be accommodated away from home for the duration of the radiation treatment difficulties managing in an unfamiliar environment away from usual support system long distance travel for treatment each day, limited knowledge or resources to manage these problems.. Radiation treatment effects can be divided into acute and late reactions. Acute radiotherapy reactions occur within days to weeks after commencing treatment, whereas late effects occur weeks to years after completing treatment. Healthy tissue responds to radiotherapy with an inflammatory response. The greatest adverse effects occur in tissues that are radiosensitive such as the skin and mucous membranes., The severity of effects is related to the cumulative radiation dose over time., There is a lack of standardised assessment of radiation side-effects and cancer treatment toxicity. Symptoms develop in several stages, further compromising effective assessment and monitoring of toxicities associated with radiotherapy. Learning activity Completed Activity Appraise current assessment tools in your health care facility for their capacity to effectively assess the following effects: radiation skin reactions xerostomia diarrhoea.
Nursing interventions are targeted at the assessment of skin reactions, teaching skin care and managing skin breakdown if it occurs. Acute effects of radiation skin reactions are visually assessed and defined in stages from erythema to dry or moist desquamation. Digital photography is an effective tool for recording skin erythema. Education on the basic principles of skin care in radiation oncology includes avoiding mechanical, thermal and chemical irritation. Radiation treatment has a drying and irritant effect on skin, and recent studies have supported the application of a moisturising cream to the treated area at least twice a day from the beginning of treatment., , The goals of skin care management are to enhance comfort, promote healing, minimise trauma and prevent infection if skin breakdown occurs. Dressings Dressings are required once the skin has broken. Exposure of superficial nerves can cause moderate to severe pain. Sera may be released from damaged cells, and dressings need to be moist and so that new epithelial cells are not separated from the vascular bed. A wound with serous loss is a potential site for infection, and the dressing needs to maintain cleanliness and prohibit the growth of damaging microorganisms. Dressings to broken skin areas also need to protect against friction from clothes and other irritants. Hydrogel and hydrocolloid wound dressings can provide protection, and maintain a moist, healing environment., , The management of radiation skin reactions should be in line with supportive care principles as discussed in Module 5: Cancer supportive care principles. Learning activities Completed Activities Access the article (free resource, but you must register and log in to access it) and describe the individual and radiation-related factors which influence skin response to radiation. Describe the clinical presentation of the following tissue responses to radiation: erythema pruritis hyperpigmentation dry desquamation moist desquamation. Appraise the effectiveness of current tools in your health care facility to assess radiation skin reactions. Summarise evidence based recommendations in the treatment and management of the following radiation skin reactions: erythema dry desquamation