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Radiation Side Effects

  • Skin care management in cancer patients: an evaluation of quality of life and tolerability

    Chicago, IL (Northwestern University - Original Article) –March 25th, 2010
    Ann Cameron Haley, Cara Calahan, Mona Gandhi, Dennis P. West, Alfred Rademaker and Mario E. Lacouture

    Thursday, March 25th, 2010

    Skin care in cancer patients is suboptimal in part due to a lack of products and knowledge specific for this population. Our findings suggest that QoL improves with test article use, all of which were rated as good/very good for tolerability. Moreover, skin toxicity as manifested by dry skin, hand-foot skin reaction, and skin rash (dermatitis) were decreased with use of test articles within 4 weeks.

    Discussion

    Dermatologic toxicities are common side effects associated with anticancer treatments, and these adverse events often negatively impact a patient’s quality of life and willingness to continue with treatment [3]. Management of these events in cancer patients is suboptimal in part due to the lack of products specifically designed for this patient population. In seeking to investigate the tolerability and effects on quality of life for products designed for cancer skin care management, these findings suggest that quality of life, as measured by Skindex-16, improves with products specifically designed for cancer skin care management. Moreover, the severity of skin toxicity graded according to CTCAE decreases within 1-month use of products specifically designed for cancer skin care management, and dermatology quality of life significantly improves as early as 1 month for individual domains (symptoms, emotions, functions).

    This study demonstrates that products specifically designed for cancer skin care management improve skin-related quality of life. Moreover, patients with rosacea and rosacea-like erythematous facial skin are often very sensitive to skin care products that can worsen inflammation and produce irritation [16]. This study demonstrated cancer patients with pre-existing rosacea tolerate test articles A, B, and C. Maintenance of cutaneous integrity during cancer treatments with the use of moisturizers may aid in mitigating dry skin, which may be associated with pruritus and infections, minimizing these comorbidities [17, 18].

    In summary, specifically tailored skin care management for cancer patients is well tolerated by patients currently undergoing anticancer therapy or radiation, and a majority of subjects report that such therapies are better than previous regimens used. A majority of participants also report improved dermatology QoL. Previous studies indicate that dermatology QoL rebounds within 4 months of completion of anticancer regiments, making it important for patients to receive interventions during anticancer therapy and the immediate 4-month follow-up period [19].

    Advance knowledge of side effects and proactive management approaches have been shown to decrease anxiety, improve adherence to cancer treatment, and improve QoL and patient outcomes [5]. Studies suggest that anticancer therapy side effects are less anxiety provoking when anticipated [20]. If patients engage in anticipatory coping, a mechanism involving “affective and behavioral rehearsal,” patients feel in control when toxicities resulting from cancer treatments arise [21]. A cancer skin care management program fulfills patient engagement of anticipatory coping in order to optimally anticipate and control cutaneous side effects associated with anticancer therapy.

    Acknowledgments  We are grateful to Lindi®Skin for providing test articles. M.E.L. is supported by a Zell Scholarship from the Robert H Lurie Comprehensive Cancer Center and a Dermatology Foundation Career Development Award.

  • Helping to win back Control of Your Life After Undergoing Cancer Therapy

    Health Talk Radio with Mealine Cole M.S.

    (Health RadioOriginal Post)

    Listen to the Full Interview Here

    Excerpt from Health Radio:   “A recent survey by CancerCare showed that nearly 80% of people with cancer were concerned about the impact skin effects had on their quality of life during treatment. Unfortunately, many people don't realize the issues created by skin effects. In a first-ever initiative, renowned health-care providers identify and describe how cancer treatment-related toxicities have a negative effect on quality of life from the perspective of patients and survivors.

    Advances in cancer treatments have greatly improved survival rates for many diagnoses. Yet, the lingering side effects of many cancer treatments have only recently begun to be addressed.

