Therefore, outreach from nurses to oncologists is critical.4 There is an opportunity to engage with oncology nurses, who are most heavily involved in patient education and typically serve as a point of contact among the various health care providers.4,24-26 For instance, in Sweden, patient coordinators are usually specially trained oncology nurses who are essential in guiding the journey for the patient with cancer. A non-profit cancer association funds the position of these oncology nurses.
Education and the Role of Oncology Nurses
Communication in the fast-evolving area of oncology is necessary to provide tailored general measures and skin care supported by evidence and practice-based expert recommendations.4,17-40 Patients and caregivers need to understand that cAEs can often be managed effectively, especially when they are identified early.4,24-26,39
Although data is scarce to support the prevention of severe cAEs for patients with cancer and survivors, the NECOM advisers agreed that early education on behavioral measures, skin care, and sunscreen use is beneficial to patients.4 Communication with other health care professionals on best practices enables optimal care delivery.17-25 For instance, radiation oncologists, typically advise their patients not to put any products on their treatment areas, resulting in severely compromised skin.4 However, studies have shown that using a barrier cream decreases cutaneous skin side effects.4
Pharmacists are also important multidisciplinary cancer care team members and often provide patient education that may or may not align with the oncologist’s or dermatologist's recommendations.4,17-40,53 Many cancer treatments are photosensitizing; oncology nurses must enthusiastically educate patients about the risks of sun exposure.4,13,12,54-62 Oncologists can discontinue anticancer therapies due to cAEs; involving dermatologists, especially early on, can reduce or prevent treatment interruption or discontinuation.4,17-53 Educating oncologists on accurately grading skin toxicities may also help reduce avoidable dosage changes or even treatment interruption.4,13,17-39 According to the NECOM advisors, patient education on skin care should occur before initiation of cancer treatment; nurses should assess whether patients are compliant with their skincare regimens in case of skin concerns and checkin regularly.4,13,27,54-62
The preemptive role of skin care in improving QoL for patients and helping to avoid cancer treatment interruption deserves attention from health care providers who treat patients with cancer.4,24-26 Healthy and sufficiently moisturized skin prior to initiating anticancer treatment will reduce the incidence and severity of cAEs.4,24-26
An American and European study assessed 95 patients with cancer who were treated with a 7-week course of panitumumab and received either preemptive or reactive skin care.50 The preemptive skincare regimen started 1 day before the anticancer treatment, continued for 6 weeks, and comprised a moisturizer and a broad spectrum (SPF >15) sunscreen. The reactive skincare regimen had the same products but started at onset of cAEs. The authors found a reduced incidence of cAEs and lower patientreported QoL impairment in the preemptive skin care regimen group compared with those who initiated the skin care regimen once the cAEs occurred.50
Conventional moisturizers contain occlusives, humectants, and emulsions.4,70 Newer moisturizers include distinct ratios of lipids that resemble physiological compositions and are designed to restore skin barrier disruptions and deliver better efficacy.31-33,39
Cancer Treatment-Related cAEs
Anticancer treatments comprise surgery, radiation therapy, chemo, targeted immune and hormonal therapies, and transplants. 4,13,25,26,39 Frequently, a combination of these anticancer treatments are used.4
The current algorithm focuses on general and skin care measures before, during, and after cancer treatment to promote a healthy skin condition and reduce the severity of cAEs. The NECOM review summarized cancer treatments and related cAEs.4 The glossary4 from the NECOM review is reproduced and modified by the advisors to discuss relevant cAEs for the algorithm (Figure 2).
