One of the benefits of teaching is the copious amounts of learning I receive through connecting with other practitioners just as passionate about improving survivorship for breast cancer patients as I am. As you can imagine, my recent teaching adventures in New Zealand and Australia revealed some differences in cancer treatment compared to the States. After a lecture in which I discuss the indications and side effects of radiation treatment a few physiotherapists from New Zealand raved about a wound care product called Mepitel Film which can be used prophylactically during radiation to prevent skin changes. I was obviously interested as I have never heard of this product. Today I performed a little internet research on Mepitel Film and wrote this blog in hopes of sparking a conversation amongst radiation oncologists, nurses and allied health providers about trends they witness for skin care during radiation treatment.
The extent of skin changes associated with radiotherapy varies from mild redness, similar to sunburn, to ulcers which can be accompanied by pain, burning and itchiness. Approximately 1/3 of women undergoing whole breast irradiation will develop significant skin changes (1). Physical therapists working with breast cancer patients must be acutely aware to protect the integument while treating side effects of cancer treatment such as lymphatic cording, lymphedema, post-mastectomy pain syndrome and shoulder and rib dysfunction. Radiation beams affect not only the integumentary system, but also the bone, muscle, fascia and lymphatics within the field of treatment. Although there are no clear guidelines regarding manual therapy and exercise for patients undergoing radiation, therapists must know that what is happening on the surface of the skin is not always indicative of the health of deeper tissues and radiation changes continue after cessation of radiotherapy.
Mepitel Film is a thin, transparent dressing which adheres closely to the small folds of the skin. This product reportedly does not contain skin-reacting chemicals and stays in place without the use of adhesive materials. Mepitel Film provides a barrier reducing friction from clothing or adjacent skin which can create abrasive folds, therefore, the skin’s stem cells can heal from the effects of radiation without as much mechanical disruption (2).
A study was published in the Radiotherapy & Oncology Journal in 2014 assessing the affects of Mepitel Film dressing on radiated skin in breast cancer patients. 78 participants took part in the trial conducted by the University of Otago in Dunedin, New Zealand. The skin of subject was divided into halves; one half was dressed with Mepitel Film and the other with aqueous cream. The study concluded that Mepitel Film dressing prevented the development of painful skin ulcerations called moist desquamation. Cream-treated skin developed wounds in 26% of patients, however, no cases of wounds or severe skin reactions were found in Mepitel treated skin. 44% of patients had a skin reaction under Mepitel Film, but none progressed to moist desquamation. Skin reactions that developed under the Mepitel dressing were 92% less severe with regard to itching and irritation (3).
As a physiotherapist and advocate of comprehensive and integrated care for breast cancer patients, based on the positive research findings of Mepitel Film, I would be interested to learn more about the widespread use and clinical observations associated with this product. I would like this blog to provoke conversation amongst patients, physicians and medical practitioners about other prophylactic skin care practices and treatment of skin changes resulting from radiotherapy treatment. Thank you for your input!
1.) Fisher J, Scott C, Stevens R, et al: Randomized phase III study comparing best supportive care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13. Int J Radiat Oncol Biol Phys 48:1307-1310, 2000
2.) University of Otago. "Skin reactions during radiation therapy preventable." ScienceDaily. ScienceDaily, 12 February 2014. <www.sciencedaily.com/releases/2014/02/140212112849.htm>.
3.) Herst P, Bennett N, Sutherland A, et al: Prophylactic use of Mepitel Film prevents radiation-induced moist desquamation in an intra-patient randomised controlled clinical trial of 78 breast cancer patients. Radiother Oncol. 2014 Jan;110(1):137-43.
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