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

About 90% of cancer patients receiving external beam radiation treatment develop radiation dermatitis.16,19,20 Radiation treatment-related cAEs are categorized as acute or chronic radiation dermatitis. Skin damage is limited to the area that received radiation and can be aggravated by concurrent systemic therapies.19

Systemic cancer treatments such as chemotherapy, targeted, and immunotherapy are frequently related to cAEs. These cAEs include xerosis, erythema, hand-foot syndrome (HFS), nail changes (onycholysis, pigmentary alteration, brittle nails), and other (Table 2).16-31

Patients reported significant limitations to daily activities and reduced QoL due to cAEs.4-6,20,21,32 Functional and emotional domains of QoL evaluated in patients receiving anticancer treatment showed multiple negative experiences such as increased psychological distress and avoidance of personal relationships, leading to social isolation.4-6,21,32 Alopecia is especially bothersome for women and seems the most traumatic AE related to various systemic cancer treatments.17,20-22

Clinicians acknowledge the importance of considering the management of cAEs as a part of optimizing cancertreatment efficacy; however, there is limited appreciation of the preemptive skincare's role in improving patients' QoL and avoiding cancer treatment interruption.32-34

The severity of cAEs clinically correlates with significant health deficits.11 Therefore, if the patients' skin should be in an optimal condition and sufficiently moisturized before starting anticancer treatment, reducing the incidence and severity of cAEs enhances patients' QoL and treatment outcomes.5,10-12

In an American and European study, ninety-five patients treated with panitumumab received either preemptive skincare or reactive skincare and were followed during the seven-week anticancer treatment period.5 The preemptive skincare regimen started one day before the anticancer treatment, continued for six weeks, and comprised a moisturizer and a broad spectrum (SPF >15) sunscreen. The reactive skincare regimen had the same products but started once the cAEs occurred. The incidence of cAEs had reduced, and patient-reported QoL impairment was lower in the preemptive skincare regimen group compared to those who received skincare once the cAEs had occurred.5

Facial cAEs such as acneiform rash particularly impair patients' QoL, as shown in a cross-sectional study including patients receiving targeted therapy with epidermal growth factor receptor inhibitors.32 Further cAEs that markedly reduced patients' QoL comprised erythema, xerosis, pruritus, and paronychia in different parts of the body such as the face, neck, chest, abdomen, and thighs.32-34

Statement 2: Early education and appropriate skin care, including cleansing, hydration, and photoprotection, may improve quality of life and prevent severe skin side-effects for cancer patients and survivors.

Attention for prevention, early and correct diagnosis ruling out life-threatening cAEs can improve patients' QoL, adherence to cancer treatment, and, therefore, outcomes.6-12

Although data is scarce to support the prevention of severe skin sequelae for cancer patients and survivors, the NECOM panel agreed that early education on preventive measures using skincare is beneficial to patients.

The multidisciplinary oncology team including a dermatologist should build a therapeutic relationship with the patient enabling their active participation in the cancer treatment plan.10,12 Before initiating treatment, the treating physician and nurse, or other multidisciplinary oncology team members, should have a detailed conversation with the