INTRODUCTION:

Cancer is a universal and non-communicable disease that affects people without regards to gender, culture, race and economic status. It can occur at any organ or part of body and involves any types of tissue or cells. There are huge variations in the occurrence of cancer throughout the world. Cancer is the second most common killer disease in many nations [1].

Radiotherapy is one of the main modality in the management of cancer treatment, along with chemotherapy and surgery. The goal of Radiotherapy is to provide maximum damage to tumor with the minimal side effect [2]. One of the most common side effects of radiation is acute skin reaction, affecting up to 90% of people receiving radiation treatment for their cancer [3-7].

The reactions are the result of radiation treatment disrupting the normal process of cell division and regeneration in the basal cell layer of the skin, resulting in cell damage or cell death [8]. The damage can be a result of several processes, including a reduction of endothelial cell changes, inflammation, and epidermal cell death. The tissue damage occurs immediately after the first dose of Radiation therapy [9, 10].

Effects of Radiotherapy on skin are Inflammation of skin tissue within the radiotherapy field, discoloration of the overlaying skin, desquamations, epilation within the radiotherapy field, edema of skin, breakdown of skin with minor trauma, ulceration and burn and bleeding [10,11].

The severity of skin reaction varies from mild erythema to sever moist desqumation and necrosis [12, 13]. The higher prevalence of Radiotherapy induced skin reaction has created interest in methods of preventing and managing such reactions.

So that radiation induced skin reactions cannot be avoided but some positive efforts can be effective in its management. So we have to provide a sound educational programme to patient, during and after the radiotherapy to protect and minimizing radiation induced skin reactions.

OBJECTIVES:

1. To assess the knowledge and practices of cancer patients in selected hospital for management of Radiation induced skin reactions and association with selected variables.

2. To assess the correlation between knowledge and practices regarding skin reactions.

3. To seek the association between knowledge and practices for management of Radiation induced skin reactions with selected variables.

MATERIAL AND METHODS:

Present study was conducted at Radiotherapy unit, Safdarjung hospital, New Delhi during October2015-january 2016. A total of 60 patients were selected for the present study. Sampling was performed among cancer patients receiving Radiotherapy. Purposive sampling was used and samples were selected, who were receiving Radiotherapy dose more than 30 Gy. by Cobalt -60 machine. Both male and female were included in the study. Patients, who had received Radiotherapy less than one week treatment duration and having history of skin cancer, were excluded from the study. Data was collected by using demographic profile, knowledge questionnaire and expressed practice checklist. Quasi experimental approach was selected for study.

Ethical consideration

Ethical clearance was obtained from the Institute Ethics Committee. The study participants were the Cancer patients receiving Radiotherapy at Safdarjung hospital, New Delhi. Written informed consent was taken from subjects. The study participants were assured that the obtained findings would be used for the research purpose only.

Data analysis

Data was coded, entered in MS Excel worksheet and analyzed. Descriptive analysis was used using frequency, percentage, mean, SD and chi-square tests, p- value of <0.05 was taken as statistically significant.

Table No.-01 Frequency and percentage distribution of demographic characteristics and clinical profile. N=60

Sample characteristics

Frequency

Percentage

Experimental Group

Control Group

Total

01. AGE

A. 05-20 Years

B. 21-40 Years

C. 41-60 Years

D. Above 60 Years

3.33

28.33

35.00

33.33

02. GENDER

A. Male

B. Female

54.67

43.3

03. TYPES OF CANCER(Area)

A. Head and neck

B. Chest

C. Abdominal cavity D. Pelvic cavity

63.33

16.67

20.00

04. STAGE OF CANCER

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

20.00

55.00

20.39

02.91

05. TREATMENT APPROACH

A. Only Radiotherapy

B. Radiotherapy with Chemotherapy

51.67

48.33

06. PERSONAL HABITS

A. Smoking B. Alcohol

C. Tobacco chewing D. None

23.33

03.33

25.00

48.33

07. DOSE OF RT

A. 40-50 Gy

B. 51-60 Gy

C. 61-70 Gy

D. Above 70 Gy

51.67

13.33

35.00

Table No.- 2 “t” value of Pretest and Post test Knowledge scores of Cancer patients of Experimental group and Control group. N=60

GROUP

KNOWLEDGE

MEAN

SD_D

SE_MD

t- value

EXPERIMENTAL GROUP (N=30)

POST TEST

17.90

7.00

0.O65

1.527

4.584^*

CONTROL GROUP (N=30)

POST TEST

10.90

“t” value at df (58) t-value = 2.0017, * significant at 0.05 level of significance

TABLE No.- 3 “t” value of Pretest and Post test Practice scores of Cancer patients of Experimental group and Control group. N=60

GROUP

PRACTICE

MEAN

SD_D

SE_MD

“t”- value

EXPERIMENTAL GROUP (N=30)

POST TEST

13.93

6.60

1.794

1.406

4.694^*

CONTROL GROUP (N=30)

POST TEST

07.33

“t” value at df (58) t-value = 2.0017, * significant at 0.05 level of significance

TABLE No.-4 Coefficient of correlation between post-test knowledge and practice scores in experimental group. N=30

GROUP	CORRELATION BETWEEN POST TEST KNOWLEDGE AND PRACTICE SCORES
Experimental group (N=30)	VERIABLES	MEAN	MEAN DIFFERENCE	“r” Value
	POST TEST KNOWLEDGE SCORES	17.90	03.97	0.3613^*
	POST TEST PRACTICE SCORES	13.93

“r” value at df (29) r-value = 0.355, * significant at 0.05 level of significance

TABLE – 05 Chi-square values showing associations between post test knowledge scores and selected factors of experimental group N=30

Selected variables

Above median

Below median

Chi-square χ²

1.AGE (years)

A. 5-20

B. 21-40

C. 41-60

D. Above 60

2.313^*

Df-3

2.TYPES OF CANCER(Area)

A. Head and neck

B. Chest

C. Abdoman cavity

D. Pelvic cavity

1.611^*

Df-2

3.STAGE OF CANCER

A. Stage I

B. Stage II

C. Stage III

D. 4. Stage IV

1.6797^*

Df-3

4.Dose of Radiotherapy

A. 40-50 Gy

B. 51-60 Gy

C. 61-70 Gy

D. Above 70 Gy

0.934^*

Df-2

^{* =}Not significance

TABLE – 6 Chi-square values showing association between post test practice scores and selected factors of experimental group.

N=30

Selected variables

Above median

Below median

Chi-square χ²

1. AGE (years)

I. 5-20

II. 21-40

III. 41-60

IV. Above 60

3.025^*

Df-3

2.TYPES OF CANCER(Area)

I. Head and neck

II. Chest

III. Abdmen cavity

IV. Pelvic cavity

0.021^*

Df-2

3.STAGE OF CANCER

I. Stage I

II. Stage II

III. Stage III

IV. Stage IV

1.891^*

Df-3

4.Dose of Radiotherapy

I. 40-50 Gy

II. 51-60 Gy

III. 61-70 Gy

IV. Above 70 Gy

5.782^*

Df-2

^{* =}Not significance

RESULT:

Present study was conducted with aim to assess the effectiveness of structured teaching programme (STP) in terms of knowledge and practices about Radiotherapy induced skin reactions. STP was found an effective strategy for enhancing knowledge (t value-4.584^*) and improving practices (t value-4.694^*) of Cancer patients receiving Radiotherapy. There was statistically significant correlation (r value-0.3613^*) between knowledge and practices regarding management of skin reactions. Knowledge and practices, both were enhanced with help of STP. Age, dose of Radiotherapy, types of cancer and stage of cancer were independent, these factors have no association with knowledge and practices.

DISCUSSION:

Cancer is a global reason for morbidity and mortality. Radiotherapy is crucial part of cancer treatment. Radiation therapy is like blessing for cancer patients but it has some drawbacks. Skin reactions are the most comman side effect of Radiotherapy. Skin reactions are inevitable but these reactions may be minimized with sound knowledge and good practices. Public awareness and early prevention programmes are important in minimizing the Radiotherapy induced skin reactions. The study was conducted with the aim to develop an educational programme for cancer patients and evaluate its effectiveness in term of knowledge and practices. Many research in the past and present decades used many interventions to increase the knowledge and practice of Cancer patients undergoing Radiotherapy.

The present study revealed that, there was a significant difference between post test knowledge scores and practice scores of Experimental and Control group. This finding is consistent with the findings of the research study conducted by Hassam JB and M. Atoof Al-Attar (2014) which reported that Nurses have poor knowledge about the management of Radiotherapy induced skin reaction of patients undergoing radiotherapy of breast cancer [14]. The study also revealed that there is a significant difference between pretest and post test knowledge scores and practice scores of Experimental group. In contrast to our findings, Mary B. and D’Sa JL (2014) conducted a study, which reported that educational package on cervical cancer to determine its effectiveness in terms of significant increase in knowledge of rural women regarding cervical cancer [15]. The educational program was effective in improving knowledge and practices of women regarding cancer. As per Ellen Trueman (2011), the educational toolkit for management of Radiotherapy induced skin reaction was helpful for in upgrading the knowledge of participents. The toolkit provides guidance and educational support to cancer patients undergoing Radiotherapy [16]. This finding was consistent with our study.

