I recently (2016) underwent radiation for breast cancer so I titled this piece “Act II” because this is the second round of radiation for me. The first episode occurred in 2000 for treatment of inoperable throat cancer so I consider myself fortunate that this was not a recurrence of squamous cell cancer of the neck, but a different type of cancer to breast tissue. The breast cancer is a ductal cell type and according to the surgeon and radiologist at Seattle Cancer Care Alliance they are not related.
The type of radiation I received for breast cancer is also different than that I received for throat cancer. I reported that I was the only patient among my cohorts that did not sustain a radiation burn during “Accelerated fractionated radiation” in 2000, which involved radiation twice a day during the last 2½ weeks of the six-week series. I have previously reported on the measures I used to prevent that radiation burn.
This paper focuses on the radiation used for breast cancer and changes in my skin during and following 34 fractions from January 21 through March 4, 2016.
First and foremost I want to report the excellent care I received from the radiation technical team as well as the entire radiation oncology team. The team included the radiation oncologist, registered nurse, dosimetrist and radiation technicians. [1]
Radiation technicians rarely get formal recognition for their work and my team provided highly competent professional care, as well making the experience a positive one. They took weekly photographs for me to document skin changes. [2] I recommend that patients who are undergoing radiation ask for this documentation and follow up with their own photographs post radiation. This is the best way to track skin changes.
What happened this time compared with the 2000 radiation?
With the latest radiation series, a bolus (flat piece of rubber-like material) was placed on the skin to increase the radiation dose to the skin and the tissues just below it. This causes the skin to become increasingly reddened and vulnerable to burn formation.
In addition to the bolus, many breast cancer radiation patients also get an extra dose of radiation that is directed to a circumscribed area. This is termed a “boost.” My boost was directed to the axilla (arm pit) and the area along the mastectomy incision line. This area needs special attention during the boost period, as well as for the two week period following radiation.
I have made appropriate modifications in the original paper on “minimizing radiation burns” to reflect these changes.
Patients who are to undergo radiation for head, neck and breast cancer learn about a litany of possible side effects from the treatment. Among the warnings I received was that about 90% of patients will experience some radiation dermatitis. What the doctor meant was that skin burns occur in about 90% of all patients receiving radiation to the head and neck. The odds are about the same for breast cancer.
With my breast cancer pre-radiation instructions, concerns about a radiation burn were downplayed. I think this is unwise. Patients need to learn that the potential for a radiation burn is real and using terms such as “it is like sunburn and will heal once radiation is finished” does not alert them to the active role patients must play to prevent radiation dermatitis.
Both the radiation oncologist and registered nurse emphasized that skin care following the end of radiation is important. It is very easy to forget about the irradiated area once treatments are finished, but radiation is a treatment that just keeps on giving, so a radiation burn is still possible even though the radiation treatment is completed. At 7 days post radiation, my skin showed signs of flaking although there were no signs of an active burn. At 21 days post radiation, there is more peeling but no signs of a radiation burn. Once I was in the post radiation period I began to use pure lavender essential oil on the reddened areas, as well as Lavender Healing Mist (LHM) and Boiron Calendula Gel. I continued using Green Tea solution once a day.
It pays to attend to your skin both during and following radiation treatment. Skin damage begins with the first radiation treatment; it occurs even when it is not yet visible. A burn can occur up to 21 days following radiation. Aging skin is even more vulnerable than that of younger persons.’ At age 84, my skin did remarkably well.
The location of the area to be irradiated makes a difference. Head, neck and breast cancer patients are very prone to develop radiation burns. Areas of the body that have skin folds such as the groin are also at high risk because of a “bolus effect” (skin folds can cause a higher radiation dosage to the skin). The need to take meticulous care of the skin during radiation and for two to three weeks following completion of radiation is well documented in the literature.
The Salvo, et al. (2010) review of 33 prophylactic (prevention) trials reported that topical corticosteroids were the most common agents used, and that Biafine Cream was not found to be superior to standard regimes in the prevention and management of acute radiation-induced skin reactions. [3]
According to the research literature, the most common methods for preventing and minimizing skin reactions to the irradiated area are the use of corticosteroid creams and Aloe vera or other lanolin-free products. But are corticosteroid creams, Aloe Vera creams and other prescription formulations the best remedies to use? The research literature does not answer that question.
