Module 11

1
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.
2
EPEC Oncology Education in Palliative and
End-of-life Care Oncology

• Module 3q
• Symptoms Skin

3
Skin wounds . . .

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

4
. . . Skin wounds

• Associated with
• Pain
• Depression
• Anxiety
• Poorer interpersonal interactions

5
Key points

• Pathophysiology
• Assessment
• Management

6
Skin symptoms

• Organ system
• Highly innervated
• Visible
• Psychological, social, and spiritual
• Interdisciplinary care
• Symptom control

7
Chemotherapyextravasation pathophysiology

• Acute wound
• Products of inflammation
• Redness
• Swelling
• Pain
• Cell death
• Necrosis, open wound

8
Radiation pathophysiology

• Radiation damage
• Acute wound
• Products of inflammation
• Cell death

9
Decubitus ulcers pathophysiology

• Pathophysiology
• Ischemia
• Fat is protective

10
Malignant wounds pathophysiology

• Disrupted physiology
• Products of inflammation
• Neovascularization
• Bleeding
• Necrosis
• Anaerobic and fungal infections

11
Assessment . . .

• Acute versus chronic
• By wound type

12
Chemotherapy extravasation assessment

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

13
Radiation assessment

• Radiation sensitizers
• Topical agents
• Drugs, including chemotherapy
• Dose and fractionation schedule
• Expected course

14
Decubitus ulcers

• Assessment
• Risk factors
• Prevention
• Skin protection shear / tear / moisture
• Pressure reduction and pressure relief

15
Decubitus ulcers staging

• Non-blanchable erythema
• Partial-thickness skin loss
• Full-thickness skin loss
• Extensive necrosis exposing muscle or bone

16
Management

• Acute versus chronic
• By wound type

17
Necrotic wound management

• Debridement
• Surgical
• Enzymes and gels
• Mechanical
• Pain control
• Cleansing

18
Chemotherapy extravasation management

• Contain damage
• Stop infusion
• Neutralize
• Assess for surgical consultation
• Watch and wait

19
Radiation management

• Promote healing
• Avoid cytotoxic agents
• Moist environment
• Treat infection
• Pain control

20
Decubitus ulcers management

• Goals healing vs non-healing
• Healing
• Debridement
• Dressings that promote healing
• Non-healing
• Pain control, comfort
• Prevent worsening

21
Decubitus ulcers dressing

• Moist, interactive environment
• Control infection
• 6 types of dressing
• Foams
• Alginates
• Hydrogels
• Hydrocolloids
• Thin films
• Cotton gauze

22
Malignant wounds management

• Healing vs non-healing
• Infections
• Odors
• Pain
• Exudate
• Bleeding

23
Odors

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

24
Summary

• Use comprehensive assessment and
  pathophysiology-based therapy to treat the cause
  and improve the cancer experience