In contrast to our data, Corole Bauer et al. (2015) conducted a study on skin care practices of cancer patient receiving Radiation therapy. Skin care protocol was effective minimizing skin toxicity [17].

The study also revealed that there was no association of knowledge and practices with age, stage of Cancer, dose of Radiotherapy and types of Cancer. No study was available to compare the result of our study. Structure teaching programme was effective not only in enhancing knowledge but also the practices about Radiotherapy induced skin reactions. No research was available to compare the findings of the study.

So the present study proved to be effective in enhancing the knowledge and practices of cancer patients about management of Radiotherapy induced skin reactions. It showed a significant increase in knowledge and practice of Cancer patient undergoing Radiotherapy. Health care providers have to impart the knowledge about skin reactions prior to radiotherapy

CONCLUSION:

Structured teaching programme on management of Radiotherapy induced skin reactions was found to an effective strategy in enhancing the knowledge and practice of cancer patients. There was relationship between post test knowledge and post test practice scores means knowledge was increasing with good practices. Knowledge and practices were independent and having no relationship with age, dose of Radiotherapy, types of cancer and stage of cancer. Skin reactions can’t prevent but minimized by good skin care practices.

REFERENCES:

1. Xiaomie Ma and Herbert Yu. Global Burden of Cancer. Yale Journal of Biology and Medicine.2006;79 (3-4):85-94.

2. Maddock–Jennings W, Wilkinson JM, Shillington D. Novel approaches to radiation induced skin reactions: a literature review. Complementary Therapies in Clinical Practices. 2005; 11(4):224–31.

3. Porock D. Factors influencing the severity of radiation skin and oralmucosal reactions: development of a conceptual framework. European Journal of Cancer Care. 2002; 11(1):33–43.

4. Petrova et al. skin Toxicity during Hypo fractionated breast irradiation in patient with early breast cancer. 3^ed Medical physics and Biomedical Engineering conference. www.iaea.org

5. Rebecca L. et al. A cancer journal for clinicians.2016; 66(1): 7-30.

6. Rosella Di Franco. Radiation Oncology.2013; 8(1): 1

7. Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A review of our current understanding. American Journal of Clinical Dermatology. 2016;17(3):277-92

8. Sitton E. Early and late radiation-induced skin alterations. Part II: Nursing care of irradiated skin. OncolNurs Forum 1992; 19(6):907–912.

9. Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment. Journal of the American Academy of Dermatology. 2006; 54(1):28–46.

10. Bastrom A, Lindman H, Swartling C, Berne B, Bergh J. Potent corticosteroid cream significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiotherapy Oncology. 2001; 59(5):257-265.

11. Bolderston A, Liyod NS, Wong RK, Holden L, Robb-Blenderman L. The prevention and management of acute skin reactions to radiation therapy: a systematic review and practice guideline. Support Care Cancer. 2006; 14:802-817.

12. Glean E, Edwards S, Faithfull S, Meredith C, Richards C, Smith M, et al. Intervention for acute radiotherapy induced skin reactions in cancer patients: the development of a clinical guideline recommended for use by the College of Radiographers. Journal of Radiotherapy in Practice.2001; 2:75-84.

13. Noble-Adams R. Radiation induced skin reactions 3: evaluating the RISRAS. British Journal of Nursing. 1999; 8(19): 1305–1312.

14. Hassam JM and Wafaa M. Atoof. Effectiveness of an educational programme on Nurse’s knowledge concerning side effect of Radiotherapy at Al-Amal National hospital for cancer managementin Baghdad city. Kufa Journal for Nursing Scinceses. 2015; 5(2): 1-10.

15. Mary B and D’Sa JL. Evaluation of an educational programme on cervical cancer for rural women in Mangoalore, Southern India. Asian Pacific Journal of Cancer Prevention. 2014; 15(16):6603-6608.

16. Trueman E. Skin reactions in radiotherapy. Nursing Times.2010; 108(6):17

17. Corole Bauer, Palela Laszewski and Morris Magnan. Promoting Adherence to Skin Care Practices among Patients Receiving Radiation Therapy. Clinical Journal of Oncology Nursing.2015; vol-19(2): 196-198

Received on 19.02.2017 Modified on 01.03.2017

Int. J. Nur. Edu. and Research. 2017; 5(2): 198-202.

DOI: 10.5958/2454-2660.2017.00043.6