Oncodermatologist Perspective - Why Side Effect Management Should Be Preventative, Not Curative

Oncodermatologist led conversation with Dr Corina van den Hurk, Dr Nicole LeBoeuf, Dr Beth McLellan, and Dr Ian Tattersall. March 2022.

Some of the most concerning chemotherapy side effects such as sickness and nausea have been appropriately tackled with pharmaceutical interventions, but from a patient’s perspective, hair loss and skin toxicity are still under-prioritized. Can the early integration of oncodermatological practices ensure that interventions are a preventative measure, rather than a curative measure?

"Just about every single patient entering a cancer center who is likely to undergo treatment is a potential patient where an onco-dermatologist has a role"

Dr Nicole LeBoeuf, MD, MPH
  • Side effects affecting the skin, hair and nails impact every single patient receiving chemotherapy, and have a huge impact on quality of life during and after treatment
  • Dermatological interventions can be significantly more effective if they are positioned as a preventative measure in the treatment timeline, as opposed to a curative measure at the end 
  • Collaborative multidisciplinary approaches between oncology and dermatology are needed to ensure patients are receiving the appropriate care, as there are currently an insufficient number of oncodermatologists to ensure equitable patient access
  • Skin toxicity scales and guidelines are needed to increase research and education that will lead to changes in practice

Oncodermatology is a relatively new discipline, but there is no doubt about the positive impact that the appropriate interventions can have on a patient’s quality of life and experience of cancer treatment as a whole. Covering everything from chemotherapy-induced alopecia to radiation dermatitis, nail changes and mucositis, there are huge incidences of skin toxicities all of which can be managed most effectively with dermatological guidance.  

The historically reactive nature of dermatology within the oncology setting is beginning to shift, with exciting work being carried out to ensure that oncodermatology is present in an anticipatory manner to prevent side effects before they happen. For this to be possible, it is essential that there is multidisciplinary buy-in within cancer institutions. Easy access to oncodermatologists in cancer centers predominately results from an acknowledgment and prioritization of the importance of side effect management, and the transformational effect it has on patient experience.  It must also be acknowledged that for a large number of patients, seeing an oncodermatologist can be challenging, if not impossible, as there is a lack of accessibility due to the relatively low numbers specializing in the field.   

A collaborative working relationship with oncology and dermatology will also be fundamental to the development of appropriate guidelines. Consensus has been challenging in the past due to relatively low specialism in oncodermatology, and oncologists often being tasked in contributing the dermatological elements of these guidelines. However, increasing numbers are establishing proactive oncodermatological working groups to form and a push for new, or at least revised, guidelines to be developed in the near future. Development of clear grades and scales when it comes to toxicities will also be key to the facilitation of research which can accurately describe oncodermatological issues.  

‘It fundamentally requires a multidisciplinary approach, because the dermatologist is never the first person that you see for your cancer’ – Dr Ian Tattersall

As the field sees an increase in treatment options such as immunotherapy, and much more targeted drugs become common place in treatment plans, dermatological side effects have inevitably become more varied and complex. The reality is that these side effects have expanded beyond those which oncologist’s should be realistically expected to identify and manage. Again, this is where the sub-specialty of oncodermatology will become even more valuable and in demand.     

Looking to the future, the hope is for increased access to, and integration of, oncodermatological practices to ensure that prevention is the focus when it comes to skin toxicities. The development of grades and scales of toxicities will allow for more accurate research, and embedding dermatologists and their knowledge base into oncology departments will most certainly help to tackle some of the disparities in access to oncodermatological support.

Lacouture ME, et al. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021 Feb;32(2):157-170.

Lacouture ME, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011 Aug;19(8):1079-95.