The American Cancer Society projects that 1.6 million new cases of cancer will be diagnosed in 2012. Of those new patients, 790,000 will be women. Breast cancer will affect 227,000 women, with lung, genital and colon cancers comprising the next most-common forms. The good news is that thanks to early detection and better treatment options, cancer deaths have dropped in recent years, and they continue to decline. However, as researchers and doctors focus on aggressive treatments and newer methods that are less taxing on the patient, two time-tested measures—conventional chemotherapy and radiation treatments—still frequently produce debilitating side effects. Most of us are familiar with the hair loss effect of these cancer treatments, and many know about their damaging effect on nails—causing yellowing, thickening and cracking. But as a spa professional, the issue you’re most likely to witness among clients who are chemotherapy and radiation recipients are adverse skin side effects. The good news is, you may be able to help and, perhaps more importantly, you may be in a position to minimize additional harm.
Cause and Effect
There are two types of radiation treatment most commonly used today to battle cancer. One is external beam therapy, in which a machine administers localized radiation to the cancer site. Sometimes called “tattoo radiation,” this method involves inking a permanent mark into the skin to serve as a guidepost during the treatment. Brachytherapy (internal radiation) is treatment in which a source of radiation is positioned inside the body. For this method, seeds, ribbons or capsules are placed via a catheter, or radiation is delivered through liquid, pills or intravenously. With either method, the exposure to strong radiation can produce a harmful effect on the skin, similar to that of intense sun damage. “ The National Cancer Institute (NCI) reports these common skin changes: • Redness, which can occur on any part of the body • Pruritus, or itching • Dry and peeling skin • Moist reaction, which can also lead to sores and ulcers • . “The skin might be burned, or it might be yellow, dead and devoid of its pink blush, deprived of oxygen.” Chemotherapy is a drug protocol used to kill cancer cells or slow their growth. Frequently, a combination of medications are used simultaneously, delivered through pills, liquid or, most commonly, intravenously. During the chemotherapy treatment period, the skin can gradually become very dry and dehydrated. “Chemo is fundamentally meant to shrivel you up so that you can poison the root; that’s how you kill the cancer,” says Bray. “The skin actually shrinks, tries to sloth itself faster than it can grow back, and can become cracked or oozy underneath.” For skin affected by radiation and chemotherapy treatments, the NCI offers patients some general, but important, recommendations: • Don’t rub, scrub or scratch irritated areas. • Don’t put anything too hot or too cold on the skin. • Take lukewarm showers and pat skin dry. • Be aware that skin may feel better in cold, humid environments. • Wear soft, loose clothing. • Protect the skin from the sun. • Don’t use adhesive tape or bandages.
Soothe and Protect
Professional skin care can alleviate or minimize some of the side effects of cancer treatment, but it must be approached differently with each individual. “Skin on these clients can be so sensitive to the touch that even water can be upsetting,” says Bray. “Perhaps you’ll be able to use a gentle enzyme to lightly exfoliate. On the face, perhaps facial massage is what a client will need most. You’re not going to do a classic facial with extractions and peels.” Side effects of medication to skin may have nothing to do with the site of the cancer itself. There may be wounds caused by the deadening of the skin; there may be rashes and ulcers. “The whole body is dealing with the treatment,” says Bray, who cautions that spa professionals should never try to treat wounds. In general, it’s whole-body hydration and moisturizing that is most urgent. “It may be that a client comes in for a skincare regimen to use during treatment, but many of our oncology clients first come in for help with relaxation,” Smith says. “We may perform a facial massage. Or a pre- or post-operative massage. Research shows that people who are more relaxed before surgery require less pain medication afterward.” One of the most important ways skincare professionals can help oncology clients is to provide guidance about product use. Every single thing that makes contact with their skin, from shampoos to deodorants to moisturizers, has the potential to worsen an existing side effect. Many oncologists’ offices are able to provide the basic dos and don’ts of skin care—but many aren’t. “When your lips are so brutally dried out that you feel like they’ve been through a windstorm and your doctor tells you to use Chapstick, that’s not going to be of much help,” notes Bray. Avoiding products that use perfumes and alcohol is a good start. However, as Bray explains, a product that works for one person won’t necessarily for another, so it’s a matter of trial and error. “There are a thousand and one wives’ tales,” she acknowledges—in fact, so many that Bray keeps recommendations in a binder for her clients to peruse. She recommends the following ingredients for their gentle healing properties, which can be found in product formulations or created from scratch: • vitamin E • seaweed • manuka honey • pharmaceutical-grade aloe vera • hyaluronic acid • calendula • castile soap That spa standard, lavender, may seem like a fitting choice as well, but Bray issues a warning. “Many products contain lavender, but it’s a tricky ingredient because even though soothing, it’s a phytoestrogen plant,” she explains. “So I don’t want to use it on clients with estrogen-related cancers.” Clients may also come in for nail help. “We give medicures—medical-grade nail care,” says Smith. The care involves minimizing the risk of infection, similar to that of a diabetic client; there’s no cuticle or knife work, and only the most careful exfoliation. Fortunately, many side effects to skin and nails diminish once cancer treatments are over.
Knowledge and Care
Oncology skin care is a growing specialty. A few organizations offer online and on-site courses. At the Skincare Therapy Institute, director of education Tina Yvette Mclendon teaches spa professionals how to recognize and care for skin affected by cancer treatments. She also points out how a client’s cancer may only be one factor in their overall skin profile. “Yes, someone’s skin may have aged prematurely due to treatment, but that person may have had dry skin prior to becoming ill, and/or they may be perimenopausal,” she says. “We have to take a ‘whole person’ perspective, and look at their age, their ethnicity, their other health issues. And keep in mind that while some people’s cancer treatment has a beginning and an end, others may be on chemotherapy for the rest of their lives.” Mclendon also helps spas provide care for oncology clients by teaching them about general spa safety for these guests. Cancer patients may have compromised immune systems and be extremely susceptible to illness and infection. She recommends the following safeguards: • Treatment rooms should be fully disinfected. • Treatment areas should be well ventilated. • Treatment areas should be free of chemicals and chemical fumes. • All applicators and equipment tips should be disposable. • Practitioners should wear gloves. • Employees should never work with oncology clients when they are sick; mouth-covering masks should be used if there is any possibility of illness. • Products should be used in single-application amounts to avoid cross-contamination. If your spa offers oncology aesthetics, it’s important to get the word out, as patients don’t always know where to turn when their doctor’s advice isn’t enough. However, Medical Day Spa’s Smith cautions about the importance of cooperating with clients’ medical professionals. “We always get a referral or permission before treating a client,” she emphasizes. Bray agrees. “I always send oncologists full reports as to what I’m doing in the spa with one of their patients, and doctors and especially nurses are very supportive,” says Bray. “I also offer to come to their offices and explain what I do, so they know I am not trying to step on their toes.” Mclendon’s 300 graduates report back to her regarding their inroads in the cancer community. “For some reason, the response in Texas has been phenomenal,” she says. “We’ve got oncologists employing aestheticians to come into their offices. The medical community is embracing us.” Mclendon also works with a non-profit organization connected to a hospital in which a grant has facilitated payment for aesthetic services. “We don’t use a lot of product or technology with our oncology clients, so we can make it affordable,” she says. Often, it’s the attention that provides the most healing. “To have your toenails polished creates a sense of normalcy that these clients may not have had for a long time,” says Bray. “It’s also that I’m touching them, even if all they can take is a light-touch massage. Sometimes people are afraid to touch patients with a chronic or terminal illness. Cancer isn’t contagious.”