    For Lindi Snider, the creation of Lindi Skin started with her personal experience watching friends go through cancer treatment. They expected the nausea, fatigue and hair loss associated with chemotherapy and radiation therapy, but they were not aware of the impact that these therapies would have on their skin. In discovering there was not one line of skin care products specifically developed for people with cancer, it occurred to Lindi that someone had to create one.. and so she did. She aligned herself with dermatologists, oncologists, nurses, patients and skincare formulators to create the first and only complete skin care line developed for the unique needs of people with cancer. She comes on the show to discuss her experiences and how they have changed her life.”

  • Chemo/Radiation Side Effects

    Oncology Nursing News - Original Article –January 12th, 2010

    Because chemotherapy targets rapidly growing cells, skin, hair follicles and nails are also frequently affected. The most common reactions to chemotherapy include hair loss, hyperpigmentation, hand-foot syndrome, extravasation injuries, and nail dystrophies. Hypersensitivity can also occur, but is less common.1 Although these disorders are not life threatening, they can cause significant distress to patients. LEARN MORE

    Oncology Nursing News Logo

    http://www.oncologynursingnews.com/

  • Landmark study reports skin toxicities

    New York & Philadelphia (Supportive Care in Cancer) January 6th, 2010

    In a first-ever initiative, renowned health-care providers identify and describe how cancer treatment-related toxicities have a negative effect on quality of life from the perspective of patients and survivors. The findings of this study, made possible by CancerCare and Lindi Skin, are now available exclusively from the medical journal, Supportive Care in Cancer, at http://www.springerlink.com/content/9n31658g173g1277/.

    “The impact of dermatologic toxicities was found to be unanticipated prior to cancer treatments, to a greater degree than gastrointestinal and constitutional side effects” stated Dr. Mario Lacouture, Associate Attending Physician, Memorial Sloan-Kettering Cancer Center. “Since these events have a negative effect on survivors' lives, pretreatment counseling and effective interventions are vital in order to maximize quality of life and minimize unnecessary treatment interruptions or discontinuations.”

    This landmark skincare study was pursued by medical leaders and centers including: Mona Gandhi, Department of Dermatology, Northwestern University’s Feinberg School of Medicine; Karen Oishi, University of Texas, M.D. Anderson Cancer Center, Houston, TX; Beth Zubal, Washington University School of Medicine, St. Louis, MO; and Dr, Mario E. Lacouture SERIES Clinic, Robert H Lurie Comprehensive Cancer Center, Northwestern University’s Feinberg School of Medicine, now at Memorial Sloan-Kettering Cancer Center.

    “Advances in cancer treatments have greatly improved survival rates for many diagnoses. Yet, the lingering side effects of many cancer treatments have only recently begun to be addressed,” said Rosalie Canosa, Program Division Director, CancerCare. “This survey breaks new ground in understanding not only the physical but also the psychological impact of these side effects from the patient’s perspective, and what can be done to help alleviate them.” 

    The results of this breakthrough study released by Supportive Care in Cancer articulate that cancer survivors reported an increased concern regarding dermatologic toxicities, including irritated and dry skin, after receiving their cancer treatment. These events had a negative effect on their lives.

    CancerCare is a national nonprofit organization that provides free, professional support services to anyone affected by cancer: people with cancer, caregivers, children, loved ones, and the bereaved. CancerCare programs—including counseling and support groups, education, financial assistance and practical help—are provided by professional oncology social workers and are completely free of charge. Founded in 1944, CancerCare provided individual help to more than 100,000 people last year, in addition to the more than 1 million unique visitors to its websites. Find out more about CancerCare by calling 1-800-813-HOPE (4673) or at www.cancercare.org.

    Lindi Skin (www.lindiskin.com ) was created with the counsel of leading dermatologists and oncologists for those suffering the skin side effects of specific cancer therapies. This extensive collection of mild and luxurious serums, lotions and balms is the only full line of skincare products developed to improve the lives of individuals undergoing chemotherapy and radiation therapy.

    Press Contact: Leslie Padilla / 610-500-4698 / l_padilla@comcast.net

  • Maintaining Skin, Hair and Nail Health for Cancer Patients and Survivors

    Chicago, IL (Northwestern Memorial HospitalOriginal Article) June 23rd, 2009

    Transcript of Power Patient webcast with Mario Lacouture, M.D.

    Excerpt:

    The Cancer Skin Care Program at Northwestern
    Andrew Schorr:
    Most everyone knows that today's intense, often, cancer treatment can cause side
    effects. Normally there are some side effects, and they can be on your hair, your
    skin and your nails, and certainly that can impact a patient's quality of life. Coming
    up next on Patient Power is an interview with an expert from Northwestern
    Memorial Hospital sharing his knowledge how best to manage these side effects.

    Andrew Schorr:
    Hello and welcome to once again to Patient Power sponsored by Northwestern
    Memorial Hospital. I'm Andrew Schorr. Well, we all know that our efforts to beat
    cancer with powerful medicines can have side effects that go along with it. Now,
    these are side effects that you may experience while you're going through
    treatment, or they could be effects that come later, even years later, and so you
    need to be mindful of that. Now, the most apparent side effect that many people
    are aware of from some cancer drugs is some drugs can you cause you to lose your
    hair. I was a leukemia patient, the drugs I took didn't cause that, although I was
    bald already, but women who have been treated for breast cancer or kids who are
    treated for leukemia may lose their hair, but there also can be effects on your skin
    or your nails. And beyond that is some of the newer medicines do have side effects
    like this. So newer medicines, even more powerful, but can have some significant
    effects on your skin.

    And of course the one thing you don't want to have happen during treatment is
    have these effects become so great that you need to stop your therapy, in other
    words put a stop to the cancer-fighting medicines that you're taking. Well, there is
    a doctor at Northwestern, an oncologic dermatologist, who specializes in helping
    cancer patients get through all this, stay on their therapy or deal with later effects,
    and that is Dr. Mario Lacouture. He's a dermatologist at Northwestern Memorial
    Hospital, and he's assistant professor of dermatology at Northwestern University's
    Feinberg School of Medicine. Also I should tell you that he is the director of the
    cancer skin care program in the department of dermatology at the Robert H. Lurie
    Comprehensive Cancer Center at Northwestern. Dr. Lacouture, thank you so much
    for being with us. Tell us, this program sounds quite unusual, and I know it was
    the first in the country, started just in early 2006. What is this program?

    Read the full webcast HERE

  • Scientific Findings: Cancer and Skin Toxicity

    San Francisco, CA (UCSF Department of DermatologyOriginal Article) April 20th, 2009

    Abstract: As inhibitors of the epidermal growth factor receptor (EGFR) become an increasingly common therapeutic option in cancer, appropriate management of their associated toxicities emerges as a critical part of treatment. Cutaneous manifestations, probably linked to the function of the EGFR in epithelial development, are the most common adverse reactions to EGFR inhibition. The key manifestations are follicular eruptions, nail disorders, xerosis, and desquamation. Growing attention continues to be devoted to the analysis of these events, particularly given their potential role as markers of responsiveness to treatment. However, to date, there are few evidence-based guidelines for the appropriate management of these dermatologic events. Multidisciplinary collaboration between oncologists and dermatologists will be required to improve our understanding and optimize the characterization of these skin toxicities, and to design effective management approaches. Read More

    published April 20th, 2006

     

  • Cancer-Specific Products: An Unnecessary Balm?

    By Kayleen Schaefer

    New York, NY (NY Times - Original Link) Thursday, July 10th, 2008

    FOR the last seven years that Kairol Rosenthal, 35, has battled thyroid cancer with hormone pills, radiation, surgery and grit, she has had to contend with 101-degree fevers, heart palpitations and a lack of appetite so pronounced she has to force herself to eat.

