The Emerging Role of Supportive Oncodermatology in Multidisciplinary Cancer Care

Palliative care has become an accepted and important early intervention in the treatment of cancer. Defined as care that “improves the course of the disease in a number of ways. It minimizes a patient’s symptoms, increases his or her quality of life (QOL), and improves overall satisfaction.”¹ As the practice continues to develop, new ways for oncology clinicians to aid their patients’ course of disease and quality of life are emerging.

As part of our 10-year celebration, the editors of Oncology Nurse Advisor are also looking forward at emerging trends that may define oncology care in the next decade. A type of palliation that is making inroads in cancer care is supportive oncodermatology, a collaborative subspecialty between oncology and dermatology that aims to address the dermatologic adverse events associated with cancer therapy. An innovator in the field is Adam J. Friedman, MD, professor and interim chair of Dermatology and director of Supportive Oncodermatology, George Washington School of Medicine and Health Sciences in Washington, DC.

Identifying a Need for Specialist Care

The rapid development and use of targeted therapies have led to increased incidence of both established and new cutaneous toxicities. Although supportive oncodermatology is still somewhat in its infancy, the field is making an impressive impact (email communication, Adam J. Friedman, May 2020). However, there is a dearth of data to support what clinicians are seeing in the clinic, so Dr Friedman and his colleagues initiated a study to better document the impact of a dedicated clinic for these patients and to identify areas for improvement. They described how a comprehensive supportive oncodermatology program could improve patients’ quality of life in a recently published report.¹

In a cross-sectional survey of patients who received care at the George Washington University Supportive Oncodermatology Clinic, Dr Friedman’s team sought to determine the role of dermatology within a multidisciplinary cancer care approach. Most of the patients were referred to the clinic by their oncologists. The survey was completed by 13 male patients and 21 female patients aged 45 to 64 years. The most common malignancies among the survey respondents were breast cancer (47%) and white blood cell disorders (24%).

Study participants were referred to the oncodermatology clinic for treatment of adverse effects related to the skin (55%), nails (15%), and hair (12%). In their survey responses, patients reported that their nail-related adverse effects were treated with moisturizer, antibiotics, antifungals, vinegar soaks, urea, Nuvail™, and tazarotene. Seven percent of respondents were unable to recall what treatments they received.

Those who experienced hair-related adverse effects were treated with minoxidil, scalp cooling caps, bimatoprost, and other therapies such as essential oils. One patient was unable to recall what treatment was administered for their hair-related adverse effects. Most patients received more than one type of treatment for nail, skin, and hair issues regardless of treatment area.¹

Quality of Life Measures

Before undergoing treatment at the Supportive Oncodermatology Clinic, patients reported an average quality of life (QOL) score of 6.5, which indicated a “moderate effect” on quality of life, compared with an average score of 3.8 after beginning treatment, which corresponded to a “small effect” on QOL. On average, after undergoing supportive treatment at the clinic, patients’ QOL category scores (physical symptoms, embarrassment, clothes, social/leisure, work/school, close relationships) decreased, indicating a significant improvement in the effects of dermatology-related adverse effects on QOL.

An exception was the QOL score for physical symptoms of itch, pain, or soreness. These scores did not demonstrate a significant decrease. The greatest difference in score reduction was for embarrassment.¹