Outpatient dermatology consultations for oncology patients with acute dermatologic adverse events impact anticancer therapy interruption: a retrospective study

Abstract

Background Dermatologic adverse events (dAEs) of anticancer therapies may negatively impact dosing and quality of life. While therapy interruption patterns due to dAEs have been studied in hospitalized cancer patients, similar outcomes in outpatient oncodermatology are lacking. Objectives To analyse the therapy interruption patterns, clinico-histopathologic characteristics and management outcomes of outpatient dermatology consultations for acute dAEs attributed to the most frequently interrupted class of oncologic agents. Methods We performed a retrospective cohort study of all cancer patients who received a same-day outpatient dermatology consultation for acute dAEs at our institution from 1 January to 30 June 2015. Relevant data were abstracted from electronic medical records, including demographics, oncologic history and explicit recommendations by both the referring clinician and consulting dermatologist on anticancer therapy interruption. Consultations with the most frequently interrupted class of oncologic treatment were characterized according to clinico-histopathologic features, dermatologic management and clinical outcomes. Results There were 426 same-day outpatient dermatology consultations (median age 59, 60% female, 30% breast cancer), of which 295 (69%) had systemic anticancer therapy administered within 30 days prior. There was weak inter-rater agreement between referring clinicians and consulting dermatologists on interruption of anticancer treatment (n = 150, j = 0.096; 95% CI À0.02 to 0.21). Seventy-three (25%) consultations involved interruption by the referring clinician, most commonly targeted therapy (24, 33%). Maculopapular rash was commonly observed in 23 consultations with 25 dAEs attributed to targeted agents (48%), and topical corticosteroids were most frequently utilized for management (22, 38%). The majority (83%) of consultations with targeted therapy-induced dAEs responded to dermatologic treatment and 84% resumed oncologic therapy, although three (19%) at a reduced dose. Rash recurred only in two instances (13%). Conclusions A high frequency of positive outcomes in the management of targeted therapy-induced dAEs by outpatient consulting dermatologists and low recurrence of skin toxicity suggests impactful reductions in interruption of anticancer therapy.

Effect of dermatological consultation on survival in patients with checkpoint inhibitor‐associated cutaneous toxicity

“…These findings underscore the therapeutic value of dermatologists within their current scope of practice. [32][33][34] However, these findings also suggest that patients with cirAEs evaluated outside of the dermatology setting may have significant unaddressed symptoms, meriting refined approaches to care delivery. Potential innovations targeting providers could include integration of clinical decision support systems encouraging NCCN-based treatment, development of care pathways to standardize referral processes by cirAE subtype, 47 and evaluation of care modalities with the potential to enhance access, such as teledermatology.…”

“…Although the interplay between these elements remains underexplored for patients receiving ICI therapies, for patients receiving other forms of anticancer treatment, available evidence suggests that dermatology referral may enhance care. [32][33][34] In the ICI context, the limited data analogously underscore potential clinical benefits, with a recent single-centre study of hospitalized patients with cirAEs suggesting that dermatology consultation may reduce cirAE/toxicity-associated immunosuppression and disruptions to ICI therapy. 32 If similar benefits persist across care settings, low referral rates may represent a source of modifiable morbidity, but the interplay between care features and clinical outcomes remains unclear.…”

Subjective evaluation of skin toxicity and quality of life in patients undergoing anti-cancer treatment at the Department of Cancer Chemotherapy

“…According to Nikolaou et al and Barrios et al skin toxicity caused by targeted drugs is a more frequent reason for dose modification compared to standard chemotherapy. This poses a risk of premature termination of anticancer therapy [18,19]. The increasing availability of targeted therapy causes the proper management of skin toxicity to become an important issue.…”

“…Barrios et al analysed the medical data of 44 patients in whom discontinuation of anticancer treatment due to skin toxicity was considered. In the dermatological assessment, interruption of anticancer treatment was considered justified in only 6 of the 44 cases [18].…”

Supporting Virtual Dermatology Consultation in the Setting of COVID-19

“…The Dermatology Service at Memorial Sloan Kettering Cancer Center (MSK) provides dermatology services for patients undergoing oncologic care [ 10 ] and manages patients diagnosed with and at high risk for cutaneous malignancies. Given the exigencies of these types of dermatologic patient needs [ 11 ], patient care, in both person and virtual, has dramatically changed over the past few months.…”