of patients would decline chemotherapy because of fear of hair loss.7
A study of patients with breast cancer receiving radiation therapy reported that cAEs induced by radiotherapy negatively impact physical wellbeing, body image, emotional wellbeing, functional wellbeing, and treatment satisfaction.8 Scars resulting from oncologic surgical procedures can lead to psychological problems in 15% of survivors of childhood cancers.9
The aim of the skincare algorithm for patients with cancer and survivors is to promote healthy skin and reduce cancer treatment-related cAEs.
NECOM Project Status
The Nordic European Cutaneous Oncodermatology Management (NECOM) project initiated by La Roche-Posay and with the help of 2 members of the Canadian Skin Management in Oncology Group (CaSMO) explored clinical insights in cAEs and focused on skincare regimens involving hygiene, moisturization, sun protection, and camouflage products.4
The NECOM group (advisors) discussed and reached a consensus on evidence- and opinion-based best practice recommendations for oncology skincare programs to support all stakeholders in the Nordic European health care setting working with oncology patients throughout the entire continuum of care to achieve optimal outcomes and improve QoL for patients.4 The next step in the project was to develop an algorithm to assist with the management of cAEs, possibly reduce their incidence or severity, recommend optimal therapies, and maintain healthy skin using general measures and nonprescription skin care based on the information in the NECOM consensus paper.4
Even though the current algorithm is adapted to Scandinavian countries, it could be applied worldwide to support all health care providers treating oncology patients, including physicians, nurses, pharmacists, and advanced providers.
A study of patients with breast cancer receiving radiation therapy reported that cAEs induced by radiotherapy negatively impact physical wellbeing, body image, emotional wellbeing, functional wellbeing, and treatment satisfaction.8 Scars resulting from oncologic surgical procedures can lead to psychological problems in 15% of survivors of childhood cancers.9
The aim of the skincare algorithm for patients with cancer and survivors is to promote healthy skin and reduce cancer treatment-related cAEs.
NECOM Project Status
The Nordic European Cutaneous Oncodermatology Management (NECOM) project initiated by La Roche-Posay and with the help of 2 members of the Canadian Skin Management in Oncology Group (CaSMO) explored clinical insights in cAEs and focused on skincare regimens involving hygiene, moisturization, sun protection, and camouflage products.4
The NECOM group (advisors) discussed and reached a consensus on evidence- and opinion-based best practice recommendations for oncology skincare programs to support all stakeholders in the Nordic European health care setting working with oncology patients throughout the entire continuum of care to achieve optimal outcomes and improve QoL for patients.4 The next step in the project was to develop an algorithm to assist with the management of cAEs, possibly reduce their incidence or severity, recommend optimal therapies, and maintain healthy skin using general measures and nonprescription skin care based on the information in the NECOM consensus paper.4
Even though the current algorithm is adapted to Scandinavian countries, it could be applied worldwide to support all health care providers treating oncology patients, including physicians, nurses, pharmacists, and advanced providers.
METHODS
The NECOM project used a modified Delphi technique for interactive decision-making for medical projects following the AGREE II instrument.10,11
The process entailed preparing the project, selecting the panel, and conducting systematic literature searches. Followed by a panel meeting on March 23, 2022, to discuss the systematic literature review results addressing nonprescription skincare for prevention, treatment, and maintenance of cAEs and to discuss and adopt statements based on the evidence and coupled with the expert opinion and experience of the advisors. An online process was used to fine-tune the evidence- and opinion-based best practice recommendations for oncology skincare programs and to prepare and review the publication.
The process entailed preparing the project, selecting the panel, and conducting systematic literature searches. Followed by a panel meeting on March 23, 2022, to discuss the systematic literature review results addressing nonprescription skincare for prevention, treatment, and maintenance of cAEs and to discuss and adopt statements based on the evidence and coupled with the expert opinion and experience of the advisors. An online process was used to fine-tune the evidence- and opinion-based best practice recommendations for oncology skincare programs and to prepare and review the publication.
LITERATURE REVIEW
The first NECOM paper4 searched for publications in the English language published from 2010 to November 2020 on PubMed, and using Google Scholar as secondary source. The searches were conducted on January 12 and 13, 2021. Searches identified the literature on current best practices in cAEs using nonprescription skin care. The selected literature was clinically relevant to oncodermatology in the Nordic European countries and addressed efficacy, safety, quality of life aspects, handling and comfort, adherence to treatment, and availability of the skincare regime. For the current algorithm, the same dermatologist and physician/scientist who conducted the previous systematic literature review4 searched for publications from December 2020 to February 14, 2022, on February 15 and 16, 2022. Guidelines, consensus papers, reviews, clinical trials describing current best practices in cAEs using over-the-counter skin care, and clinical research studies published in English were selected. Excluded were articles with no original data (unless a review article was deemed relevant), those not dealing with skin care for prevention and treatment of cAEs, and those published in a language other than English. Search terms used included: Radiation treatment and cAEs; OR chemotherapy and cAEs; OR targeted therapy and cAEs; OR immunotherapy and cAEs; OR Hormonal treatment and cAEs; OR Health-related quality of life and cAEs; OR cAEs skincare and prevention; OR cAEs skincare and treatment; OR cAEs and adjunctive skincare; OR cAEs and nonprescription skincare; OR cAEs and skincare adherence, concordance; OR cAEs skincare and efficacy, safety, tolerability, skin irritation OR cAEs and staff and patient education.
The results of the searches were evaluated independently by the 2 reviewers. The initial searches yielded 146 publications. After excluding duplicates (n = 61) and articles deemed irrelevant, 85 remained (12 guidelines/algorithms, 24 reviews [of which 15 were systematic reviews], 39 clinical studies [of which 10 were randomized controlled trials], and 10 other papers).
Clinical evidence from topical treatments on the efficacy of cAEs was graded using a pre-established grading system (American Academy of Dermatology evidence-based guideline development process).12 This grading system rates study type (level A [clinical double-blind RCT of high quality], B [RCT of lesser quality], or C [Comparative trial with severe methodologic limitations]). Additionally, the reviewers graded the likelihood of changing confidence in the measured effect (1 [unlikely] to level 4 [the effect is very uncertain]) of the study.12 The chosen grading system is relevant for clinical algorithm development and considers knowledge development in a fast-evolving field (Table 1).
The reviewers drafted an algorithm based on the selected literature before the meeting. During the meeting, the NECOM group set and fine-tuned the algorithm and revised it online after the meeting. The NECOM panel defined the final algorithm
The results of the searches were evaluated independently by the 2 reviewers. The initial searches yielded 146 publications. After excluding duplicates (n = 61) and articles deemed irrelevant, 85 remained (12 guidelines/algorithms, 24 reviews [of which 15 were systematic reviews], 39 clinical studies [of which 10 were randomized controlled trials], and 10 other papers).
Clinical evidence from topical treatments on the efficacy of cAEs was graded using a pre-established grading system (American Academy of Dermatology evidence-based guideline development process).12 This grading system rates study type (level A [clinical double-blind RCT of high quality], B [RCT of lesser quality], or C [Comparative trial with severe methodologic limitations]). Additionally, the reviewers graded the likelihood of changing confidence in the measured effect (1 [unlikely] to level 4 [the effect is very uncertain]) of the study.12 The chosen grading system is relevant for clinical algorithm development and considers knowledge development in a fast-evolving field (Table 1).
The reviewers drafted an algorithm based on the selected literature before the meeting. During the meeting, the NECOM group set and fine-tuned the algorithm and revised it online after the meeting. The NECOM panel defined the final algorithm
