Exploring a multi-disciplinary model of supportive cancer care for monoclonal antibody treatment-related dermatological symptoms

Dikla Kruger; Noah Samuels; Judith Lacey; Yael Keshet; Orit Gressel; Roni P Dodiuk-Gad; Katerina Shulman; Yehudit Tapiro; Miri Golan; Eran Ben-Arye

doi:10.1007/s00520-023-07642-5

Exploring a multi-disciplinary model of supportive cancer care for monoclonal antibody treatment-related dermatological symptoms

Support Care Cancer. 2023 Feb 23;31(3):185. doi: 10.1007/s00520-023-07642-5.

Authors

Dikla Kruger^{1

2}, Noah Samuels³, Judith Lacey^{4

5

6}, Yael Keshet⁷, Orit Gressel^{1

8}, Roni P Dodiuk-Gad^{8

9

10}, Katerina Shulman^{11

12}, Yehudit Tapiro¹¹, Miri Golan¹, Eran Ben-Arye^{1

8}

Affiliations

¹ Integrative Oncology Program, Oncology Service; Lin, Carmel, and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.
² Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Haifa, Israel.
³ The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. noahs@szmc.org.il.
⁴ Supportive Care and Integrative Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
⁵ Clinical School of Medicine, University of Sydney, Camperdown, Australia.
⁶ NICM Health Research Institute, Western Sydney University, Sydney, Australia.
⁷ Department of Sociology and Anthropology, Western Galilee Academic College, Akko, Israel.
⁸ The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁹ Department of Dermatology, Emek Medical Center, Afula, Israel.
¹⁰ Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹¹ The Oncology Service, Lin and Zebulon Medical Centers, Clalit Health Services, Haifa, Israel.
¹² Carmel Medical Center, Haifa, Israel.

Abstract

Context and objectives: The present study examined the perspectives of healthcare providers (HCPs) in designing a multi-disciplinary model of supportive cancer care for the relief of dermatology-related symptoms caused by monoclonal antibody therapies.

Methods: The study employed a mixed research methodology, with qualitative research embedded within a pragmatic prospective study of a registry protocol study. Patients undergoing oncology therapy with MoAB, anti-HER2, and anti-PD-L1 monoclonal antibodies were identified among a cohort of patients referred to an integrative oncology (IO) consultation for symptom relief and improved quality of life (QoL). Case studies with significant dermatology-related concerns were selected and presented to a panel of 6 HCPs trained in medical oncology, oncology nursing, family medicine, supportive cancer care, and IO. HCP narratives were qualitatively analyzed and assessed using ATLAS.Ti software for systematic coding.

Results: Of the 924 patients referred to the IO consultation, 208 were treated with monoclonal antibodies, from which 50 were selected for further evaluation. Of these, 7 cases were presented to the HCP team who were asked to identify treatment gaps requiring a multi-disciplinary approach. Qualitative analysis identified 3 major themes: a biophysical perspective; a psycho-social-spiritual perspective; and the implementation of integrated care.

Discussion: There is a need for a multi-disciplinary approach when treating patients suffering from monoclonal antibody treatment-related skin toxicities. HCP-reported themes highlight the need to identify patients for whom such an approach is warranted; conditions in which a psycho-social-spiritual perspective should be considered, in addition to a bio-physical approach; and considerations of who should be designated as the patient's primary case manager.

Keywords: Dermatology; Integrative oncology; Monoclonal antibodies; Rash; Supportive cancer care.

MeSH terms

Complementary Therapies* / methods
Humans
Medical Oncology
Neoplasms* / drug therapy
Prospective Studies
Quality of Life