Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan S. Leventhal

Abstract

Introduction:Dermatologic conditions emerging from cancer therapy are common and frequently impact patients’ quality of life. The field of supportive oncodermatology has emerged to provide specialized care to oncology patients with such cutaneous toxicities. Despite tremendous progress, studies investigating the scope of these reactions in patients with Skin of Color (SoC) are largely lacking. The objective of this study was to characterize the spectrum of dermatologic conditions in SoC patients at the Yale Cancer Center oncodermatology clinic and their associated impact on oncologic therapy.

Methods: After Institutional Review Board approval (HIC # 2000026042), a retrospective review was conducted of oncology patients with SoC who were referred to the oncodermatology clinic at the Yale Cancer Center from June 2017-June 2020. SoC patients were identified using race and ethnicity demographic data extracted from the medical record. Demographics, clinical characteristics, oncologic treatment, dermatologic diagnoses, response to therapy, and impact on oncologic care were recorded.

Results: 200 patients met inclusion criteria which resulted in 277 recorded dermatologic toxicities/adverse effects. The mean age (SD) of patients was 55 (14.8) years and the majority of patients were female (N=139). Patients self-identified as Black/Non-Hispanic (N=110), Other/Hispanic (N=63), Asian/Non-Hispanic (N=24), or Black/Hispanic (N=3). The most common malignancies were breast cancer (29.5%), lymphoma (19.0%) and lung cancer (9.0%). The most common anticancer treatments were targeted chemotherapy (22.5%) traditional chemotherapy (21.0%), immune checkpoint inhibitor therapy (10.0%), stem cell transplantation (7.0%), and endocrine therapy (5.5%).

Acneiform rash was the most frequent diagnosis (19.5%) followed by xerosis/dermatitis (19.1%), nail changes (8.7%), primary pruritus (7.9%), hand-foot syndrome (6.5%), primary pigmentary alteration (4.7%), and non-scarring alopecia (4.3%). Post-inflammatory hyperpigmentation was noted in 38.6% of cases. Outpatient oncodermatology consultation was associated with clinical improvement on follow-up in 85.9% of toxicities and continuation of cancer therapy in 92.8% of cases. Pigmentary alteration, scarring alopecia, nail changes, chronic radiation changes, keloids, and chronic graft-versus-host disease were most recalcitrant to therapy.

Conclusions: This study highlights the diverse scope of dermatologic toxicities as well as treatment outcomes in patients with SoC at a tertiary care center. The high clinical response rate of cutaneous toxicities in patients with SoC after oncodermatology consultation and infrequent interruption of cancer treatment underscores the importance of multidisciplinary care. While most patients responded to dermatologic consultation, longstanding cutaneous sequalae may occur (e.g. post-inflammatory hyperpigmentation, scarring alopecia, chronic radiation changes). Dermatologists and oncologists should recognize the scope of cutaneous toxicities that may arise in cancer patients with SoC. Dermatologic consultation was associated with clinical improvement and continuation of cancer therapy in the vast majority of cases.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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