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Changes in skin and nails

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Treatment for cancer commonly affects skin and nails. Skin cancer may require surgical treatment with resultant scarring and change in appearance. Rash and itchy or dry skin are common side effects of some drug therapies as well as radiotherapy. In some cases, the rash may look like a bad case of acne. The skin may become darker (hyperpigmentation) with some chemotherapies, or more sensitive to sunlight after chemotherapy or radiotherapy. Some drug treatments may cause inflamed and painful fingernails and toenails, or even the separation of the nail from the nail bed. A side effect of other drug treatments is a painful condition of the palms of the hands and soles of the feet called hand-foot syndrome.

Vocational implications

Patients need to cover the affected or treated skin and protect it from the sun, wind and extreme temperatures. The appearance of some skin conditions may cause a patient to feel embarrassed or insecure about their appearance. If the nails or skin are painful, torn or bleeding, this can limit dexterity and function.

What patients can do

Speak to your patient about the management of bothersome skin or nail changes. There are some treatment options, including antibiotics and topical steroid that can be very helpful. Gentle cleansers and emollient creams that are free of perfume, alcohol and other drying agents are best for cleaning. Sun exposure should be avoided as this can exacerbate dry skin. Patients may use dermatologist-approved cosmetics to cover redness and skin eruptions.

For all skin cancer prevention, patients should wear sun protective clothing, apply sunscreen, and try to avoid direct sunlight. For more information on sun protection, see the Canadian Cancer Society web page Being safe in the sun or the BC Cancer Agency webpage Sun Safety.

Job accommodation ideas

There are several ways that jobs can be modified to accommodate skin and nail changes. An occupational therapist can recommend hand exercises to increase strength and coordination if this is an issue as well as a desensitization program.

Modify work tasks and equipment:

  • Photosensitivity (sensitivity to light)
    • If the patient is photosensitive, request alternative duties that can be done indoors.
    • If the job requires a uniform, request clothing options that protect the patient from the sun when working outdoors (e.g., wide-brimmed hat, long sleeved shirts, pants).
  • Painful fingers and hands:
    • Ask for protective gloves that are suited to the work tasks. Thin cotton gloves can be worn indoors for comfort. If nails are damaged, waterproof gloves should be used in tasks that frequently expose the hands to liquid.
    • Use electric tools in place of manual tools when possible.
    • Cover the handles of commonly used equipment with fabric or padding to increase comfort.
    • Build up” handles of tools with foam pipe insulation to increase the handles’ diameter.
    • Use a headset if the employee is frequently on the telephone.
    • For jobs that involve computers and typing, use speech recognition software, alternatives to a standard keyboard and mouse and/or switches accessed by other body parts to accommodate very sensitive fingertips.
  • Painful toenails and feet
    • Refer the patient to an assessment by a foot specialist for custom-made, off-loading insoles to reduce pressure on the feet.1
    • If the patient works standing up, they should sit down when possible. Use a stand-lean chair or keep a rest chair nearby.
    • If the patient frequently stands, install an anti-fatigue mat or wearable anti-fatigue surfaces
    • Request a mobility aid such as a walker to reduce weight load on the feet.
    • Arrange an assessment by a physical therapist or occupational therapist, who can recommend appropriate mobility aids to minimize energy expenditure.
  • Hand-foot syndrome:
    • Ask that tasks exposing the hands to extreme heat, such as dish washing, be reassigned to others.
    • Limit tasks that involve repetitive friction on hands or feet:
      • Use electric tools to replace manual effort.
      • Vary repetitive tasks with other duties.
    • Cover the handles of commonly used equipment with fabric or padding to decrease friction.

Modify the work environment:

  • Painful toenails and feet
    • Request parking close to the building entrance.
    • Relocate the workstation closer to the washroom, break room or other frequently used space.
  • Hand-foot syndrome:
    • Request parking close to the building entrance.
    • Relocate the workstation closer to the washroom, break room or other frequently used space

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