放射性皮炎指南
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
IV
1 1 1 2 3 4 4 5 8 9 12 13 14 14 14 15 15 17 21 21 22 23
Framework..................................................................... Goals of Treatment. Review of Literature. ... ... .... .. ... ... ... ... ... ... ... ... ......... ... ... ... .... Products..... RadiaCare Gel. ......................................................... Xenaderm............................................................... Humatrix................................................................ Product Summary. ................................. .................... DISCUSSION............................................................................ Strengths....................................................................... ... Limitations........................................................................ Role of the Nurse Practitioner............................................... ... CONCLUSION & FURTHER IMPLICATIONS.................................... REFERENCES. ... ... ... ... ... ... ...... ...... ... ... ... ... ... ... ... ............ ... ... ... .... FIGURES................................................................................... Skin........... Noble-Adams Conceptual Framework. ............. ..... ... ...... ... ... ... . Proposed Conceptual Framework....................
WASHINGTON STATE UNIVERSITY College of Nursing May 2005
To the Faculty of Washington State University: The members of the Committee appointed to examine the clinical of DIANA JEAN WOOLLUM find it satisfactory and reconlmend that it be accepted.
RADIATION DERMATITIS AND WOUND CARE IN THE BREAST CANCER PATIENT
By DIANA JEAN WOOLLUM
A clinical project submitted in partial fulfillment of the requirements for the degree of MASTER IN NURSING
源自文库
IV
INTRODUCTION Breast cancer can affect any woman, despite race, age or ethnic background. According to the American Cancer Society (2005), out of an estimated 662,870 women who develop cancer, 32% will be diagnosed with breast cancer. Many women with early stage breast cancer are candidates for breast conservation therapy, which combines conservative surgery with radiation (Fisher et aI., 2002). In more advanced breast cancer requiring mastectomy, adjuvant radiation therapy has been shown to improve overall survival (Ragaz et aI., 1997). In 2001, 67,391 (44%) women that were diagnosed with breast cancer were treated with radiation (American College of Surgeons, 2001). Despite technological advances in the way radiation is delivered to patients, it is estimated "in some series, that 90% of patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis (Porock & Kristjanson, 1999). The purpose of this article is to introduce products that are currently being used or have been used in clinical studies throughout the country. The goal is to determine which products decrease pain and promote healing in breast cancer patients undergoing radiation therapy experiencing radiation dermatitis. Currently the literature is devoid of clinical standards of care for the treatment of radiation dermatitis. Radiation Therapy Radiation therapy is defined as, "the use of high energy x-rays or particles to treat disease" (Bruner, Haas, & Gosselin-Acomb, 2005, p.12). Radiation is delivered through medial and lateral tangential x-ray beams for the duration of six to seven weeks of daily treatments. A tangential beam minimizes the volume of normal lung and cardiac tissue that is irradiated (Harper, Franklin, Jenrette, & Aguero, 2004, p 989). The intracellular
III
RADIATION DERMATITIS AND WOUND CARE IN THE BREAST CANCER PATIENT
Abstract
By Diana Jean Woollum, M.N. Washington State University May 2005
Chair: Lorna Schumann Radiation dermatitis is a common side effect in the breast cancer patient receiving radiation therapy. This reaction causes increased pain and ultimately decreased quality of life. The purpose of this article is to introduce the reader to products that are currently being used or have been used in clinical studies for radiation therapy and wound care. The goal is to detennine which products decrease pain and promote healing in breast cancer patients with radiation dennatitis. Ultimately, nurse practitioners will be able to use this as a guide in understanding and treating breast cancer patients who present with radiation dermatitis.
1
target is cancer cell DNA (Harper et aI., 2004, p 989). The goal is to damage the defective DNA (cancer) and cause cellular death to rapidly growing cancer cells. One must remember that skin cells also grow rapidly and are affected by radiation therapy. There should be a balance between eradicating the cancer and minimizing damage to the skin, also known as radiation skin necrosis. Radiation and Skin In order to understand the pathophysiology of radiation damage to the normal skin, it is important to review how the skin normally regenerates itself. The skin is made up of two layers; the epidermis and dermis. As superficial cells are shed through normal desquamation, new cells are formed in the basal layer of the epidermis and these cells continually replace those that are lost. The dermis, which contains blood vessels, sweat glands, nerves and hair follicles, provides the supportive structure required for the epidermis to regenerate. (Figure 1 - Skin layers). The normal process of renewing the epidermis takes approximately four weeks (Wells & MacBride, 2003, p. 135). Ionizing radiation damages the mitotic ability of stem cells within the basal layer. This prevents the process of repopulation and thus weakening the integrity of the skin. Repeated radiation impairs cell division within the basal layer, so the degree to which a skin reaction develops is dependent on the survival of actively proliferating basal cells in the epidermis. Moist desquamation occurs when stem cells in the basal layer are eradicated. This inhibits repopulation in time to replace the damaged tissue. (Glean et aI., 2001, pg. 75-81). Radiation causes a skin reaction after an accumulated dose is given to the tumor and the surrounding tissue. These reactions are measurable by four different grades.
ii
TABLE OF CONTENTS Page ABSTRACT. ... .... ..... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ...... ... .. INTRODUCTION. ... ....... .. ... ... ... ... ... ... ... .... .. ... ... ... ... ... ... ... ... .... Radiation Therapy................................... .............. ........... Radiation and Skin. ... ...... ... ... ... ... ... ... ... .... .. ... ...... ...... ... ..... Skin Care ,. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . .. ...... .
