PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

CONFERENCE COVERAGE 14

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.

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%).

The results underscore the importance of a dermatologic evaluation for the diagnosis, attribution, and management of anticancer therapy-induced dermatologic adverse events.

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

© 2017 American Academy of Dermatology Association.

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