Economic burden of dermatologic adverse events induced by molecularly targeted cancer agents.

OBJECTIVE: To report the financial impact of diagnosing and treating the dermatologic toxicities (dTs) that develop in patients receiving targeted anticancer therapies. DESIGN: Single-center retrospective and prospective medical record data extraction. SETTING: Department of Dermatology, Northwestern University, Chicago, Illinois. PATIENTS: One hundred thirty-two adults who presented between November 1, 2005, and June 30, 2008, and who were diagnosed as having 1 primary cancer type and were treated with 1 molecularly targeted agent. MAIN OUTCOME MEASURE: Standard billable costs to the patient for dT-related medications, clinic visits, laboratory and diagnostic testing, and therapeutic procedures. RESULTS: The 132 patients had a median of 3 clinic visits for dT management with a median cost of $1920 per patient. Sorafenib was associated with the most costly overall median cost per patient ($2509 per patient), and imatinib was associated with the least costly overall median cost per patient ($1263 per patient). Among the 7 targeted drugs and all 10 dTs, the most costly dT (measured by cost of treatment with medications) was hand/foot skin reaction, associated with sorafenib therapy (median cost, $968 per patient) (P < .001). The second most costly dT was panitumumab-associated acneiform eruption (median cost, $933 per patient) (P < .001). CONCLUSION: The cost of diagnosis and treatment of dTs associated with targeted agents contributes to the overall economic burden of cancer care. Efforts toward the prevention of dTs may be important for decreasing the financial burden in oncology.

Skin care management in cancer patients: an evaluation of quality of life and tolerability.

PURPOSE: The objective of this study is to evaluate quality of life (QoL) and tolerability of three articles specifically developed for cancer skin care management (skin moisturizer, face moisturizer, and face wash). METHODS: Participants were cancer patients (n = 99) receiving systemic anticancer therapies and/or radiotherapy at Northwestern University. Subjects were assessed at the initial visit for adverse skin reactions based on the National Cancer Institute's Common Terminology Criteria for Adverse Events version 3.0 and completed the Skindex-16 questionnaire, a self-reported dermatology-specific QoL instrument. All subjects were provided with three test articles and were instructed to use each test article once daily for 4 weeks. At the 4-week follow-up (n = 77), the Skindex-16 was readministered, adverse skin reactions were assessed, and tolerability questionnaires were administered for each article used. RESULTS: Dry skin, hand-foot skin reaction (HFSR), and skin rash (dermatitis) decreased significantly from baseline to follow-up. Presence of nail changes, skin rash (desquamation), and acne/acneiform eruptions did not significantly change from baseline. Subjects had a significantly lower mean overall Skindex-16 score at 4-week follow-up when compared to baseline. Most patients rated their overall experience with each test article as good or very good (highest rating). CONCLUSION: Skin care in cancer patients is suboptimal in part due to a lack of products and knowledge specific for this population. Our findings suggest that QoL improves with test article use, all of which were rated as good/very good for tolerability. Moreover, skin toxicity as manifested by dry skin, hand-foot skin reaction, and skin rash (dermatitis) were decreased with use of test articles within 4 weeks.