Treatment side effects involving skin hamper quality of life for cancer patients, new survey shows

Dermatology Nursing, August, 2008 by Daniel B. Burfeind

Skin-related side effects are a concern for most cancer patients who have undergone cancer treatment, according to a new survey by CancerCare. The survey also revealed that, while less than two in five people with cancer were concerned with the prospect of skin-related side effects prior to starting treatment, nearly 80% were concerned about the actual skin effects they experienced as a result of their treatment and how those side effects--namely, irritation, rash, and dryness--affected their quality of life.

"Many people starting cancer treatment are unprepared for its effect on their skin. In fact, the survey revealed that concern about skin irritation and dryness increased more than that of any other side effect after people underwent treatment," said Diane Blum, MSW, executive director of Cancer Care. "These survey findings show the need to better inform and educate people being treated for cancer about what to expect about possible skin problems, and to help them find the remedies that can help treat these uncomfortable symptoms."

The survey, conducted in early 2008, involved 345 patients who participated in a CancerCare Telephone Education Workshop, a free, 1-hour briefing on a cancer-related topic by oncology experts that can be listened to live over the telephone or later via podcast. Survey respondents reported having either breast, ovarian, lung, colon/rectal, prostate, bladder, or kidney cancer and were undergoing or had completed various treatment regimens.

Survey results showed that 63% of respondents agreed with the statement: "The effect or impact on my skin was worse than I thought." Further, one in three respondents said the skin-related side effects have negatively affected their lives. For example, a 35-year-old woman being treated for breast cancer commented, "My hands and face hurt so much that it is tough to drive or even do the dishes. I am still trying to clear it up, and I wish there was something to make me feel better." A 62-year-old male survey participant noted, "I don't want to go out in public. The fullness and redness in my face and neck due to radiation make me uncomfortable about my appearance. I don't even want to go to bingo with my wife."

Survey respondents said that "dryness" tops the list of damaging or negative physical effects on their skin as a result of treatment (61%). Nearly half (49%) cited fingernail problems and one-third (34%) cited both redness and itching. Of note, a majority of respondents (51%) agreed that it is difficult to find a lotion that is effective at treating skin problems resulting from cancer treatments.

"Sustaining quality of life is of paramount importance to an individual who is undergoing treatment for cancer, and proactively managing side effects of the skin, hair, and nails is critical for doing this successfully," said Mario Lacouture, MD, director, Cancer Skin Care Program, department of dermatology, Northwestern School of Medicine, Chicago, IL. "Many medicines, be they traditional chemotherapy agents, the newer targeted treatments, or radiation, will cause a range of dermatologic problems at the same time they successfully treat the individual's cancer. Therefore, it is imperative that these untoward effects are treated early and effectively, in order to maintain quality of life and ensure that anti-cancer treatments can be administered consistently to achieve the best possible clinical outcome."

Dr. Lacouture, a dermatologist who specializes in cancer treatment related skin problems, is a leader in the emerging field of Supportive Onco-Dermatology. Supportive Onco-Dermatology (SOD) is the interdisciplinary medical management of the effects of cancer treatments on the skin. SOD addresses poor quality of life, compliance with medicine, and psychosocial issues.

Cancer Care has a fact sheet for individuals with cancer about managing skin side effects available at http://www.cancercare.org/pdf/fact_sheets/fs_skin_care.pdf

Daniel B. Burfeind, RN, DNC, is a Staff Nurse, Molts Department, Panzer Dermatology, Newark, DE; and a Dermatology Nursing Editorial Board Member.