    The hormone therapy, designed to slow tumor growth, leaves red blotches on her face and bone-dry patches along her jaw line, said Ms. Rosenthal, a choreographer and writer in Chicago.

    “I have not yet made my peace with having skin that doesn’t look good,” said Ms. Rosenthal, who spends most of her free time hunting for news about thyroid cancer. “I want my skin to look good.”

    So Ms. Rosenthal was pleased when she heard an advertisement for Lindi Skin, a skincare line designed for cancer patients, on a radio program called “The Stupid Cancer Show.”

    “It’s great someone has cancer patients in mind,” said Ms. Rosenthal, who is writing a book about living with the disease, to be published by Wiley.

    She ordered samples of the brand’s face wash and lavender face serum, which, Lindi Skin’s Web site says, “are intended to help individuals feel better, both physically and emotionally and gain a greater degree of control over the side effects they experience during radiation therapy and chemotherapy.”

    Depending on whom you ask, such products give patients one more tool to ease side effects or false hope that a cancer-specific balm is more effective than a mild drugstore lotion.

    It’s now easier than ever for cancer patients (and their relatives who come bearing presents) to find skin-care lines made specially for them. At least five brands are now sold in the gift shops of prominent hospitals, and some makers give free samples to oncologists for distribution to patients.

    Lindi Skin started in 2003 with six products, after its founder, Lindy Snider, watched two friends endure cancer treatment. In March, its 13-piece line of creams and skin cooling wraps arrived in drugstores including the Duane Reade chain and the independent Minooka Pharmacy in Minooka, Ill. For the first time, the American Cancer Society is considering including Alra, a 20-year-old skin-care line, in its catalog, which is mailed to 1.2 million people.

    As far as cancer side effects go, far greater attention has been paid to hair loss, fatigue and nausea than to the burns caused by radiation and dry skin caused by chemotherapy. But the tide is starting to turn. Northwestern University opened the Cancer Skin Care Program, one of the first centers of its kind, in 2006.

    And oncologists and dermatologists are giving greater consideration to dermatologic issues, in part because new cancer-fighting drugs called targeted therapies can cause rashes so severe that some patients threaten to drop out if they are left untreated.

    “There are more drugs that cause skin issues nowadays,” said Dr. David Decker, an oncologist at William Beaumont Hospital in Royal Oak, Mich. “Radiation has always caused problems, but there are new drugs that cause issues, so skincare has become more of a focus.”

    That has created an opportunity for makers of cancer-specific balms to grab the attention of doctors who previously might have dismissed them. Lindi Skin has nine sales representatives to hand out samples to oncologists (and plans to add three more this year). Jean Soulios of Beverly, Mass., who has had breast cancer, distributes samples of her Jeans Cream, an aloe-and-vitamin-E balm for skin irritated by radiation or chemotherapy, to about 20 hospitals. (It is also now sold in about 75 stores.)

    “Addressing skin care is not unreasonable,” said Dr. David F. Horne, an assistant clinical professor of dermatology at NewYork-Presbyterian/Weill Cornell. “The patient may have a tumor in their lung but the changes they’re seeing are in their skin.”

    Some oncologists don’t wait until a rash or blotches develop. Instead, early in treatment, they recommend soothing body washes and creams to patients. For instance, Dr. David I. Rosenthal, the director of head and neck radiation research at M. D, Anderson Cancer Center in Houston, gives his patients samples of Lindi Skin Cooler Rolls and body lotion.

    “It is my impression that these skin conditions that are cancer-treatment-related are neglected,” said Dr. Rosenthal, who sits on Lindi Skin’s medical advisory board but is not paid by the company. “They can cause discomfort for the patient and should be addressed proactively.”

    Still, there’s no proof that any of the products designed for cancer patients calm or heal skin irritated by radiation or chemotherapy any better than over-the-counter products like Cetaphil or CeraVe, according to the oncologists, dermatologists and oncology nurses interviewed for this article. Even Dr. Rosenthal said that “there’s not been any scientific study to show that these products are superior in any way.”

