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
Abstract
Background: An increasing number of patients survive or are living with cancer. Anticancer treatments frequently have cutaneous adverse events (cAEs) that may severely impact patients' quality of life and interrupt anticancer treatment. The US Cutaneous Oncodermatology Management (USCOM) project aims to improve cancer patients' and survivors' quality of life by offering tools for preventing and managing cAEs.
Methods: An algorithm was designed to reduce the incidence of cAEs, treat cAEs, and maintain healthy skin using general measures and over-the-counter agents to support all healthcare providers treating oncology patients, including physicians, nurses, pharmacists, and advanced providers. The panel used a modified Delphi approach, developed, discussed, and reached a consensus on statements and an evidence-based algorithm.
Results: The USCOM algorithm includes education on cAEs for patients and clinicians supporting prevention, treatment, and maintenance using skincare measures before, during, and after cancer treatment. A skincare regimen including hygiene, moisturization, and sun protection products should be safe and effective in helping to minimize cAEs and improving skin conditions such as erythema, xerosis, pruritus, and photosensitivity. The number and quality of studies evaluating skincare formulations and regimens for cAEs are increasing, but the evidence on the benefits of specific formulations is still scarce.
Conclusions: The algorithm focuses on general measures and skincare to prevent or reduce the severity of cAEs. Increased awareness of cAEs by the multidisciplinary team treating and guiding the cancer patient throughout their care may improve patient outcomes.
J Drugs Dermatol. 2021;20:9(Suppl):s3-19.
BACKGROUND
According to the National Program of Cancer Registries and the North American Association of Central Cancer Registries in the United States (US) in 2019, the estimated number of new cancer cases was 1,762,450.1 In 2019, the five most commonly diagnosed cancer types in the US for men were prostate cancer, lung and bronchus cancer, colorectum cancer, and urinary bladder cancer. For women, excluding basal and squamous cell skin cancers, common types were breast cancer, colorectal cancer, lung cancer, uterine cancer, and melanoma.1-4 Increasingly, patients are diagnosed early, and the quality of cancer treatment has improved. Therefore, now more than ever, Americans are living with or surviving cancer.1-4 As a result, increasing numbers of patients are living with cutaneous toxicities or sequelae of cancer or cancer treatments.5
When targeting cancer, various options are available depending on the type, the stage of the disease, and patient-related factors. Treatments may include surgery, radiation, transplantation, chemotherapy, targeted therapy, immunotherapy, hormonal therapy, or combinations of these.5 Cutaneous adverse events (cAEs) from anticancer treatments occur frequently and are reported as one of the most impactful side effects of cancer treatment.6,7 These cAEs are often visible and, as a consequence, alter the patients' self-image, leaving their disease exposed.6,7 Additionally, cAEs related to cancer
