A Patient Journey Focus on Oncodermatology

Throughout the course of treatment, patients and providers alike are often focused on the progression of the cancer diagnosis more than anything else. But adverse effects like skin toxicities can be highly damaging to patients’ quality of life and treatment outcomes.

At the Association of Cancer Care Centers’ (ACCC) 41st National Oncology Conference, Jennifer N. Choi, MD, professor of dermatology and chief of the divisions of oncodermatology and medical dermatology at the Northwestern University Feinberg School of Medicine at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University spoke alongside Lawrence Stallings, a cancer survivor, about the significant impact that oncodermatology can have on a patient’s quality of life.

Damaging Skin Toxicities

Dr. Choi began by discussing the importance of managing adverse effects—especially skin toxicities like dry skin, rashes, itching, and photosensitivity—during cancer treatment. “A lot of the time, skin toxicities are unanticipated prior to the start of therapy,” she explained. “Patients often don’t know what can happen. And when they do get side effects, it can really impact their quality of life, lead them to discontinue treatment, and affect psychological well-being.”

Some 58% of patients experience chemotherapy-induced alopecia, according to Dr. Choi, and cite it as one of the most traumatic adverse effects of their treatment. In addition, up to 15% of survivors report psychological problems due to scarring and other visibly apparent side effects. With these statistics in mind, Dr. Choi stressed the importance of making oncodermatology services available within each cancer center so patients have instant access. “If you don’t have a dedicated one in your center, you have to schedule an appointment with the nearest [dermatologist] in your community, which could be 3 months out,” she said. Patients suffering from skin toxicities often can’t afford to wait that long. In addition to symptom management, a dedicated oncodermatology department also allows patients to contribute to ongoing research.

Comprehensive Oncodermatology Services

Led by Dr. Choi, the oncodermatology program at the Robert H. Lurie Comprehensive Cancer Center includes an active inpatient dermatology consultation service and provides comprehensive skin care and skin cancer surveillance for high-risk patients and all cancer survivors. The program also prioritizes patient education about the role that non-medication skincare products play in helping to offset adverse effects related to treatment and improve skin health and quality of life. Patients are strongly encouraged to always use sun protection, apply an emollient twice daily, avoid products with fragrances, look for ingredients like hyaluronic acid and ceramides in their skin care products, and use topical steroids as needed for excessively dry and itchy skin.

A Patient Story

The second half of the session was led by Lawrence Stallings, who shared the struggles with side effects he faced during and after his cancer treatment. “I’m so grateful for my doctors who have dedicated their lives and careers to helping patients manage skin toxicities,” he expressed. Some patients feel pressured to continue with treatment if adverse effects are not deemed life-threatening. “Life-threatening can be subjective. There’s medical life-threatening, and then there’s quality of life–threatening,” Mr. Stallings explained.

Mr. Stallings was first diagnosed with kidney cancer in 2015, after which his kidney was removed. Five years later, he experienced a metastatic event. “They found something in my lung,” he said. “That was my first contact with an oncologist. Then I moved into immunotherapy and targeted therapy.”

In 2021, 3 months into his cancer therapy, Mr. Stallings started noticing strange side effects that included severe itching, the appearance of black lines under his fingernails, foot pain, and the cessation of sweating. Soon, the side effects became life-changing. “The itching got so bad it would keep me up at night,” he recounted. “The foot pain was so bad my doctor gave me a boot for 8 weeks. Eventually, I was no longer able to go outside. My nervous system was so overstimulated that it was debilitating. I was confined to an air-conditioned room, and my quality of life plummeted.”

Months later, Mr. Stallings finally found answers from a doctor in an oncodermatology program who identified his symptoms as hand-and-foot syndrome and idiopathic pure sudomotor failure. “I had spent almost a year in excruciating pain telling people something is wrong, not knowing if anyone could help me,” he said. The relief of finally receiving a diagnosis was overwhelming.

For further treatment of his skin toxicities, Mr. Stallings was later referred to the La Roche-Posay thermal center in France in August of 2023. There he received balneotherapy (water-based treatments) that included 4 daily treatments: a misting facial, a de-inflammation misting shower, a soaking tub, and an underwater massage and filiform shower. “Not only did it provide care for my skin—it provided care for my soul,” said Mr. Stallings. “This place really heals people—not just physically, but mentally. To look in the mirror every day and see what cancer is doing to your body is mentally taxing.”

Mr. Stallings closed by reaffirming the life-saving care that oncodermatology programs provide. “I had to stop immunotherapy after 4 months instead of 2 years because it was making my life unlivable,” he stressed. “Sustaining a life that a person doesn’t want to live is pointless.” His story underscores the valuable lessons providers can learn from understanding the patient experience and the way treatment impacts quality of life.

This presentation was supported by La Roche-Posay.