    Mimi Bartholomay, an oncology clinical nurse specialist at Massachusetts General Hospital Cancer Center, where the gift shop sells Lindi Skin and Jeans Cream, said she worries that cancer patients will think the hospital endorses them. (It doesn’t.)

    “They’re marketing to a vulnerable population,” she said. “Cancer patients go through so many body image concerns and changes. They get scars. Their skin changes from radiation. Sometimes the chemotherapy causes rashes. Their hair can fall out. They’re going to try anything to look and feel better.”

    Ms. Snider of Lindi Skin doesn’t think she’s taking advantage of cancer patients. “Most people, if they have a special need, they’re willing to buy a product,” she said. “It’s sort of like saying, ‘Why isn’t chemo free?’ Doctors who administer chemo make money on that. We need to afford to make these products. I’m trying to fill a need.”

    Jeans Cream and Lindi Skin are packaged in a way that they wouldn’t seem out of place at Bloomingdale’s, but they also sell for department-store prices. Lindi’s body wash costs $20 for 8 ounces, and its face serum, $40 for 1 ounce. Seven ounces of Jeans Cream is $45.

    Ms. Rosenthal, for one, can’t afford them. “Forty bucks,” she said, “is two co-pays to a doctor or four co-pays for my prescription drugs.” But she did like the Lindi line, finding it “excellent for hydrating my skin. I have a hard time tolerating even naturally scented products, but I have no problem with Lindi’s lavender scent.”

    Alra, a three-product line developed by Henry Ott after his wife, Sarah, underwent radiation therapy for breast cancer, is far cheaper, $13 for vitamin-E-and-aloe cream.

    Radiation can cause what looks and feels like a sunburn on the area the beam passes through to get to cancerous cells, and chemotherapy can make the skin and lips dry and itchy because it indiscriminately tries to damage all fast-growing cells, including skin cells.

    Simple wound care should heal skin aggravated by either treatment, the dermatologists interviewed for this article said. They recommended washing the affected area gently, patting it dry, keeping it moist and bacteria-free with a petroleum-jelly product like Aquaphor, and covering it with gauze. “I say to patients, ‘You’ll have just as good as an outcome with standard wound care, rather than expensive products,’ ” said Dr. Horne of NewYork-Presbyterian.

    But targeted therapies can be harder on the skin than radiation or chemotherapy, Dr. Decker and Dr. Rosenthal said. They attack tumor cells specifically instead of all cells and can cause very dry skin or an upper- or full-body rash.

    Dr. Mario Lacouture, the director of Northwestern’s Cancer Skin Care Program, sometimes treats skin conditions caused by targeted therapies with prescription corticosteroids and antibiotics. He will soon begin a study of over-the-counter products to see which best ameliorate side effects of targeted therapies. (Lindi Skin gave a $65,000 contribution to his research.)

    Dianne Dassa, of New York, 66, said that Lindi products helped heal her radiation burn and her psyche. While being treated for breast cancer, she used the Lindi body wash and serum, preferring them to the body wash and Aquaphor her radiologist suggested. When they arrived, Ms. Dassa said, “They were so beautifully packaged, I felt like I was getting a gift.”

  • New Products for Cancer Patients

    (WOWTOriginal Article) May 2nd, 2005

    Researchers have developed skin care products designed specifically for patients undergoing cancer treatment. The Lindi Skin care line doesn't have strong fragrances or ingredients that are known to cause inflammation, sensitivity or irritation.