1 1 1 2 3 4 4 5 8 9 12 13 14 14 14 15 15 17 21 21 22 23
Framework..................................................................... Goals of Treatment. Review of Literature. ... ... .... .. ... ... ... ... ... ... ... ... ......... ... ... ... .... Products..... RadiaCare Gel. ......................................................... Xenaderm............................................................... Humatrix................................................................ Product Summary. ................................. .................... DISCUSSION............................................................................ Strengths....................................................................... ... Limitations........................................................................ Role of the Nurse Practitioner............................................... ... CONCLUSION & FURTHER IMPLICATIONS.................................... REFERENCES. ... ... ... ... ... ... ...... ...... ... ... ... ... ... ... ... ............ ... ... ... .... FIGURES................................................................................... Skin........... Noble-Adams Conceptual Framework. ............. ..... ... ...... ... ... ... . Proposed Conceptual Framework....................
WASHINGTON STATE UNIVERSITY College of Nursing May 2005
To the Faculty of Washington State University: The members of the Committee appointed to examine the clinical of DIANA JEAN WOOLLUM find it satisfactory and reconlmend that it be accepted.
RADIATION DERMATITIS AND WOUND CARE IN THE BREAST CANCER PATIENT
By DIANA JEAN WOOLLUM
A clinical project submitted in partial fulfillment of the requirements for the degree of MASTER IN NURSING
源自文库
IV
INTRODUCTION Breast cancer can affect any woman, despite race, age or ethnic background. According to the American Cancer Society (2005), out of an estimated 662,870 women who develop cancer, 32% will be diagnosed with breast cancer. Many women with early stage breast cancer are candidates for breast conservation therapy, which combines conservative surgery with radiation (Fisher et aI., 2002). In more advanced breast cancer requiring mastectomy, adjuvant radiation therapy has been shown to improve overall survival (Ragaz et aI., 1997). In 2001, 67,391 (44%) women that were diagnosed with breast cancer were treated with radiation (American College of Surgeons, 2001). Despite technological advances in the way radiation is delivered to patients, it is estimated "in some series, that 90% of patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis (Porock & Kristjanson, 1999). The purpose of this article is to introduce products that are currently being used or have been used in clinical studies throughout the country. The goal is to determine which products decrease pain and promote healing in breast cancer patients undergoing radiation therapy experiencing radiation dermatitis. Currently the literature is devoid of clinical standards of care for the treatment of radiation dermatitis. Radiation Therapy Radiation therapy is defined as, "the use of high energy x-rays or particles to treat disease" (Bruner, Haas, & Gosselin-Acomb, 2005, p.12). Radiation is delivered through medial and lateral tangential x-ray beams for the duration of six to seven weeks of daily treatments. A tangential beam minimizes the volume of normal lung and cardiac tissue that is irradiated (Harper, Franklin, Jenrette, & Aguero, 2004, p 989). The intracellular
III
RADIATION DERMATITIS AND WOUND CARE IN THE BREAST CANCER PATIENT
Abstract
By Diana Jean Woollum, M.N. Washington State University May 2005
Chair: Lorna Schumann Radiation dermatitis is a common side effect in the breast cancer patient receiving radiation therapy. This reaction causes increased pain and ultimately decreased quality of life. The purpose of this article is to introduce the reader to products that are currently being used or have been used in clinical studies for radiation therapy and wound care. The goal is to detennine which products decrease pain and promote healing in breast cancer patients with radiation dennatitis. Ultimately, nurse practitioners will be able to use this as a guide in understanding and treating breast cancer patients who present with radiation dermatitis.
1
target is cancer cell DNA (Harper et aI., 2004, p 989). The goal is to damage the defective DNA (cancer) and cause cellular death to rapidly growing cancer cells. One must remember that skin cells also grow rapidly and are affected by radiation therapy. There should be a balance between eradicating the cancer and minimizing damage to the skin, also known as radiation skin necrosis. Radiation and Skin In order to understand the pathophysiology of radiation damage to the normal skin, it is important to review how the skin normally regenerates itself. The skin is made up of two layers; the epidermis and dermis. As superficial cells are shed through normal desquamation, new cells are formed in the basal layer of the epidermis and these cells continually replace those that are lost. The dermis, which contains blood vessels, sweat glands, nerves and hair follicles, provides the supportive structure required for the epidermis to regenerate. (Figure 1 - Skin layers). The normal process of renewing the epidermis takes approximately four weeks (Wells & MacBride, 2003, p. 135). Ionizing radiation damages the mitotic ability of stem cells within the basal layer. This prevents the process of repopulation and thus weakening the integrity of the skin. Repeated radiation impairs cell division within the basal layer, so the degree to which a skin reaction develops is dependent on the survival of actively proliferating basal cells in the epidermis. Moist desquamation occurs when stem cells in the basal layer are eradicated. This inhibits repopulation in time to replace the damaged tissue. (Glean et aI., 2001, pg. 75-81). Radiation causes a skin reaction after an accumulated dose is given to the tumor and the surrounding tissue. These reactions are measurable by four different grades.
ii
TABLE OF CONTENTS Page ABSTRACT. ... .... ..... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ...... ... .. INTRODUCTION. ... ....... .. ... ... ... ... ... ... ... .... .. ... ... ... ... ... ... ... ... .... Radiation Therapy................................... .............. ........... Radiation and Skin. ... ...... ... ... ... ... ... ... ... .... .. ... ...... ...... ... ..... Skin Care ,. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . .. ...... .