New Supportive Dermatology Program for Oncology Patients

There are roughly 1.5 million people with cancer in the U.S. – many of whom will receive radiation or undergo chemotherapy. As a result of these potent therapies, nearly 50 percent of cancer patients will experience adverse skin effects ranging from mild dermatitis to more severe skin changes such as peeling, blisters, bleeding, edema and often painful callous-like lesions on their palms and soles.

Supportive dermato-oncology is a new subspecialty in dermatology that arose from the need for physicians to address the skin-related side effects of cancer and cancer treatment. This targeted dermatological care can vastly improve the cancer patient's day-to-day life through correct diagnosis and treatment of skin conditions—from the simple to the complex.

Stanford launched its dermato-oncology clinic in September of 2012. The clinic is the brainchild of Bernice Kwong, MD, clinical assistant professor of dermatology, who recognized this unmet need after seeing oncology patients during her dermatology residency. Kwong approached Dermatology Chair Paul Khavari, MD, PhD with the idea, and together with the Cancer Center and the Cutaneous Oncology Program, a new service was born.

"I want to help optimize diagnosis and management of cutaneous eruptions in cancer patients to improve their skin side effects and quality of life," says Kwong. "My goal is to decrease as much as possible any interference to the patient's cancer therapy. This is an incredibly critical component of comprehensive patient care at Stanford."

Same day service provided

Dr. Kwong sees patients in Clinic A at the Cancer Center on Wednesday and Friday afternoons and at Hoover Pavilion on Tuesdays and Thursdays. Still in its infancy, the Dermato-Oncology Clinic currently sees about seven to ten patients each afternoon, many of whom are sent directly to Kwong by their oncologists on the same day as their routine follow-up appointments in the Cancer Center.

"If a patient has a new rash or is reacting to a new treatment, I want their oncologist to know that they can call, and we will try to see their patient that same day," she adds.

Prompt recognition of cancer-related skin side effects, toxicities and potentially harmful reactions to medications is a key aspect of this new field. Skin conditions must be treated in a timely manner so that cancer treatment can continue or resume without undue delay. Since many of these dermatologic conditions can be treated effectively under the care of a dermatologist, it is critical to try to eliminate any added pain or discomfort a cancer patient may have due to a noticeable side effect from their treatment.

"A significant portion of patients receiving cancer treatment will experience skin side effects, and for some, it will be the most socially or functionally devastating aspect of their cancer care," says Susan Swetter, MD, professor of dermatology and director of the Stanford Pigmented Lesion and Melanoma Program. "Dr. Kwong's availability and expertise have been instrumental in improving the care of cancer patients who have developed adverse skin reactions. I suspect her dermato-oncology practice will continue to grow and provide great benefit for patients and practitioners alike."

When Kwong first began seeing patients in the Cancer Center, she was surprised at the severity of their skin complications and at their willingness to endure them. "Some of these patients have significantly decreased quality of life because of blistering hands or feet or painful itchy skin," she says. "But many of them are reluctant to seek care because they don’t want to risk interrupting their cancer treatment."

New therapeutics create new skin effects

As more patients undergo treatment at the Cancer Center, the need for this supportive skin care continues to expand, she adds. The emergence of novel chemotherapeutic agents, many of which are being used in clinical trials at Stanford, have resulted in new and complex skin-related issues. Since starting in September, Kwong has begun to see patterns emerge between certain rarely used therapeutic agents and specific skin reactions. By concentrating oncology patients into one dermatology clinic, Kwong hopes to more frequently identify links between specific treatments and skin complications and anticipate possible adverse effects in patients undergoing similar therapies. She is also able to help distinguish between treatment-related and non-treatment related skin conditions. This is immeasurably helpful to clinicians weighing the value of continuing cancer treatment against debilitating side effects.

"Many of our patients have skin problems both related and unrelated related to their cancer," says Lynn Million, MD, clinical associate professor of radiation oncology. "Many skin conditions seen in radiation oncology benefit from a specialized dermatology team. Dr. Kwong's team evaluates our patients while they are undergoing radiation treatments and makes treatment recommendations to ease their often-painful skin condition. This multi-disciplinary approach to the management of cancer patients is a great new resource for the Stanford Cancer Center."

Kwong also runs the adult inpatient dermatology consultation service at Stanford Hospital, where her team helps to manage transplant patients, many of whom suffer from cutaneous graft versus host disease.

To refer a patient to the Supportive Dermato-Oncology Program, email Bernice Kwong at bernicek@stanford.edu or page her at #23588.

By Grace Hammerstrom