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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.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
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Module 3q
Symptoms – Skin
Skin wounds . . .

Acute vs. chronic; likely to heal or not

Chemotherapy agent extravasation

Radiation damage

Decubitus ulcers

Malignant wounds
. . . Skin wounds
Associated with

Pain

Depression

Anxiety

Poorer interpersonal interactions
Key points
1. Pathophysiology
2. Assessment
3. Management
Skin symptoms

Organ system

Highly innervated

Visible

Psychological, social, and spiritual

Interdisciplinary care

Symptom control
Chemotherapy
extravasation: pathophysiology

Acute wound

Products of inflammation
Redness
Swelling
Pain

Cell death
Necrosis, open wound
Radiation:
pathophysiology

Radiation damage

Acute wound

Products of inflammation

Cell death
Decubitus ulcers:
pathophysiology

Pathophysiology
Ischemia

Fat is protective
Malignant wounds:
pathophysiology

Disrupted physiology

Products of inflammation

Neovascularization
Bleeding

Necrosis
Anaerobic and fungal infections
Assessment . . .

Acute versus chronic

By wound type
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
Radiation: assessment

Radiation sensitizers
Topical agents
Drugs, including chemotherapy

Dose and fractionation schedule
Expected course
Decubitus ulcers

Assessment
Risk factors

Prevention
Skin protection – shear / tear / moisture
Pressure reduction and pressure relief
Decubitus ulcers: staging
1. Non-blanchable erythema
2. Partial-thickness skin loss
3. Full-thickness skin loss
4. Extensive necrosis exposing
muscle or bone
Management

Acute versus chronic

By wound type
Necrotic wound:
management

Debridement
Surgical
Enzymes and gels
Mechanical
Pain control

Cleansing
Chemotherapy
extravasation: management

Contain damage
Stop infusion
Neutralize

Assess for surgical consultation

Watch and wait
Radiation: management

Promote healing
Avoid cytotoxic agents
Moist environment
Treat infection
Pain control
Decubitus ulcers:
management

Goals: healing vs non-healing

Healing
Debridement
Dressings that promote healing

Non-healing
Pain control, comfort
Prevent worsening
Decubitus ulcers:
dressing

Moist, interactive environment

Control infection

6 types of dressing
Foams
Alginates
Hydrogels
Hydrocolloids
Thin films
Cotton gauze
Malignant wounds:
management

Healing vs non-healing

Infections

Odors

Pain

Exudate

Bleeding
Odors

Topical and / or systemic antibiotics
Metronidazole
Silver sulfadiazine

Kitty litter

Activated charcoal

Vinegar

Burning candles
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience