Zhu, G., Lin, J.C., Kim, S.B., Bernier, J., Agarwal, J.P., Vermorken, J.B., . . . He, X. (2016). Asian expert recommendation on management of skin and mucosal effects of radiation, with or without the addition of cetuximab or chemotherapy, in treatment of head and neck squamous cell carcinoma. BMC Cancer, 16, 42-016-2073-z. 

PURPOSE: To review the current guidelines for grading skin toxicity and mucosa toxicity during radiation, with or without concurrent cetuximab or chemotherapy

 

TYPES OF PATIENTS ADDRESSED: Patients with head and neck squamous cell carcinoma undergoing radiation therapy, with or without cetuximab or chemotherapy

The authors stated their intent to review the literature and the Asian head and neck expert panel meeting regarding the current grading systems in use for skin toxicity and mucositis in patients with head and neck squamous cell carcinoma treated with radiation therapy with or without cetuximab or chemotherapy. In terms of skin toxicity grading, the authors developed a new grading system for what was labeled \"bio-radiation dermatitis,\" and it is not clear if this was used or will be used in their countries or other countries. The grading related to the skin’s response to radiation and whether the reaction limited the patient’s activities of daily living. Recommendations for skin care were consideration of prophylactic antibiotics but not routine systemic use unless grade 3 mucositis was present, maintaining hygiene and avoidance of aloe vera, topical antibiotics or steroids for grade 4, and corticosteroids for symptom relief. Regarding mucositis related to radiation therapy to the head and neck, the authors included a table of clinical practices that are commonly used to manage mucositis in Asia. These methods included practices that do not appear to be common in the United States (including mouth rinses using betadine or thymol and aspirin gargles). Recommendations included maintaining oral hygiene with the addition of saline and bicarbonate rinses.

There did not appear to be clear-cut implications for nursing in terms of nursing assessment or responsibilities in skin toxicity or mucositis grading. The authors’ conclusion section related the importance of physicians’ awareness of patient assessment and did not mention nursing or nursing’s role in the care of this patient population. Nurses could potentially use the new grading system in their assessments or for helping to develop policy and procedure in their institutions related to the management of the skin and oral side effects of radiation with or without cetuximab or chemotherapy for patients with head and neck cancer. Nurses can educate patients to maintain skin and oral hygiene with salt and soda oral rinses during treatment, avoid the use of aloe vera on the skin, and advocate for the use of topical steroids and antibiotics for symptom relief and management of skin toxicities, consistent with other evidence.