literature searches and reach a consensus on the statements and algorithm based on the selected literature. The virtual discussion was followed by virtual follow-up, replacing the use of a questionnaire.14 The process entailed preparing the project, selecting the panel, and conducting systematic literature searches followed by three steps (Figure 1).
Step 1: Virtual panel meeting on September 5, 2020 to review the results of the systematic literature review addressing OTC skincare for prevention, treatment, and maintenance of cAEs and to discuss and adopt statements using evidence coupled with the panels' experience and opinion.
Step 2: Virtual panel meeting on December 5, 2020 to develop, review, and reach consensus on the algorithm.
Step 3: Online process to fine-tune the statements and the algorithm and to prepare and review the publication.
The literature review included guidelines, consensus papers, and publications on the management of cAEs, and clinical and other research studies published in the English language from January 2010 to August 2020. Excluded were articles with no original data (unless a review article was deemed relevant), not dealing with skincare for prevention and treatment of oncology-related cAEs, and publication language other than English.
A dermatologist and a physician-scientist conducted the searches on August 25 and 26, 2020 on PubMed and Google Scholar as a secondary source of the English-language literature using the terms:
Skincare regimens 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 = 36) and articles deemed not relevant for the statements and algorithm (other subjects, low quality, a small number, case studies), 70 papers remained. Thirty were review articles including four systematic reviews, four guidelines/algorithms, five epidemiology studies, one book, one definitions article, and twenty-nine clinical studies (Figure 2).
The literature search results were evaluated independently by two reviewers who graded the clinical publications for study type and quality (randomized controlled trial [RCT) of high quality = A, B, or C) and assigned a level of evidence (level 1 to level 4) using the pre-established criteria (Table 1).15
Twenty clinical publications addressed cAEs impacting the quality of life, dermatologic consultation, or skincare, providing important information to support the statements and the USCOM practical algorithm on prevention, treatment, and maintenance using OTC skincare. Most were graded C-3 (n = 13); there were four C-2, and three articles graded B-2 (Table 2).
The reviewers drafted statements based on the selected