A systematic review of patient-reported outcome instruments of dermatologic adverse events associated with targeted cancer therapies

Abstract

Purpose Dermatologic adverse events (dAE) in cancer treatment are frequent with use of targeted therapies. These dAEs have been shown to have significant impact on health-related quality of life (HRQoL). While standardized assessment tools have been developed for physicians to assess severity of dAEs, there is a discord between objective and subjective measures. The identification of patient-reported outcome (PRO) instruments useful in the context of targeted cancer therapies is therefore important in both the clinical and research settings for the overall evaluation of dAEs and their impact on HRQoL. Methods A comprehensive, systematic literature search of published articles was conducted by two independent reviewers in order to identify PRO instruments previously utilized in patient populations with dAEs from targeted cancer therapies. The identified PRO instruments were studied to determine which HRQoL issues relevant to dAEs were addressed, as well as the process of development and validation of these instruments. Results Thirteen articles identifying six PRO instruments met the inclusion criteria. Four instruments were general dermatology (Skindex-16©, Skindex-29©, Dermatology Life Quality Index [DLQI], and DIELH-24), and two were symptom-specific (Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitors-18 [FACT-EGFRI-18] and Hand-Foot Syndrome 14 [HFS-14]). Conclusions While there are several PRO instruments that have been tested in the context of targeted cancer therapy, additional work is needed to develop new instruments and to further validate the instruments identified in this study in patients receiving targeted therapies.

Management of Treatment-Related Adverse Events with Agents Targeting the MAPK Pathway in Patients with Metastatic Melanoma

“…Dermatologic toxicities have been commonly associated with targeted therapy . The most common skin toxicities associated with BRAFi have included rash, alopecia, dry skin, hyperkeratosis, papillomas, palmar‐plantar erythrodysesthesia (PPE; hand‐foot syndrome), cutaneous squamous cell carcinoma (cuSCC)/keratoacanthoma (KA), pruritus, and photosensitivity (Table and supplemental online Table 1).…”

“…Dermatologic AEs are considered a class effect of BRAFi and MEKi, although the type, extent, and etiology of the particular AE may differ for the particular agents . General types of cutaneous toxicities commonly reported include rashes and other skin irritations, acneiform dermatitis, hyperproliferative skin disorders, and photosensitivity (Table ).…”

“…Additionally, severe dermatologic AEs may lead to impairments in patients’ daily lives, particularly for those with hand and/or foot lesions. Therefore, proper proactive management of these cutaneous AEs is critical to avoid drug delays, interruptions, or discontinuations, and to limit their impact on quality of life .…”

Dermatologic events from EGFR inhibitors: the issue of the missing patient voice

“…Other prominent dAEs induced by EGFR inhibitors are xerosis, pruritus, nail changes, mucositis, fissures of fingertips and toes, and hair changes [3–16]. It has been claimed that severe dAEs may result in significant physical and emotional discomfort [15].…”

Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors

“…At present, it seems prudent to conclude that skin reactions appear to lead to a negative impact on QoL, but our methods for capturing this impact are highly variable in their effectiveness [6,[29][30][31]. Of interest, the development of a new Functional Assessment of Cancer Therapy questionnaire specific for EGFR inhibitorattributable skin reactions may aid in unequivocally resolving the impact of skin reactions on patients' QoL and social functioning [32][33][34][35][36][37].…”