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Tuesday, June 15, 2010: 4:03 PM
New Challenges for Management of Impaired Skin and Nail Disorders Associated with Chemotherapy
Yun Jin Lee RN, MSN, KWOCN, KOAPN, OCN
Division of Nursing, Colorectal Cancer Clinic, Severance Hospital, Yonsei University Health System
Purpose
This study was performed to describe skin and nail disorders related to chemotherapy, especially, new biologic anticancer drugs. It shows how important skin and nail assessment is and introduces how to manage skin and nail disorders with complicated problems in cancer patients including with a stoma. Also it was conducted to emphasize the WOCNs role for new challenges in wound management associated with new cancer treatment.
Introduction
Patients being administering chemotherapy are at risk for altered skin integrity. There are a variety of skin reactions which need careful assessment and treatment during chemotherapy and also after treatments. Skin impairment and nail disorders related to chemotherapy such as EGFR-inhibitors(EGFRI), VEGF-inhibitors(VEGFI) and multitargeted kinase inhibitors (MKIs) (i.e. peristomal skin rash and ulcer, hand foot syndrome (HFS), skin toxicity, acneiform eruption, xerosis, fissures, nail changes, paronychia, hyperpigmentation, and impaired wound healing) are emerging as important dermatologic issue in patients with cancer. It has shown activities against multiple malignancies in clinical trials. EGFR-inhibitors (EGFRI) often cause skin toxicity, most frequently as acneiform eruption. xerosis, eczema, fissures, nail changes and paronychia can be seen in some cases. VEGF-inhibitors(VEGFI) cause delayed wound healing resulted from interference with angiogenesis. It causes not only interference with ADL but also interruption in cancer treatment.
Debilitated and immunocompromised patients with cancer have a particular risk for wound infection. Furthermore, some of them have cutaneous skin infections that impact the interference of treatments and require further treatments. In addition, management of impaired skin and nail disorders related to chemotherapy are associated with a significantly more affected negative quality of life and barrier to perform self-care than chemotherapy itself.
Conclusions
There is not yet enough evidence in management of impaired skin and nail disorders associated with new chemotherapy. It is necessary to manage and recognize skin toxicity to assure an improved quality of life in oncology patients. Further investigation is required to develop nursing implications and educational programs to teach self-management to patients regarding different cultural issue in alternative therapy by a multidisciplinery team approach. WOCNs play a key role in educating patients on how to recognize and manage skin and nail toxicity for optimal adherent treatement and support self-care.
Yun Jin Lee RN, MSN, KWOCN, KOAPN, OCN
Division of Nursing, Colorectal Cancer Clinic, Severance Hospital, Yonsei University Health System
Purpose
This study was performed to describe skin and nail disorders related to chemotherapy, especially, new biologic anticancer drugs. It shows how important skin and nail assessment is and introduces how to manage skin and nail disorders with complicated problems in cancer patients including with a stoma. Also it was conducted to emphasize the WOCNs role for new challenges in wound management associated with new cancer treatment.
Introduction
Patients being administering chemotherapy are at risk for altered skin integrity. There are a variety of skin reactions which need careful assessment and treatment during chemotherapy and also after treatments. Skin impairment and nail disorders related to chemotherapy such as EGFR-inhibitors(EGFRI), VEGF-inhibitors(VEGFI) and multitargeted kinase inhibitors (MKIs) (i.e. peristomal skin rash and ulcer, hand foot syndrome (HFS), skin toxicity, acneiform eruption, xerosis, fissures, nail changes, paronychia, hyperpigmentation, and impaired wound healing) are emerging as important dermatologic issue in patients with cancer. It has shown activities against multiple malignancies in clinical trials. EGFR-inhibitors (EGFRI) often cause skin toxicity, most frequently as acneiform eruption. xerosis, eczema, fissures, nail changes and paronychia can be seen in some cases. VEGF-inhibitors(VEGFI) cause delayed wound healing resulted from interference with angiogenesis. It causes not only interference with ADL but also interruption in cancer treatment.
Debilitated and immunocompromised patients with cancer have a particular risk for wound infection. Furthermore, some of them have cutaneous skin infections that impact the interference of treatments and require further treatments. In addition, management of impaired skin and nail disorders related to chemotherapy are associated with a significantly more affected negative quality of life and barrier to perform self-care than chemotherapy itself.
Conclusions
There is not yet enough evidence in management of impaired skin and nail disorders associated with new chemotherapy. It is necessary to manage and recognize skin toxicity to assure an improved quality of life in oncology patients. Further investigation is required to develop nursing implications and educational programs to teach self-management to patients regarding different cultural issue in alternative therapy by a multidisciplinery team approach. WOCNs play a key role in educating patients on how to recognize and manage skin and nail toxicity for optimal adherent treatement and support self-care.