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G
regory Phillips, MD, of Memorial Sloan Kettering
Cancer Center, New York, explained that admin-
istration of anticancer therapies often results in
dermatologic adverse events, which can negatively
impact quality of life and patient outcomes.
Dr Phillips and colleagues set out to compare antican-
cer therapy interruption due to dermatologic adverse
events, as well as diagnostic concordance patterns
between referring clinicians and dermatologists at their
centre.
One-hundred thirty dermatology consultations over a
2-month period in 2015 were reviewed. Consultations
were identified using a consult log. The final analysis
included 113 patients.
Patients’ demographics, reason for referral, tumour and
anticancer therapy agents, dermatologic diagnoses,
and anticancer therapy interruption due to derma-
tologic adverse events were abstracted from each
patient’s electronic medical record. Kappa statistic was
estimated for agreement between clinicians in hold-
ing anticancer therapy due to dermatologic adverse
events.
Diagnostic concordance between the referring clini-
cian and dermatologist was determined based on the
following definition: in instances where the referring
clinician underdiagnosed (for example, identified one
correct and missed three other conditions).
This was considered concordance; and in instances
where the referring clinician overdiagnosed (for exam-
ple, diagnosed three conditions, only two of which
were agreed by the dermatologists), this was consid-
ered discordant.
Overall, referring clinicians and dermatologists agreed
diagnostically only on 26% of referred cases (n=113).
Of 79 patients receiving treatment for solid or haema-
tologic cancers, dermatologic adverse event-induced
therapy interruption was documented in 41 patients
(52%).
For the 10 cases in which
the referring clinician recom-
mended holding therapy, the
dermatologist agreed only
once (10%). A kappa value
of 0.14 was reported. Fifteen
patients (19%) harboured
dermatologic conditions
attributable to anticancer ther-
apy by the referring clinician
vs 27 (34%) by the dermatol-
ogist. Attribution was unclear
in 73% and 58% of cases,
respectively.
Dr Phillips concluded that
the study showed a high dis-
cordance between referring
clinicians and dermatologists.
In addition, a weak agreement
between referring clinicians
and dermatologists holding
anticancer therapy was found.
The results underscore the
importance of a dermatologic
evaluation for the diagnosis,
attribution, and management
of anticancer therapy-induced
dermatologic adverse events.
PracticeUpdate Editorial Team
Dermato-oncologists, oncologists often disagree about dermatologic
diagnoses, cancer therapy interruption
Dermato-oncologists and oncologists have been found to disagree often about dermatologic diagnoses and cancer
therapy interruption, reveal results of a retrospective chart review.
The results underscore the importance of a
dermatologic evaluation for the diagnosis, attribution,
and management of anticancer therapy-induced
dermatologic adverse events.
© 2017 American Academy of Dermatology Association.
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