The EPECO TM Education in Palliative and Endoflife

The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

E P E C EPEC – Oncology Education in Palliative and End-of-life Care – Oncology O Module 3 q Symptoms – Skin

Skin wounds. . . l Acute vs. chronic; likely to heal or not l Chemotherapy agent extravasation l Radiation damage l Decubitus ulcers l Malignant wounds

. . . Skin wounds Associated with l Pain l Depression l Anxiety l Poorer interpersonal interactions

Key points 1. Pathophysiology 2. Assessment 3. Management

Skin symptoms l Organ system l Highly innervated l Visible l Psychological, social, and spiritual l Interdisciplinary care l Symptom control

Chemotherapy extravasation: pathophysiology l Acute wound l Products of inflammation Redness Swelling Pain l Cell death Necrosis, open wound

Radiation: pathophysiology l Radiation damage l Acute wound l Products of inflammation l Cell death

Decubitus ulcers: pathophysiology l Pathophysiology Ischemia l Fat is protective

Malignant wounds: pathophysiology l Disrupted physiology l Products of inflammation l Neovascularization Bleeding l Necrosis Anaerobic and fungal infections

Assessment. . . l Acute versus chronic l By wound type

Chemotherapy extravasation: assessment l Type of chemotherapy Vesicant, eg, doxorubicin Irritant, eg, carmustine Non-irritants, eg, fluorouracil l Extent Volume of extravasation and time Seconds, minutes, hours l Involved anatomy

Radiation: assessment l Radiation sensitizers Topical agents Drugs, including chemotherapy l Dose and fractionation schedule Expected course

Decubitus ulcers l Assessment Risk factors l Prevention Skin protection – shear / tear / moisture Pressure reduction and pressure relief

Decubitus ulcers: staging 1. Non-blanchable erythema 2. Partial-thickness skin loss 3. Full-thickness skin loss 4. Extensive necrosis exposing muscle or bone

Management l Acute versus chronic l By wound type

Necrotic wound: management l Debridement Surgical Enzymes and gels Mechanical Pain control l Cleansing

Chemotherapy extravasation: management l Contain damage Stop infusion Neutralize l Assess for surgical consultation l Watch and wait

Radiation: management l Promote healing Avoid cytotoxic agents Moist environment Treat infection Pain control

Decubitus ulcers: management l Goals: healing vs non-healing l Healing Debridement Dressings that promote healing l Non-healing Pain control, comfort Prevent worsening

Decubitus ulcers: dressing l Moist, interactive environment l Control infection l 6 types of dressing Foams Alginates Hydrogels Hydrocolloids Thin films Cotton gauze

Malignant wounds: management l Healing vs non-healing l Infections l Odors l Pain l Exudate l Bleeding

Odors l Topical and / or systemic antibiotics Metronidazole Silver sulfadiazine l Kitty litter l Activated charcoal l Vinegar l Burning candles

E P E C O Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience