The Nurse's Role in Managing Skin Toxicity

Kathryn Ciccolini, RN, BSN, OCN, an oncology nurse at Memorial Sloan-Kettering Cancer Center (MSKCC), explains that oncology nurses play a key role in patient education and the treatment of the skin toxicities associated with anticancer therapies.

As a result of this role, nurses must feel comfortable communicating, referring, educating patients and their families, and encouraging patients through their time of need. In this process, nurses must perform meticulous, accurate assessment of the skin, in order to deliver appropriate patient specific interventions that both manage and minimize side effects, allowing the patient to continue treatment uninterrupted, Ciccolini states.

It is important to examine the full picture, since patients may experience a multitude of effects from dermatologic reactions, Ciccolini suggests. These reactions may result in nonadherence to treatment, a negative impact on quality of life, financial burdens, an impact on psychosocial and physical health, a reduction in the self care activities involved in daily living, and could result in additional stress for the entire family.

On average, Ciccolini notes, 8% of patients on EGFR inhibitors are referred to a dermatologist for cutaneous toxicities. This statistic illustrates that there may be an unintentional divide in the world of onco-dermatology, since the occurrence of these toxicities is much higher than the referral rate. This may elucidate the need to establish a referral system with healthcare providers, suggests Ciccolini.

An oncology nurse should have an understanding of the integumentary system, explains Ciccolini. This should involve training in the management of cutaneous side effects, since nurses play a vital role when it comes to patients receiving treatment.

In a recent study, Ciccolini states, the patient and provider’s perception of the certain roles in chronic dermatologic treatment were investigated. In this study, the nurse was characterized as the treatment coach who provided individualized advice based on the analysis of each clinical situation. A noteworthy mention from this study, Ciccolini suggests, is that the nurse was perceived to be more accessible with a deeper understanding of the patient’s situation.

This is an important study, Ciccolini believes, since it highlights that nurses are on the frontline of care for patients. As a result, nurse intervention can lead to many positive health outcomes including adherence, quality of life, patients’ knowledge of their illness, and self-management.