    The formulations contain natural botanicals with anti-oxidant, anti-bacteria and anti-fungal properties. Sun protection is very important for patients getting cancer treatment. Lindi Sun is a lightweight sun protection spray with an SPF of 30+. There is a skin wash to clean and moisturize the skin, as well as a body lotion. For patients experiencing skin coloration problems, a specially formulated skin tint can be used to cover the area and improve the appearance of the affected skin. Specially designed sheets, called Skin Coolers, can be applied over an area to provide relief for burned or severely dry skin. There are also products for specific areas of the face - a soothing face serum, and eye hydrator and a lip balm. The cost of Lindi Skin care products ranges from $8.00 to $38.00. For information visit the company's website at http://www.lindiskin.com.

    Cancer Treatment: Chemotherapy and Radiation Therapy The American Cancer Society estimates more than 1.3 million cases of cancer will be diagnosed in the U.S. this year. Surgery is often used to remove the cancer (or as much of the cancer as possible). Patients may also receive radiation therapy and/or chemotherapy. Radiation therapy uses high doses of energy to kill cancer cells or stop them from growing. With external radiation, beams of energy are directed from over the patient to a target area inside the body. The radiation travels through healthy tissues to reach the tumor. In internal radiation, tiny radioactive seeds or pellets are implanted into or near the site of the tumor. The implants release high doses of radiation directly to the cancer cells, reducing the risk of harmful radiation to surrounding healthy tissue. Chemotherapy is the use of anticancer drugs to stop the growth of cancer cells. Although the drugs target the cancer, normal cells can also be affected - especially those that grow and multiply very quickly. Chemotherapy may be given to cure a cancer, keep it from spreading, shrink a tumor, destroy any cancer cells that have spread through the body or relieve symptoms associated with the cancer.

    Skin-Specific Side Effects of Radiation Therapy and Chemotherapy Radiation therapy and chemotherapy are both associated with side effects. External beam radiation passes through the body to reach the tumor, thus damaging healthy cells. Doctors try to limit damage by aiming the beam from different directions. However, the skin overlying the target area can still become red, irritated, dry and "burned." In some cases, the sunburn-like reaction can be severe and cause blistering. Some chemotherapy drugs can cause skin redness, dryness, peeling, rashes, itching, acne and sensitivity to the sun (which can cause severe sunburn). The hands and feet are especially prone to redness and dryness, leading to development of painful cracks and fissures in the fingers and toes. In patients who received prior radiation therapy, chemotherapy can sometimes cause an effect known as "radiation recall." In this phenomenon, the skin in the previously targeted area burns and turns red and itchy.

    Dealing with Skin Side Effects Cancer patients often experience a great deal of emotional trauma in dealing with the cancer diagnosis, making treatment decisions and enduring side effects of the treatment. The effects on the skin can be very visible and distressing to the patient. In addition, pain from redness, cracking and burning in the hands and feet can cause difficulty with wearing shoes, buttoning clothing or even preparing foods. Traditional skin care products aren't recommended for cancer patients. Many over-the-counter products contain ingredients that can further irritate sensitive skin, causing even more redness, drying and cracking. Some lotions and creams have aluminum or other metals in them that can interfere with delivery of radiation therapy. READ MORE

  • Scientific Finding: EGFR is target for Chemotherapy

    Los Angeles, CA (USC-Keck School of MedicineOriginal Article) April 5th, 2009

    Abstract: The epidermal growth factor receptor (EGFR) is overexpressed in as many as 77% of colorectal cancer (CRC) cases. The EGFR is known to be involved in carcinogenetic processes such as cell proliferation, apoptosis, angiogenesis, cell motility, and metastasis. Preclinical and clinical studies have shown that targeting EGFR is a valid strategy for anticancer therapy. Currently, 2 classes of anti-EGFR agents are in phase II/III clinical development: monoclonal antibodies and tyrosine kinase (TK) inhibitors. The most established monoclonal antibody is cetuximab, the only EGFR inhibitor that is currently approved for use in patients with metastatic CRC. Several clinical studies of cetuximab, as a single agent or in combination with irinotecan, have shown promising efficacy in patients with metastatic CRC. READ MORE

    published April 5th, 2005

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