If standard remedies and prescription drugs are not particularly effective or are prohibitively expensive, then should we look for alternative therapies?
What did a search of the alternative literature reveal?
My initial search revealed that tannic acid made from green tea is a potent burn treatment remedy. This was initially reported by two Cleveland Ohio surgeons in 1926. [4] It was because of their work that the extensive burns I experienced at age 6 were successfully treated with tannic acid solution. (See Burning Karma).
This literature search also revealed that in 1910 Rene-Maurice Gattefosse, a French chemist was severely burned on both hands. In his book Aromatherapy, he wrote just one rinse with lavender essential oil stopped the gasification of the tissue. He later began using and studying the effects of lavender essential oil on burned soldiers in military hospitals during World War I. [5]
DeHart and Whalen [6] documented that the use of lavender hydrosol with lavender essential oil in the formula is effective in the treatment of minor burns. Their data show that a first degree burn (redness) can often be prevented from becoming a blister or second degree burn.
Lavender Hydrosol with Essential Oil provides a powerful protection to the skin and is especially effective to protect the skin and minimize radiation skin burns. Pure Lavender Essential Oil is highly effective to treat burns, but prior to an actual burn, lavender hydrosol with essential oil appears to offer better protection for the skin.
Calendula has been used for medicinal purposes since the 12th Century. [7] The University of Maryland recently reported that Calendula has been shown to help prevent dermatitis or skin inflammation in breast cancer patients during radiation therapy. Calendula gel is generally considered safe to use on the skin except for people who are allergic to plants in the daisy or aster family, including chrysanthemums and ragweed; these people may have an allergic reaction to calendula (usually a skin rash).
Several radiation treatment centers recommend Calendula but do not specify the type of formulation. Nor, as a rule do these centers specify how soon to begin a prophylactic or preventative regime. My clinical observations led me to recommend Calendula Gel by Boiron. (Please note that I do not have a professional affiliation with the Boiron Company).
Since Salvo and others note that skin damage begins with the first radiation treatment, it is important to begin any burn preventative regime on the first day of radiation. Skin damage occurs even when it is not yet visible.
Protocol I used to minimize radiation skin burns
My first (DeHart) radiation series (Accelerated Fractionated Radiation) involved radiation once a day for 3½ weeks and twice a day for the final 2½ weeks of treatment. I was at high risk for a radiation burn. I previously described that saga on http://quinary5.com (Radiation Skin Care: How I avoided a radiation skin burn.) [8]
I want to pass onto others what I learned during those six weeks of treatment that may be helpful for others to minimize skin damage while undergoing radiation therapy. I also want to pass onto others what I’ve learned through my second round of radiation.
It is very important to:
- Begin the burn prevention treatment on day 1 of radiation.
- Wash area as soon as possible after treatment with green tea. (Use cotton pads. Do not use soap or rub area vigorously. Green tea solution is made with a YogicTea bag steeped in hot water. Refrigerate to prevent mold.) YogicTea is a brand name and other organic green teas may also work.
- Spray entire area with Lavender Healing Mist (special preparation)
- Breast area: include axilla (arm pits) to protect scatter radiation areas. If the axilla is also a target area because of lymph node involvement then be meticulous in protecting that area. The area just above the clavicle in the neck is also frequently radiated because of its rich source of lymph nodes. Do not neglect any area that is radiated.
- Apply Calendula GEL to the radiated area. (Calendula Gel is available through Amazon.com and some health stores.) Do not use the ointment form of Calendula or Calendula Plus. These have an oil base that may cause the skin to burn when irradiated. (Note: I did this treatment in the hospital bathroom immediately following radiation and then repeated the procedure at home.)
- Do the green tea, Lavender Healing Mist and Calendula gel treatment 3 times per day.
- Pay special attention to the skin during the radiation boost.
- Continue green tea, Lavender Healing Mist and Calendula Gel treatment for at least 2 weeks following the end of Radiation Treatment.
- AVOID oil based preparations on the irradiated area. Oil causes the skin to burn during radiation.
