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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

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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Skin and nail changes commonly affect those undergoing treatment for cancer. Skin cancer may require surgical treatment resulting in scarring and change in appearance. Rashes 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 chemotherapies1, or more sensitive to sunlight after chemotherapy or radiotherapy. Some drug treatments may cause inflamed and painful nails of the fingers and toes, 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.2

Vocational implications

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

What you can do

Speak to your healthcare team for advice about the management of bothersome skin or nail changes. There are some treatment options, including antibiotics and topical steroids, which can be very helpful. Use gentle cleansers and emollient creams that are free of perfume, alcohol and other drying agents. Avoid sun exposure as this can exacerbate dry skin. You may use dermatologist-approved cosmetics to cover redness and skin eruptions.

For all skin cancer prevention, wear sun protective clothing, apply sunscreen, and try to avoid direct sunlight. For more information on sun protection, see the Canadian Cancer Society website under Being Safe in the Sun or the BC Cancer Agency website under Sun Safety.

Job accommodations

Modify your work tasks and how you work:

Photosensitivity

  • If photosensitive, ask for alternative duties that do not require outdoor work.
  • Wear a wide-brimmed hat, long sleeve shirts and pants while working outdoors. If your work requires a uniform, request alternative clothing options that would allow you to be protected from the sun.

Painful fingers and hands

  • Wear protective gloves that are suited to your work tasks. Thin cotton gloves can be worn indoors for comfort. Waterproof gloves should be used in tasks that frequently expose your hands to liquid if nails are damaged.
  • Use electric tools in place of manual tools when possible.
  • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to increase comfort.
  • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter which requires less grip strength to hold tool.
  • Use a headset if you are frequently on the telephone.
  • For jobs that involve computer use and typing, consider using speech recognition software. Alternatives to mice and or switches accessed by other body parts are options for very sensitive fingertips.
  • Contact your local occupational therapist for possible hand exercises to increase strength and coordination if this is an issue. A desensitization program may also be helpful in decreasing sensitivity.

Painful toenails and feet

  • Wear well fitting, supportive footwear with a closed heel and rubber sole.
  • Contact your local foot specialist to receive an assessment for a custom-made off-loading insole to reduce pressure on your feet.3
  • Work in a standing position and sit down when you’re able. Use a stand-lean chair if possible; if not, keep a rest-chair nearby.
  • Use an anti-fatigue mat under surfaces where you frequently stand or add anti-fatigue surfaces to your shoes.
  • Consider using a mobility aid to reduce weight load to your feet such as a walker.
  • Other mobility aids may also be helpful in managing mobility when you have foot pain. Assessment by a local therapist (physical therapist, occupational therapist) may be best to help you find an appropriate mobility aid.

Modify your work environment:

Painful toenails and feet

  • Request parking close to your work entrance.
  • Relocate your workstation closer to the washroom, break room or other frequently used space.
  • Limit repetitive tasks on your feet and try to vary them.

Hand-foot syndrome

  • Avoid tasks that expose your hands to extreme heat, such as dishwashing.
  • Limit tasks which involve repetitive friction on hands:
    • Use electric tools to replace manual effort.
    • Reduce repetitive tasks and vary these tasks with other duties.
  • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to decrease friction.
  • Request parking close to work entrance.
  • Relocate your workstation closer to the washroom, break room, or other frequently used space.

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Changes in bowel and bladder function

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