Care Strategies

“Technically, we only have FDA [cleared] devices for cutaneous adverse events,” said Dr Friedman. Cleared and/or approved treatments include cooling caps and other barrier repair devices, as well as creams such as Biafine® topical emulsion for radiation dermatitis, the rash that develops from external beam radiation therapy. “However,” he added, “that doesn’t mean we don’t have a lot of tricks up our sleeves. Dermatologists are notorious for using treatments off-label effectively. Much of what we do in this arena falls into that category. We use topical steroids, anti-inflammatory antibiotics, oral isotretinoin, vinegar soaks, topical vasoconstrictors, and others. But, well-formulated research is needed and we are involved in that.”

Dr Friedman advocates including dermatology “in the game from the beginning.” Many patients undertake a “chemo class” before they start any treatment, and dermatology should be part of that pretreatment education and care. In a study of 379 cancer survivors who used a validated QOL tool, 67% of survivors felt that their dermatologic toxicities were worse than what they had expected, 84% were not referred to a dermatologist, and 54% thought they would have felt better had they been referred to a dermatologist.2

One major focus in this field is preventive strategies, Dr Friedman explained. Although data are limited, some small studies are showing that if started in advance of cancer treatment, a combination approach of oral doxycycline, a mild topical steroid, and sunscreen can prevent papulopustular eruptions. If patients establish a routine of using a moisturizer on damp skin and creams containing urea on the hands and feet, they can potentially prevent some hand and foot reactions from occurring.1

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Dr Friedman advises being aware of and alert for the more common and expected adverse events that occur with both chemotherapy and targeted therapies. Oncology nurses should encourage their patients to be “skin smart.” Most of these drugs increase sun sensitivity, therefore, patients should apply a moisturizer that contains sunscreen to exposed areas daily. In addition, remind patients to always wash with mild soap and apply moisturizer to damp skin.

A partnership between dermatologists and oncology nurses is essential for positive patient outcomes. “We need to collaborate more with oncology nurses,” he concluded.

References

  1. Kaplan BW. Including palliative care at diagnosis benefits patients with advanced cancer. Oncol Nurse Advisor. 2012;3(3):41-42.
  2. Aizman L, Nelson K, Sparks AD, Friedman AJ. The influence of supportive oncodermatology interventions on patient quality of life: a cross-sectional survey. J Drugs Dermatol. 2020;19(5):477-482.
  3. Gandhi M, Oishi K, Zubal B, Lacouture ME. Unanticipated toxicities from anticancer therapies: survivors’ perspectives. Support Care Cancer. 2010;18(11):1461‐1468.

This article originally appeared on Oncology Nurse Advisor