Censabella, S., Claes, S., Orlandini, M., Braekers, R., Thijs, H., & Bulens, P. (2014). Retrospective study of radiotherapy-induced skin reactions in breast cancer patients: Reduced incidence of moist desquamation with a hydroactive colloid gel versus dexpanthenol. European Journal of Oncology Nursing, 18, 499–504.

To compare the efficacy of dexpanthenol cream versus hydroactive colloid gel application during breast radiation therapy (RT)

In this retrospective study, one group of patients receiving breast radiotherapy applied dexpanthenol cream three times per day from day 1 through day 12 of radiation. From day 13 to completion, they switched their skin care regimen to hydroactive colloid gel (Flamigel^®). The other group of patients with breast cancer applied only dexpanthenol cream three times per day throughout the entire course of radiation. All patients were women with breast cancer who received a total dose of 66 Gy. Skin assessment was performed by oncology nurses using World Health Organization grading criteria for acute skin toxicity. The occurrence and time to onset of moist desquamation were endpoints for this study.

• N = 483
• MEAN AGE = 57 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Patients receiving neoadjuvant chemotherapy; hormone therapy allowed; brachytherapy patients excluded

• SITE: Single-site
• SETTING TYPE: Outpatient
• LOCATION: Belgium

• PHASE OF CARE: Active antitumor treatment

Retrospective study

• World Health Organization criteria for grading acute skin toxicity scale, breast size in diameter, chemotherapy administration, and time to onset of moist desquamation

Patients who used the hydroactive colloid gel preparation experienced moist desquamation significantly later than patients who used only the dexpanthenol cream (p < 0.0001); however, breast size had a higher hazard ratio till time to development for patients using the cream than those using the gel. The incidence of most desquamation was significantly lower in the group using the gel (p < 0.0001). The incidence was highest in women with large breasts.

Patients with breast cancer undergoing radiotherapy may benefit from using a hydroactive colloid gel from the beginning of radiation treatment until the completion of treatment for the prevention of moist desquamation. The strength of this evidence is limited because of this study's design. Women with large breasts were at higher risk for the development of moist desquamation.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement validity/reliability questionable
• Other limitations/explanation: This was a retrospective study. There was no follow-up regarding skin reaction and healing time. No subjective assessments were done during treatment (i.e., pain, quality of life, itching). No exact known concentration of ingredients used in either skin preparation was described. The treatments consisted of different vehicles of delivery (oil versus gel). Women who initially used dexpanthenol were then switched to the hydroactive colloid gel; this would have influenced final results.

When applied three times daily, the use of a hydroactive colloid gel may provide healing benefits for the skin of patients with breast cancer undergoing radiotherapy and decrease the time to onset of moist desquamation.