- AVOID swimming because of chlorine in the water.
- The radiation nurse will ask you to avoid antiperspirants (Ask about Tom’s of Maine unscented natural deodorant.)
- The radiation nurse may provide you with a gel to use on your skin. This is o.k. to use, but only in addition to the preparations I suggest. I did not use University of WA Hospital preparation and I was the only person who did not burn in the group that began treatment at the same time I did. Please do not have any preparation on your skin prior to radiation treatment.
- Please follow my protocol carefully. Radiation burns are difficult to treat and heal. If you schedule your treatments after work and can then go home to do the burn prevention treatments it is somewhat easier than having to go back to work. This tends to delay prevention treatments.
- Note: Lavender Healing Mist is a distillation of lavender hydrosol with the essential oil left in the mixture. If the essential oil is siphoned off the hydrosol it is less effective as a burn treatment.
- Discuss this option with your Radiologist. The protocol is provided for information only and should not be construed as medical advice.
Patient Comments
The following comment is from the wife of a man who recently completed radiation of the neck for inoperatable throat cancer.
“Your treatment for his neck has been a miracle. He has some redness and a little roughness, but nothing like what they were preparing him for. One of the nurses was so excited about this treatment that she wrote everything down and was holding a “clinic” with the other nurses.”
Safe Sources to purchase Lavender Hydrosol
http://www.pelindabalavender.com/Organic-Lavender-Healing-Mist-p/179.htm?Click=5342 [9]
Pelindaba Lavender Farm crafts an organic lavender hydrosol that incorporates Lavender essential oil into the formula to create Lavender Healing Mist (LHM) that is an effective product to minimize radiation burns. This product is also effective to treat minor kitchen burns.
Beware of fake hydrosols that are made from adding a few drops of Lavender essential oil to water. This practice is probably more wide spread than is generally recognized by the general public or even some health stores that sell lavender products.
European “flower water” is a true hydrosol, while American versions may not be a hydrosol.
What to look for when buying Lavender Essential Oil and Hydrosol
- Always purchase pure unadulterated hydrosol and essential oils.
- Certified organic lavender is very important though some trusted growers do not have this stamp of approval but guarantee that their plants are grown without pesticides.
- Do not purchase lavender essential oil stored in plastic bottles.
- The pH of the hydrosol should be slightly acidic or between the 5–6 range.
- A word of warning: take care when buying hydrosols because re-constituted counterfeit products are sold in some health stores and on the Internet.
Please contact Sara DeHart at the e-mail listed below with any questions. Be sure to check http://quinary5.com for indepth information about burns and the use of Lavender Healing Mist.
References
[1] Seattle Cancer Care Alliance (206.368.5808). Radiologist Dr. Waylene Wong, MD and Angie Larsh, RN provided excellent care.
[2] I want to comment on the extraordinary care I received from the team of Radiation Technicians that provided my treatments.
Lisa Marie Lam Landon, RTT
Jeffrey Womeldorf, RTT
Rudy Estioco, RTT
Mark Huether, RTT
Not only did each member of the team provide highly competent professional care, but also made my radiation treatments a positive experience
[3] Salvo, N, Barnes, E, Van Draanen, J. et al. Prophylaxis and management of acute radiation-induced skin reactions: A systematic review of the literature. Curr Oncol. 2010: 17(4) p. 94–112.
[4] Beck, CS, and Powers JH, Burns treated by Tannic Acid. Ann Surg 1926: 84 p. 19–36.
[5] Rene-Maurice Gattefosse (1910). Aromatherapy
[6] DeHart, S. and Whalen, K.M. (2014) The Essential Burn Book for Baristas and Cooks: A nurse’s fast action secrets to stop pain and minimize blisters. Amazon.com Kindle book.
[7] Calendula (2013. University of Maryland.
[8] Radiation Skin Care: How I avoided a radiation skin burn.
[9] I have a business affiliation with Pelindaba lavender farms and receive a small remuneration when the “click=5342” is used to place an order.
Sara DeHart, MSN, Ph.D.
425.673.5729
sdehart@dehartresearch.com
dehart.ss@frontier.com
http://quinary5.com
