Workflow, Educational Tools Improve Use of Silicone Film to Prevent Radiation Dermatitis

Workflow, Educational Tools Improve Use of Silicone Film to Prevent Radiation Dermatitis

Mepitel film was effective in reducing radiation dermatitis, infection, and complications related to reconstructive surgery in patients with breast cancer undergoing post-mastectomy radiation therapy, recent findings demonstrated.¹

These results were presented at the 49th Annual Oncology Nursing Society Congress.

“Approximately 80% of our post-mastectomy radiation patients use Mepitel film for the prevention of radiation dermatitis in our practice,” Miranda Hearrold, RN, a staff registered nurse in the radiation oncology department at the Mayo Clinic in Rochester, Minnesota, said during the presentation. “We've treated about 780 patients in the past 9 years with Mepitel film, and we do find that the reduction of radiation dermatitis has a significant impact on the patient's quality of life and is very useful in decreasing the anticipatory anxiety these patients often have in relation to their potential for radiation dermatitis.”

Mepitel film is a gentle, sterile, transparent, breathable, and adhesive soft silicone film dressing which has the ability to stay in place for several days at a time.

“It works really well for patients with a history of sensitive skin, and is gentle to remove,” Hearrold said. “All of these qualities make this a great option for radiation patients. When talking with patients, I often describe this product as a breathable, sticky Saran wrap that they will use throughout their radiation treatment field as their skincare while they are undergoing their radiation treatment.”

A study published in 2014 demonstrated that Mepitel film reduced skin reaction severity by 92%, compared with aqueous cream in patients with breast cancer receiving radiation therapy.² This motivated Hearrold’s team at Mayo Clinic to conduct several studies over the next few years to assess the film’s benefit in patients undergoing post-mastectomy radiation, all of which confirmed these findings.

Not only may the film reduce the risk for radiation dermatitis while improving quality of life, but it may also impact decision making for future procedures.

“We also know that patients undergoing breast reconstruction followed by radiation treatment see higher rates of implant and expander loss, infection, and reconstructive failure,” Hearrold said. “This can mean a longer reconstructive journey for these patients with more procedures both planned and unplanned.”

Her center started routinely using Mepitel film in 2018 in patients undergoing post-mastectomy radiation therapy. When implementing the use of the film into practice, the team faced several challenges including a lack of a consistent time to identify when a provider can start a conversation with a patient about the film’s potential use, lack of communication about patients interested in using the film, lack of standardized patient education, and a lack of educational tools for staff nurses.

First, the team developed a workflow to establish consistency of when the discussion around the use of Mepitel film is conducted and how to follow-up regardless of whether the patient wants to use the film or not. In addition, this workflow also includes when patients are informed about the film’s application, how to care for it, and when film replacement should be performed by the nursing staff, if necessary.

Hearrold’s team also developed an educational pamphlet to give to patients in how Mepitel film is used, instructions on how to prepare for application, how to care for skin and to protect the film, and where to purchase the product.

Educational materials were made for teaching staff how to apply and care for Mepitel film for patients regardless of whether they were undergoing reconstruction. This included a video that demonstrated the application of the film to a patient with breast cancer undergoing reconstruction. Patients who undergo a standard 25-fraction treatment course are recommended to purchase two 10 cm by 25 cm pieces and eight 15 cm by 20 cm pieces of film.

“We educate them on coming to that appointment with clean and dry skin, so don’t put lotion or deodorant on their treatment site,” Hearrold said. “Next we'll have them change into a gown. And then on our staff table, we'll have them replicate treatment position.”

When in this position, nurses will apply the film in a particular order around the treatment field, all while ensuring that it is laying flat. Nurses will start on the lateral side of the treatment field in the axilla, where a 10 cm by 25 cm piece of film will be used to cover the axilla and lateral chest wall. Based on the patient’s anatomy, the 15 cm by 20 cm piece can be placed horizontally or vertically to cover the rest of the chest wall. Those with a larger chest may require an additional piece of the 15 cm by 20 cm film to cover the upper chest wall. Of note, the typical superior border is the clavicle, and inferior border is approximately 1 to 2 inches above the bottom rib.

“You can see [in this educational video] we have 2 staff RNs applying the film, which I think is helpful when you’re just getting underway with the use of the film, as it can be a little bit tricky to use,” Hearrold said. “But then as you get more adjusted to using the film, we typically only have 1 RN doing this.”

Hearrold discussed some best practices for the use of Mepitel film, like not covering superior to the clavicle ad the posterior field or upper back. Nurse visits can be completed as needed for patching of the film area during treatment. If the film is adhering well, it can stay in place for the duration of treatment. Patients are asked to avoid activities that may cause excessive sweating and to use a barber’s cape to protect the film during a shower.

The application of Mepitel film may also pose some challenges for oncology nurses. For example, patients are asked to avoid using lotion on skin that is not covered by the film and to keep away from its edges. Also, men with excessive chest hair may not be good candidates for this approach. For patients who may experience itching of the skin underneath the film, they can apply slight pressure to the area and use oral antihistamines.

“[Itching] varies from slight to more severe,” Hearrold said. “For slight itching, you could just do some pressure to the area. In more significant itching patients, we move to an oral antihistamine, so like our Claritin or Zyrtec during the day and Benadryl at night to help relieve itching. And then in more severe cases, you would probably want to remove the film in the area and then follow your standard of skincare practice.”

After the patient completes treatment, the film can remain in place for up to 2 weeks, and no patching is recommended after treatment is completed. As the film wears off and areas of skin with dermatitis are exposed, it is recommended that patients follow standard of care for radiation dermatitis.

Hearrold mentioned that successful implementation of the workflow and educational tools around Mepitel film at her center has led to its adoption in 5 satellite radiation facilities.

References

1. Hearrold M, Klein K, Peterson L, et al. Development of Nursing Process for Integration of Mepitel Film for Prevention of Radiation Dermatitis. Oral abstract presented at: 49th Annual Oncology Nursing Society Congress; April 24-28, 2024; Washington, D.C.
2. Herst PM, Bennett NC, Sutherland AE, Peszynski RI, Paterson DB, Jasperse ML. 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;110(1):137-143. doi:10.1016/j.radonc.2014.01.005