Modified Delphi Consensus on Interventions for Acute Radiation Dermatitis in Breast Cancer: A Canadian Expert Perspective

PURPOSE: Acute radiation dermatitis (ARD) is a prevalent adverse effect of radiotherapy in patients with breast cancer, and there is a lack of high-quality data regarding its prevention and management. This study employs a systematic and iterative process to compile the perspectives of Canadian radiation oncology, nursing, and dermatology experts, aiming to establish consensus-based recommendations for the prevention and management of ARD in breast cancer patients. METHODS AND MATERIALS: A modified Delphi consensus was conducted with the participation of 19 experts from across Canada. The process involved a systematic review of existing literature on the prevention and treatment of ARD in breast cancer, from January 1946 to September 2023. After review of the literature, participants first provided their opinions on the strength and quality of the evidence for the identified interventions. A second round assessed the degree to which the interventions would be recommended in either low- and/or high-risk settings. Two more rounds consolidated consensus. RESULTS: After the four rounds, consensus for recommendation was reached for 3 prevention interventions in both low- and high-risk patients: prevention care education, moisturizing, and washing. For high-risk settings, 2 additional prevention interventions reached consensus: Mepitel Film and mometasone furoate. With regards to the management of ARD, there was consensus for recommendation of Mepilex Lite, betamethasone valerate, mometasone furoate, saline soaks/cold compresses and barrier creams. CONCLUSIONS: This pan-Canadian modified Delphi consensus provides expert-reviewed and evidence-based recommendations for interventions to prevent and manage acute radiation dermatitis in patients with breast cancer. The endorsed interventions offer valuable guidance for clinicians and their patients, highlighting areas where consensus among experts has been achieved.