US Cutaneous Oncodermatology Management (USCOM): A Practical Algorithm

September 2021 | Volume 20 | Issue 9 | Supplement Individual Articles | 3ss | Copyright © September 2021

Published online September 1, 2021

Mario E. Lacouture MD,a Jennifer Choi MD,b Alice Ho MD,c Jonathan Leventhal MD,d Beth N. McLellan MD,e Anneke Andriessen PhD,f Maxwell B. Sauder MD,g Edith Mitchell MDh

aOncodermatology, Memorial Sloan Kettering Cancer Center, New York, NY
bOncodermatology Program, Department of Dermatology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
cRadiation Oncology, Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, New York, NY
dOncodermatology, Smilow Cancer Hospital at Yale, New Haven, CT
eMontefiore's Division of Dermatology and Montefiore Einstein Center for Cancer Care; Dermatology, Jacobi Medical Center, New York, NY fRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
gOncodermatology, Princess Margaret Cancer Centre, Pigmented Lesion Clinic, Toronto Dermatology Disparities; Gastrointestinal Centre, Toronto, ON, Canada
hCenter to Eliminate Cancer Disparities, Gastrointestinal Oncology, Thomas Jefferson University Hospital and Jefferson Methodist Hospital, Philadelphia, PA

impact the quality of life and disrupt cancer treatment.

Many studies are available on cAEs; however, more robust studies are needed on prevention, treatment, and maintenance using skincare.5-12,17-20,22,25,29,39 cAEs negatively affect functional and emotional domains relating to QoL in cancer patients. Moreover, multiple negative experiences due to cAEs may increase psychological distress and avoidance of personal relationships, leading to social isolation.6-8,39

Patients reported that cAEs significantly limit their daily activities and are an essential contributor to a reduced QoL.6-8,39 Women noted alopecia as the most traumatic adverse event of various systemic cancer treatments.18,23,24,40

Although clinicians acknowledged the importance of achieving a sufficient balance between cancer-treatment efficacy and cAEs to maintain an optimal QoL in cancer survivors, the research available on the prevention and treatment using an effective skincare regimen for these cAEs is limited.6-12,39

Cutaneous AEs Impact Cancer Treatment
Statement 3: Disabling skin reactions is a significant problem for many patients and their treating physicians.

Cytotoxic and targeted cancer treatments that impede cancer cells' proliferation also affect rapidly proliferating organ systems. The most commonly documented cAEs include papulopustular rash, xerosis, pruritus, nail changes, chemotherapy-induced alopecia, and hand-foot syndrome/ skin reaction.8 The probability of cancer patients to develop cAEs with cytotoxic and targeted cancer treatments significantly impact wellness and treatment adherence.5-12,18,28-40 Persistent cAEs may be disabling, and over 50% of cancer patients treated with selected agents may experience an interruption in therapy secondary to these toxicities.10,11 It is important to have a dermatologist on the multidisciplinary oncology team to enable accurate diagnosis and treatment of the cAEs, allowing the continuation of cancer treatment that historically would have been discontinued.8,39,41

When reviewing inpatient records from 2011–2018, Chen et al (2019) selected 33 cases with confirmed cAEs due to immunotherapy with similar severity grading.9 Systemic steroids used to manage these cAEs decreased the cancertreatment effect of immunotherapy https://pubmed.ncbi.nlm. Involving a dermatologist in the treatment of cAEs, the retrospective study showed that patients were less likely to receive systemic steroids (18% vs 55%) and less likely to have cancer treatment disrupted or discontinued (0 vs 36%).9 Another study by Barrios et al (2017) demonstrated that 50% of patients who received cytostatic and targeted therapy experienced an interruption in treatment due to cAEs.11

Skincare Benefits for cAEs
Statement 4: When acute cutaneous reactions develop, effective skincare should be reinforced to reduce further complications and assist in managing toxicities.

Currently, cutaneous toxicity programs are being established, aiming to promote dermatologic health in cancer patients.39 A multidisciplinary team, including dermatologists, can improve oncology patients' care.8-10,12 Attention for prevention and early and correct diagnosis ruling out life-threatening cAEs can improve adherence to cancer treatment and, therefore, outcomes.8-10,12

A multidisciplinary panel of clinicians treating oncology patients recommended that, ideally, dermatologic services should be readily available for patients undergoing cancer treatments.12 The service should include urgent access to a dermatologist to identify and assist in managing lifethreatening cAEs.12 Moreover, when acute cAEs develop, an effective skincare regimen should be put in place immediately to prevent further deterioration of the condition and improve patient comfort and quality of life.12,39,44,45 Although studies have demonstrated that dermatological care resulted in improved patient-reported QoL and cancer treatment outcomes, the influence of skincare on cancer treatment adherence is yet to be elucidated.8

Statement 5: Supportive care and appropriate skincare continue to be mainstays of prevention and treatment for acute and chronic dermatologic toxicities.

The number and quality of studies evaluating skincare formulations and regimens for various cancer-treatmentrelated cAEs increase, but the evidence on the benefits of specific formulations is still scarce. Currently, most available studies include patients with ARD. Rosenthal et al (2019) reviewed the efficacy of topical agents for ARD and found formulations containing aloe vera, chamomile, ascorbic acid, pantothenic acid, dexpanthenol, and trolamine to lack benefits.22 They further showed that formulations containing hyaluronic acid, epidermal growth factor, granulocytemacrophage colony-stimulating factor, and topical corticosteroids have potential benefits.22 The review did not consider those topical agents that have ingredients known as soothing to be beneficial, such as niacinamide, panthenol, squalene, glycerin, shea butter, and allantoin.47

Lüftner et al (2018) conducted a multicenter prospective observational open-label study to evaluate the use of a 12-product kit for fifty patients receiving chemotherapy who received skincare kits before starting their cancer treatment with instructions to use the skincare throughout the treatment phase.48 The study indicated skincare benefits, helping to