SUPPLEMENT INDIVIDUAL ARTICLE: Skincare for Cancer Patients in Scandinavia

December 2021 | Volume 20 | Issue 12 | Supplement Individual Articles | ss4 | Copyright © December 2021

Published online November 30, 2021

Ada Girnita MD PhD,a Henrik F. Lorentzen MD,b Sampsa Kauppi MD,c Charles W. Lynde MD FRCPC,d Maxwell B. Sauder MD FRCPC DABD,e Henrik Schmidt MD,f Anneke Andriessen PhD,g Andreas Stensvold MD PhDh

aSkin Cancer Center Karolinska University Hospital Stockholm, Sweden
bDepartment of Dermatology and Venerology Aarhus University Hospital, Denmark
cPrivate practice, Terveystalo and Epilaser Oy, Finland
dDepartment of Medicine University of Toronto, Toronto, ON, Canada; Lynderm Research, Markham, ON, Canada
ePrincess Margaret Cancer Centre; Pigmented Lesion Clinic, Toronto Dermatology Centre, Toronto, ON, Canada
fDepartment of Oncology, Aarhus University Hospital, Denmark
gRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
hOncology Department Oestfold Hospital, Norway

the quality of life (QoL). Moreover, cAEs can be disabling or disfiguring, cause pruritus or pain, leading to reduction or discontinuation of anticancer treatment, reducing patient outcomes.4-10

Clinically significant physical health deficits correlate with cAEs severity and threaten long-term outcomes such as for breast cancer survivors.11 Despite improving survival rates, cancer treatment frequently leads to emergency department visits and hospitalization due to reactive rather than proactive management of cAEs.10 Supportive care programs that extend beyond the anticancer treatment are needed to reduce the number and severity of cAEs, maintaining health, and enhancing the survivorship period after treatment and onwards.10,11

Early and preemptive management of cAEs can improve body image, physical, emotional and functional wellbeing, treatment adherence, and treatment response.5,6,10 One of the measures is a preemptive over-the-counter (OTC) skincare regimen, which has been shown to improve patient's QoL and skin condition.5,6,10 In a study of ninety-five patients receiving panitumumab-containing therapy, the forty-eight patients who received pre-emptive skincare showed a 50% reduction in incidence and severity of cAEs compared to the forty-seven patients in the reactive skincare group. The latter received the regime after cAEs had occurred.5

Despite many publications on cAEs related to anticancer treatment, cancer patients and oncology treatment teams have limited awareness of the use of preemptive skincare comprising cleansers, moisturizers, and sunscreen to improve skin condition.10,12 A multidisciplinary oncology treatment team should educate on prevention, treatment, and maintenance using OTC skincare as part of their cancer patients' comprehensive care before cancer treatment starts.10

The Nordic European Cutaneous Oncodermatology Management (NECOM) project initiated by La Roche-Posay aims to improve cancer patients' and survivors' quality of life by offering guidance for preventing and managing cAEs. Two members of the Canadian Skin Management in Oncology Group (CaSMO) participated to share their experience with the subject. The NECOM group explored clinical insights in addressing skin issues in oncology patients and focused on skin care regimens involving hygiene, moisturization, sun protection, and camouflage products. The NECOM panel of clinicians who treat cAEs developed, discussed, and reached a consensus on evidence and opinion-based best practice recommendations for oncology skincare programs. The aim is to support all stakeholders in the Nordic European healthcare setting working with oncology patients and cancer survivors throughout the entire continuum of care to achieve optimal outcomes, improving patients' QoL.


The NECOM project used a modified Delphi communication technique for interactive decision-making for medical projects following the AGREE II instrument.13,14 Due to COVID-19 travel restrictions, the method was adapted from face-to-face meetings and a questionnaire to a virtual meeting and onlinefollow up to discuss the outcome of literature searches. The process entailed preparing the project, selecting the panel, and conducting systematic literature searches. Followed by a virtual panel meeting on February 6, 2021, to discuss the systematic literature review results addressing OTC skincare for prevention, treatment, and maintenance of CAEs, and discuss and adopt statements using evidence coupled with the expert opinion and experience of the panel. 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
Searches identified the literature on current best-practice in cAEs using OTC skincare before the expert panel meeting. 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. The inclusion criteria comprised guidelines, consensus papers, reviews, clinical trials describing current best-practice in cAEs using OTC skincare, and clinical research studies published in the English language from 2010 to 2020. Excluded were articles with no original data (unless a review article was deemed relevant), not dealing with skincare or topical treatment for prevention and treatment of cAEs, and publication language other than English. A dermatologist and a physician/scientist conducted the searches on January 12 and 13, 2021, on PubMed and Google Scholar as a secondary source of the English-language literature, using the terms:

Skincare regimes prevent and treat cutaneous toxicities associated with radiation treatment, chemotherapy, targeted therapy, immunotherapy, hormonal treatment, prevention, management, maintenance of cutaneous toxicities, and healthrelated quality of life. Adjunctive skincare, OTC skincare, staff and patient education, communication strategies, adherence, concordance, efficacy, safety, tolerability, and skin irritation.

The results of the searches were evaluated independently by two reviewers who resolved discrepancies by discussion. The searches yielded one hundred and six publications. After excluding duplicates (n = 56) and articles deemed not relevant