The Dermatologist spoke with Adam Friedman, MD, FAAD, professor of dermatology at George Washington School of Medicine and Health Science and director of the supportive oncodermatology clinic, about supportive oncodermatology and its role in cancer treatment.
Since the development of targeted biologics and small molecule inhibitors, patients with certain cancers are living longer. However, some of the treatments that extend patients’ lives are also associated with dermatologic adverse effects that can reduce their quality of life and limit treatment duration and efficacy, or even lead to treatment cessation.
To address the needs of this patient population, Adam Friedman, MD, FAAD, associate professor of dermatology at George Washington (GW) School of Medicine and Health Science, partnered with the GW Cancer Center to open an oncodermatology clinic. Dr Friedman is the director of the clinic, which he said addresses 2 important needs.
“The clinic serves as a resource for the GW Cancer Center to utilize when the expected hair, skin, and nail adverse events occur in their exponentially growing patient population in order to minimize the associated morbidity of their therapies,” he said. “Also, it is a much-needed training opportunity for residents who will no doubt encounter these and many more dermatologic issues relating to cancer interventions.”
According to Dr Friedman, supportive oncodermatology is an emerging subspecialty between oncology and dermatology that seeks to address the dermatologic adverse events associated with cancer therapies, as well as provide necessary monitoring of patients to ensure the best potential survivorship.
“My goals are to provide the highest level of care to enable a patient to kick cancer’s ass without any handicap and to prepare future dermatologists for this exponentially increasing patient population with unique care needs,” he said. “I think a supportive oncodermatology program is a wonderful way to bridge the divide between oncology and dermatology.”
Preventive Strategies to Reduce Dermatologic Adverse Effects
There are several options for preventing and treating dermatologic adverse effects associated with cancer treatments. “In general, proper skin care is a must,” said Dr Friedman. “This includes mild soap use, moisturizers to wet skin, and proper use of sun protective measures that includes both sunscreen and protective clothing.”
For reactions to certain treatments, Dr Friedman suggested some options that have shown success both in the literature and anecdotally. Prophylactic sun protection, moisturizer, twice-daily 100 mg doxycycline, and hydrocortisone 2.5% cream have been shown to prevent papulopustular eruptions without sacrificing efficacy among patients receiving epidermal growth factor receptor inhibitors and human epidermal growth factor receptor 2 inhibitors, he said. Isotretinoin is another viable option when doxycycline fails, he added. For patients receiving tyrosine kinase inhibitors, there is evidence that urea 40% cream can prevent, as well as manage, hand and foot syndrome. Cooling gloves and DigniCap have been shown to prevent taxane associated onycholysis and alopecia, respectively.
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“I have found pretreatment with topical steroids and vasoconstrictors (oxymetazoline) somewhat helpful to prevent onycholysis, and topical rogaine 5% foam as well as bimatoprost to limit scalp and eyebrow/lash alopecia, which seems to decrease likelihood of permanent alopecia that occurs in about 20% of taxane-treated patients,” he said.
In addition, Dr Friedman said, “I have instructed patients to apply a class 1 steroid and barrier protectant (zinc oxide vs aluminum magnesium hydroxy stearate) prior to and throughout the course of radiation and have witnessed limited to no radiation dermatitis.”
Barriers for Care
“The greatest barrier for care is unfortunately our colleagues for whom we are offering our assistance,” he said. “It has been an uphill struggle encouraging oncologists, oncology nurses, radiation oncologists, etc to refer these patients not only when the skin, hair, and nail issues occur, but even more importantly, even before the patient starts treatment to minimize and even prevent some of these reactions to therapy.”
In order to diminish the disconnect between dermatology and oncology, Dr Friedman uses a multifaceted approach that includes—interdisciplinary education, administrative support, and direct-to-consumer marketing. He lectures at oncology grand rounds and regional meetings on the topic of supportive oncodermatology, as well as creates handouts for physicians and patients, to educate others about the field (Figure).
Figure. Dr Friedman lectures at oncology grand rounds and regional meetings on the topic of supportive oncodermatology, as well as creates handouts for physicians and patients, to educate others about the field.
To reduce barriers to access, the clinic, through the support of La Roche Posay, has a part-time administrator who helps with patient navigation and referrals to make the process as effortless as possible. In addition, he uses the media to educate the public about the clinic, and oncodermatology, so patients can advocate on their behalf and be referred to the program.
“In just a year, we have developed a wonderful and collaborative relationship with the GW Cancer Center, which goes well beyond my clinic to include additional specialty clinics, as well as bench and clinical research collaborations,” said Dr Friedman. “While supportive oncodermatology is still a fledgling field in some respects, it is quickly taking center stage given the incredible age of medical advances in which we live.”