A. L. Kieft1, H. Yin2, A. K. Bhatt3, F. A. Vicini4, D. Kendrick5, K. Griffith5, E. Trumpower5, M. Mietzel6, J. A. Hayman7, L. J. Pierce6, and M. M. Dominello8; 1Detroit Medical Center - Wayne State University, Detroit, MI, 2Department of Biostatistics, University of Michigan, Ann Arbor, MI, 3Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, MI, 4Department of Radiation Oncology, GenesisCare, Farmington Hills, MI, 5Michigan Radiation Oncology Quality Consortium Coordinating Center, Ann Arbor, MI, 6Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 7University of Michigan, Ann Arbor, MI, 8Department of Radiation Oncology, Karmanos Cancer Center, Detroit, MI
Purpose/Objective(s): Acute radiation dermatitis (ARD) is a common toxicity in breast radiotherapy (RT). There is a plethora of topical treatments that physicians prescribe, or patients use, with little consensus or data to guide recommendations. Here we attempt to review the use of preventive therapy (PT) versus reactive therapy for ARD in breast cancer patients and to determine if there is an association between the use of PT and improvement in patient reported outcomes (PROs). Materials/
Methods: Patients receiving RT (conventional or hypofractionation, with or without boost) to the breast from 1/1/2012-12/31/2020 were prospectively enrolled in a statewide quality consortium. Included patients had completed the baseline PROs form for week 1 of therapy through final week. A PT was defined as topical “aloe vera/plant gel, Eucerin, Aquaphor, lotion/cream, Calendula/my girls, or Vaseline,” used at baseline – defined as first week of radiotherapy. All other topical therapies administered after first week were defined as reactive. Patient groups were compared using chi-squared test via the data management and decision management software. Results: 8386 patients met inclusion criteria. 34 unique topicals were reported as used by patients. 3403 patients (40%) reported use of a PT during 1st week of RT (baseline). The percentage of patients using reactive treatment increased steadily throughout the course of RT; 16% at week 2 and 39% by final week but was more frequently used by patients who had not initiated PT at baseline (35.9% vs. 30.7% p<0.0001). Patients who used a PT at baseline were less likely to report subsequent skin peeling (23% vs 15.5%, p<0.001) or redness in the treated breast (55.8% vs 40.5%). However, these patients were more likely to report hurting (20.4% vs 17.8%, p=0.0084), stinging (22% vs 20%, p=0.0481), itching (24.1% vs 21%, p=0.0023), and pain (27.8% vs 23.5%, p<0.0001), than patients not initiated on a topical PT at start of treatment. The association of redness varied across race with white patients (59.6% vs 42.2%, p<0.001) and, “other” patients (58.5% vs 41.3% p=0.0153) reporting significantly less redness with the use of PT. No significant association was found for black patients (33.9% vs 32.6%). Conclusion: The use of topical PT and RT for ARD in breast RT is common and variable. PT reduced breast redness for white and “other” patients but not black patients, highlighting the limitations of assessing the full extent of skin toxicities in women of color. Further, white patients may be more aggressively treated with reactive therapies because erythema is more apparent. Patients of any race who use a PT are less likely to report skin peeling. Discordantly, use of a PT was associated with statistically more, though small absolute difference, in pain. This may be due to separate processes mediating desquamation versus breast pain, with topical treatment only impacting the former.
