Nurse’s internship leads to change in national guidelines for skin care during cancer treatment

Trish Bieck, RN

Trish Bieck, RN, talks with patient Chris Bedford.

Given the complexity of cancer treatment, skin care may seem like a small matter. However, Trish Bieck, RN, a senior nurse specialist at the James P. Wilmot Cancer Center, knew that skin issues were a constant source of anxiety for many patients receiving radiation therapy. Through research she began for her internship with the Clinical Nursing Research Center at Strong Memorial Hospital, Bieck discovered that the routine advice to avoid using moisturizer or other topical agents on the radiation field within four hours of treatment was rooted in myth instead of scientific evidence. As a result, patient recommendations locally and nationally have changed.

Bieck examined whether evidence supports the exclusion of moisturizer or other topical agents on the radiation field within four hours of treatment. Generally, the use of skin lotion is viewed as a way to decrease or diminish skin changes, which are a common and distressing side effect of radiation treatment. However, one widely held theory is that the presence of lotion can actually increase the risk of a bad skin reaction by inducing a bolus effect, or inadvertently making the skin thicker and thereby boosting the surface dose of radiation.

Yet going without lotion can result in skin damage and dryness, which can lead to infection and pain. It can also interrupt treatment and increase chances that malignant cells will repopulate while the skin heals.

Following a literature review of relevant articles, interviews with experts, an examination of benchmarks at international cancer centers, and consultations with professional organizations, Bieck found a wide variation in practice nationally.

“My role is to instruct patients, and this is something I was asked about often. But it always bothered me that there didn’t seem to be any rationale behind this restriction,” said Bieck, who has worked in Radiation Oncology for 20 years. “When I looked into it, I discovered little evidence to support the four-hour policies. Instead, the practice was based on historical practice—in other words, ‘just because; that’s the way we do it.’ ”

Bieck’s findings, which were published in the Clinical Journal of Oncology Nursing, prompted the National Cancer Institute to revise its recommendations for patients and to rewrite its widely distributed brochure, Radiation Therapy and You, incorporating the new findings. In addition, Wilmot developed standardized skin-care guidelines and revised its education materials. “We’ve had a lot of feedback, and we’re very pleased we could explore a topic that makes a difference for patients going through cancer treatment,” said Bieck, who credits the CNRC internship for teaching her how to do the research that led to these findings.

“I had heard about the internship, and I was at the point in my career where I felt I could do more. I had a lot of questions and I felt like this would be a great professional growth opportunity for me,” she said. “I thought that maybe I could come out of the year-long experience with something I could publish. I gained knowledge and authority to speak with my physician colleagues on the topic. That makes me feel stronger as a nurse.”

Bieck was surprised, too, that when all was said and done, she wasn’t the only one to gain from the internship experience. “I have tried to share what I have learned with my coworkers because of all the support they gave to me,” she said. “I can’t say enough how important it is to ask ‘why’ and to be able to support what you do with evidence.”

 

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