Prevalence And Clinical Outcomes Of Radiotherapy-Induced Skin Burns Among Cancer Patients At The Kenyatta National Hospital

Abstract

Background: Cancer is one of the leading causes of death globally. In Kenya, it’s the third leading cause of death after cardiovascular and infectious diseases. Radiotherapy (RT) is one of the major treatment modalities of cancer, but it’s associated with skin burns as one of the adverse effects. Locally the occurrence, predisposing factors are not clearly documented. This study determined the prevalence and clinical outcomes of RT-induced skin burns in cancer patients. Methodology: This was a descriptive cross-sectional study, which employed both quantitative and qualitative methods of data collection. The study population consisted of patients diagnosed with cancer and undergoing RT at Kenyatta National Hospital (KNH). A systematic sampling method was used to recruit a proportion of study participants each day depending on patient turn out. 79 participants were enrolled. Data was collected using open and closed-ended questionnaires and a review of past patients’ files. Statistics and data statistical software package version 14.0 (STATA) was used to analyze the data. Descriptive and inferential statistics were obtained, and findings presented in form of tables and graphs. Results: The prevalence of RT-associated burns was 49.4%. Forty-four-point eight percent (44.8%) of the patients above 40 years had burns compared to 50% who were below 40 years. The number of cycles determined the risk of burns as demonstrated by 66.6% those who had above 10 cycles had burns compared to 36.8% who had less than 10 cycles. Patients who had radiation around the head and neck 16 (61%) had burns compared to 5 (41.7%) who had chest radiation. Out of the total 55 patients on RT who had received more than 41 Gy, 33 (60%) experienced burns. Of those receiving External Beam Radiation Therapy (EBRT), 30 had burns, compared to 5 cases for those receiving Brachytherapy. Further analysis was done and showed patients who underwent brachytherapy were likely (p<0.017) to get skin burns. Fortytwo- point nine percent (42.9%) of the respondents with burns reported they appeared after the first week going upwards. The proportion of Grade 2 burns according to the Radiation Therapy Oncology Grading (RTOG) was 19.0%. From nurses feedback grade one was the most common 64.3% (9) while grade 2 had 28.6% (4). Most of the patients faced a lot of challenges emanating from RT burns as demonstrated by 76.5% reporting emotional distress, 17.6% reported health issues which included pain and mucositis. Conclusion: The study observed that there is a relationship between predisposing factors and burns. The most significant ones been allergies, number of cycles and type of radiotherapy either EBRT or brachytherapy. Of these factors some can be mitigated like nutrition, use of low fraction of radiation in patients with skin allergies. It was observed that the clinical outcomes vary depending on the degree of burns sustained. Most of the patients reported emotional distress, pain, financial constrains has been among the leading challenges they experienced.