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Prevention of radiation dermatitis with skin hygiene and washing: a systematic review and meta-analysis

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A Correction to this article was published on 15 January 2024

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Abstract

Purpose

This systematic review and meta-analysis aims to evaluate the effects of washing in patients receiving radiotherapy (RT) on radiation dermatitis (RD) severity.

Methods

A literature search was performed using Ovid MEDLINE, Embase, and Cochrane databases between January 1, 1946, and January 31, 2023. Four randomized controlled trials (RCTs) studying the effects of washing with or without soap on RD were identified. A meta-analysis was conducted for clinician-reported outcomes using RevMan 5.4 and a narrative synthesis for patient-reported outcomes due to a lack of reported data amenable to quantitative comparison in accordance with the Synthesis Without Meta-analysis (SWiM) guidelines. The Cochrane Risk of bias (RoB2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria were used to assess risk of bias and certainty of evidence, respectively.

Results

Two RCTs met the inclusion criteria for meta-analysis. Washing with or without soap significantly reduced the incidence of severe RD (OR: 0.32, 95% CI: 0.19–0.55, p < 0.01) and moist desquamation (OR: 0.25, 95% CI: 0.12–0.52, p < 0.01). Two of four trials found an association between washing and reduced itching score (p = 0.38). Pain score was not found to be significantly different with or without washing in any of the four studies (p = 0.07). The two studies that assessed burn scores did not detect any difference between the washing group versus no washing group (p = 0.25). Washing was associated with improved quality of life (QoL) measures in one study.

Conclusion

Washing with or without soap during RT resulted in less severe RD and less moist desquamation. Given the QoL benefits of washing, it should be advocated as part of routine skin care during RT.

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Acknowledgements

D.C.W.C., H.C.Y.W., and M.A.R. are joint first authors. P.B., E.C., and T.B. are joint senior authors. J.R.W. and C.v.d.H. are the Chair and Vice-Chair of the MASCC Oncodermatology Study Group, respectively. D.C.W.C., M.A.R., J.R.W., C.v.d.H., M.B., P.B., E.C., and T.B. are members of the MASCC Oncodermatology Study Group.

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Authors and Affiliations

  1. Department of Oncology, Princess Margaret Hospital, HKSAR, China

    Dominic Chun Wan Chan & Henry Chun Yip Wong

  2. Department of Radiation Oncology, Enam Medical College Hospital, Dhaka, Bangladesh

    Mahfujul Ahmed Riad

  3. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPO), Florence, Italy

    Saverio Caini

  4. Departments of Dermatology and Radiation Oncology, University of Rochester Medical Centre, Rochester, NY, USA

    Julie Ryan Wolf

  5. Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands

    Corina van den Hurk

  6. Department of Dermatology, University Hospitals, Cleveland, OH, USA

    Mara Beveridge

  7. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Henry Lam

  8. Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Pierluigi Bonomo

  9. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Edward Chow

  10. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Tara Behroozian

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by D.C.W.C., H.C.Y.W., M.A.R., S.C., and T.B. H.L. performed the literature search. The first draft of the manuscript was written by D.C.W.C., H.C.Y.W., and M.A.R., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tara Behroozian.

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The ​original ​version ​of ​this ​article ​was ​revised. There was a typographical error in Figure 1. The number of records screened under the “Screening” section of the PRISMA flowchart should read 5,173, not 416.

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Chan, D.C.W., Wong, H.C.Y., Riad, M.A. et al. Prevention of radiation dermatitis with skin hygiene and washing: a systematic review and meta-analysis. Support Care Cancer 31, 294 (2023). https://doi.org/10.1007/s00520-023-07720-8

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