cAE Triage
The oncology nurse should observe the patient's skin condition during routine cancer treatment evaluations.4,25,26,39
The Common Terminology Criteria for Adverse Events (CTCAE) grading system is a standardized classification of adverse effects of cancer therapies. Within the skin and subcutaneous tissue disorder section, there are gradings for specific toxicities such as alopecia, bullous dermatitis, eczema, pruritus, Stevens-Johnson Syndrome, etc., as well as a general category for skin toxicities without specific grading. All categories are graded 1 through 5 with 1 being mild and 5 indicating death. It was deemed that the CTCAE grading system is unsuitable for the current algorithm as the evaluation of the patient’s condition and cAEs is oncology nurse-led and requires a tailor-made approach. Moreover, these evaluations are conducted via inperson, phone, email, or telemedicine contacts.4,13,25,26,39 If it is difficult to get sufficient information via phone or email, a visit to the clinic may be needed.4 Patients may underreport their cAEs as they may not recognize it as potentially serious or assume the condition is not cancer treatment-related.4,25,26,39
Education and the Role of Oncology Nurses
Communication in the fast-evolving area of oncology is necessary to provide tailored general measures and skin care supported by evidence and practice-based expert recommendations.4,17-40 Patients and caregivers need to understand that cAEs can often be managed effectively, especially when they are identified early.4,24-26,39
Although data is scarce to support the prevention of severe cAEs for patients with cancer and survivors, the NECOM advisers agreed that early education on behavioral measures, skin care, and sunscreen use is beneficial to patients.4 Communication with other health care professionals on best practices enables optimal care delivery.17-25 For instance, radiation oncologists, typically advise their patients not to put any products on their treatment areas, resulting in severely compromised skin.4 However, studies have shown that using a barrier cream decreases cutaneous skin side effects.4
Pharmacists are also important multidisciplinary cancer care team members and often provide patient education that may or may not align with the oncologist’s or dermatologist's recommendations.4,17-40,53 Many cancer treatments are photosensitizing; oncology nurses must enthusiastically educate patients about the risks of sun exposure.4,13,12,54-62 Oncologists can discontinue anticancer therapies due to cAEs; involving dermatologists, especially early on, can reduce or prevent treatment interruption or discontinuation.4,17-53 Educating oncologists on accurately grading skin toxicities may also help reduce avoidable dosage changes or even treatment interruption.4,13,17-39 According to the NECOM advisors, patient education on skin care should occur before initiation of cancer treatment; nurses should assess whether patients are compliant with their skincare regimens in case of skin concerns and checkin regularly.4,13,27,54-62
The preemptive role of skin care in improving QoL for patients and helping to avoid cancer treatment interruption deserves attention from health care providers who treat patients with cancer.4,24-26 Healthy and sufficiently moisturized skin prior to initiating anticancer treatment will reduce the incidence and severity of cAEs.4,24-26
An American and European study assessed 95 patients with cancer who were treated with a 7-week course of panitumumab and received either preemptive or reactive skin care.50 The preemptive skincare regimen started 1 day before the anticancer treatment, continued for 6 weeks, and comprised a moisturizer and a broad spectrum (SPF >15) sunscreen. The reactive skincare regimen had the same products but started at onset of cAEs. The authors found a reduced incidence of cAEs and lower patientreported QoL impairment in the preemptive skin care regimen group compared with those who initiated the skin care regimen once the cAEs occurred.50
Conventional moisturizers contain occlusives, humectants, and emulsions.4,70 Newer moisturizers include distinct ratios of lipids that resemble physiological compositions and are designed to restore skin barrier disruptions and deliver better efficacy.31-33,39
Cancer Treatment-Related cAEs
Anticancer treatments comprise surgery, radiation therapy, chemo, targeted immune and hormonal therapies, and transplants. 4,13,25,26,39 Frequently, a combination of these anticancer treatments are used.4
The current algorithm focuses on general and skin care measures before, during, and after cancer treatment to promote a healthy skin condition and reduce the severity of cAEs. The NECOM review summarized cancer treatments and related cAEs.4 The glossary4 from the NECOM review is reproduced and modified by the advisors to discuss relevant cAEs for the algorithm (Figure 2).
cAE Triage
The oncology nurse should observe the patient's skin condition during routine cancer treatment evaluations.4,25,26,39
The Common Terminology Criteria for Adverse Events (CTCAE) grading system is a standardized classification of adverse effects of cancer therapies. Within the skin and subcutaneous tissue disorder section, there are gradings for specific toxicities such as alopecia, bullous dermatitis, eczema, pruritus, Stevens-Johnson Syndrome, etc., as well as a general category for skin toxicities without specific grading. All categories are graded 1 through 5 with 1 being mild and 5 indicating death. It was deemed that the CTCAE grading system is unsuitable for the current algorithm as the evaluation of the patient’s condition and cAEs is oncology nurse-led and requires a tailor-made approach. Moreover, these evaluations are conducted via inperson, phone, email, or telemedicine contacts.4,13,25,26,39 If it is difficult to get sufficient information via phone or email, a visit to the clinic may be needed.4 Patients may underreport their cAEs as they may not recognize it as potentially serious or assume the condition is not cancer treatment-related.4,25,26,39
