Management Strategies For Severe Acute Radiation Dermatitis And The Use Of Bolus During Radiation Therapy For Breast And Head And Neck Cancer: Results Of A Patient And Provider Survey

There are no standard-of-care guidelines for treatment of CTCAE grade 3 radiation dermatitis or for the use of bolus for post-op RT for breast and H&N cancer. Physician practice patterns and patient-reported use of topical therapies for radiation dermatitis have not been well-defined. In this study, we surveyed radiation oncologists (RO’s) to determine current practice for managing grade 3 dermatitis and the use of bolus. We also surveyed breast and H&N patients to assess their use of topical treatments, correlated with patient-reported skin QOL outcomes. We conducted anonymous, online surveys of patients and providers on the OncoLink website. Patients completed a 24-question survey about skin care & radiotherapy (RT) that included a skin QOL questionnaire. Providers completed a separate 18-question survey. Responses were collected between 1/2015—3/2017. Responders were not compensated for their participation. Differences in responses with respect to baseline characteristics were assessed. P<0.05 was significant. 241 completed the survey (133 patients/108 providers). 51 RO’s completed the survey and were included in the analysis. 107 patients were analyzed (91 breast and 16 H&N). Routine use of bolus for post-mastectomy RT was reported by 98% (21use daily bolus, 22 QOD bolus, and 7 use both) and after neck dissection for H&N cancer by 29%. 82% of RO’s who use daily bolus employ 0.5 cm thickness. For treatment of grade 3 dermatitis, 46 of 51 RO’s (90%) recommend Domeboro and/or silver sulfadiazine (SS) (65% Domeboro & 71% SS). 73% recommend moisturizers with 53% recommending moisturizer plus lidocaine. Oral analgesia, topical steroids, & oral steroids were recommended by 45%, 24%, and 4%, respectively. When patients were surveyed, 93% (100/107) were advised to apply topicals for RT dermatitis. 96% used moisturizers during RT (96% of breast cancer patients and 94% of H&N patients). Common topicals included Aquaphor +/- lidocaine (57%), Eucerin (17%), steroids (16%), SS (15%), aloe (15%), generic moisturizer (14%), Coco butter (9%), Domeboro (7%), cornstarch (7%), Miaderm (6%), Glaxal (5%), Cera Ve (5%), zinc oxide (5%), and Calendula (4%). One third (32%) recorded high scores for skin burning during RT (4/5 or 5/5). Of those, 97% used moisturizers; 38% used SS; 26% used moisturizer plus lidocaine; 18% used topical steroids; and 15% used Domeboro. There was no difference in topical agents based on patient-reported burning of the skin (p>0.05) or whether the primary provider managing the skin was a nurse or physician (p>0.05). Silver sulfadiazine and/or Domeboro are commonly recommended by radiation oncologists for grade 3 dermatitis along with topical moisturizers. Patient surveys revealed heterogeneity in patient preference for topical agents. Consensus guidelines on skin care during radiotherapy are needed.