Breast cancer is the most common malignancy for women in New Zealand. The majority will receive radiation therapy as part of their treatment regime, and radiation-induced skin toxicities (erythema, dry desquamation, moist desquamation) will occur in 80–90% of patients by treatment completion. Skin toxicities can seriously impact on a patient's mental and physical well-being and yet currently there is no standard treatment with practice being based on historical and anecdotal evidence alone.
An initial single centre stage II randomised controlled trial comparing the efficacy of a silicon foam dressing with the (then) current standard treatment of aqueous cream (the control) was followed by a similar multi-centre trial. A total of 104 patients were enrolled across both trials; all received 50Gy in 25 fractions and patients doubled as their own controls to eliminate confounding patient and treatment-related factors. The trial endpoint was moist desquamation (MD). Toxicities were measured using the Radiation-Induced Skin Reaction Scale (RISRAS) which includes participant as well as the researcher components. As each participant’s experience is unique, this scale adds valuable depth to the data since the level of reaction observed does not always reflect the degree of discomfort and distress experienced by the patient.
The statistical analysis used ANOVA design of repeated measurement of paired patches for the ‘combined’ and researcher scores and the non-parametric Wilcoxon signed rank test for patient scores. The analysis clearly demonstrated a significant (42%) toxicity decrease (p<0.001).
An intriguing incongruity became apparent when the percentage of our patients progressing to MD (16% control area v 0% trial area) was compared with the patient cohort from other centres (56% control area v 30% trial area). Hypothesizing about this disparity resulted in our current research examining the correlation between the level of holistic care afforded to patients and the intensity of reactions experienced/observed.