Sun Safety in Oncology: Strategies for Education and Risk Assessment

With skin cancer rates on the rise, oncology nurses serve as a critical front line for both prevention and survivorship care. In a recent interview, Diane Stanaway, MSN, RN, NE-BC, OCN, ONN-CG, an oncology nurse navigator and clinical advocate at Hackensack Meridian Ocean University Medical Center, shared insights from her 50-year career in nursing — 36 of which have been dedicated to oncology — regarding the evolving landscape of sun safety.

Assessing historical risk

A primary challenge for nurses in survivorship or primary care settings is identifying patients with significant historical sun damage. Five or more blistering sunburns early in life can increase an individual's melanoma risk by approximately 80%. To effectively assess this risk during routine clinical intake, she suggests asking specific questions about childhood habits that patients might otherwise overlook.

“It’s important to ask them specific questions because people don't think of the other things,” Stanaway explained. These questions should cover the use of sunblock during childhood, participation in outdoor sports without protection, and even vocational history, such as construction work. For older generations, nurses should specifically ask about the use of baby oil or iodine for tanning. Furthermore, documenting a history of tanning bed use and family history of melanoma remains essential for a comprehensive risk profile.

Treatment-induced photosensitivity

Patients undergoing active treatment, including chemotherapy, radiation, or targeted therapies, face a heightened risk due to photosensitivity. Stanaway emphasized that oncology nurses must tailor their counseling to address the immediate and long-term effects of these treatments.

While immediate protection is vital during treatment, nurses should also educate patients that the photosensitizing effects of chemotherapy and radiation can last for months or even years. Counseling should prioritize physical barriers, such as wide-brimmed hats, long-sleeved shirts, and pants. Stanaway specifically recommended wide-brimmed hats over baseball caps, noting that she frequently sees sun damage on the tops of heads, ears, and sides of the face that caps fail to protect.

Innovations in sun protection

The sun safety landscape is shifting with the introduction of new sunscreen ingredients. Stanaway highlighted bemisotrizinol, a recently discussed sunscreen ingredient that offers significant benefits for the oncology population. Unlike traditional filters, this ingredient is photostable, meaning it breaks down more slowly than traditional sunscreens.

For immunocompromised patients and those undergoing treatment, bemisotrizinol is particularly beneficial because it has low water solubility and minimal skin penetration.

“The amount it enters the body is negligible,” Stanaway said, noting that there is no evidence it affects immune function or causes systemic effects. While it offers longer-lasting protection, she maintained that the standard recommendation for all sunscreens remains reapplication every two hours.

Debunking common misconceptions

A key role for oncology nurses is dispelling persistent myths regarding SPF and application. Stanaway clarified that while an SPF of at least 30 is recommended, higher numbers do not necessarily offer superior protection. “Above 30, the 70s, the 50s, the hundreds, they're not any more effective than the 30,” she stated.

Additional counseling points for nurses to share include:

• Peak hours: Patients should avoid direct sun exposure between 10 am and 4 pm.
• Hydration: Maintaining adequate fluid intake is essential during heat and sun exposure.
• Eye protection: Wearing sunglasses is necessary to prevent long-term sun damage to the eyes.

Advocacy and prevention

As a two-time skin cancer survivor herself, Stanaway’s advocacy is deeply personal. She urged nurses to engage with young adults and parents to emphasize the importance of protecting children now. Because sun damage is cumulative, protecting the skin during youth is the most effective way to prevent malignancies later in life.

By integrating these specific assessment questions and updated product knowledge into their daily practice, oncology nurses can better equip their patients to navigate the risks of sun exposure both during and after cancer treatment.