Exploring Multi-Disciplinary Cancer Care for Immunotherapy-Related Dermatological Symptoms

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 immunotherapy. Methods: This qualitative study identified patients undergoing oncology therapy with MoAB, anti-HER2 and anti-PD-L1 monoclonal antibodies 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 924 patients referred to the IO consultation, 208 were treated with immunotherapy, from which 50 were selected for further evaluation. Of these, and 7 cases were presented to the HCP team which then identified 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 immunotherpay-related skin toxicities. HCP-reported themes highlight the need to identify patients where such an approach is warranted; conditions where a psycho-social-spiritual perspective should be considered in addition to the bio-physical approach; and considerations of who should be appointed as the patient’s case manager.