Oncodermatology and the Nursing Specialist

Have You Heard….

Have you ever wished you had a dermatology team specialized in oncology accessible while managing your patients dermatologic needs? There is a field that merges the two specialties called oncodermatology. Oncodermatology embodies a full scope in the oncologic and dermatologic healthcare worlds with new clinics being developed internationally dedicated to this unique patient population.

Dermatology Nursing

The field of dermatology concentrates on the macroscopic and microscopic study of skin, hair, nails, and mucosal conditions and comprises over 3000 disease processes. On average, an adult human body constitutes 18.5ft² of skin with an underlying complex architecture essential for promoting the function of protection, homeostasis, temperature regulation, vitamin D production, sensory perception, and wound healing. Dermatology clinicians are extensively trained to manage pediatric and adult benign and malignant skin conditions requiring topical, systemic or surgical therapy. Additionally, they play a major role in caring for the dermatologic continuum of care for normal skin care and health promotion in skin cancer prevention (High, Tomasini, Argenziano, & Zaludek, 2012; Nicol, 2003) The field of dermatology requires an enhanced clinical acumen in the methodological approach to diagnosis: history, distribution, configuration, morphologic patterns, primary and secondary lesions, differential diagnosis, analyzing histopathologic findings, and utilization of diagnostic tools (High et al, 2012; Johannsen, 2003).

Awareness of dermatology nursing as a specialty began in the United States in the late 1970s with the Dermatology Nursing Association in the United States (DNA, 2016). Dermatology nurses are clinical experts and are considered the treatment coach, the primary contact for the patients, and have been reported to have a deeper understanding of the patient's situation (Lindblad et al, 2006). The dermatology nurse must be well-versed in all body systems as many dermatoses may reflect internal disease processes whether related to cancer or not (ie. dermatomyositis, cryoglobulinemia, endocarditis, livedo reticularis, erythema elevatum diutinum, paraneoplastic pemphigus, sweet syndrome, scleromyxedema, etc.) (Franks Jr., 2009; Owen & Callen, 2014). Dermatology nurses are experts at not only assessment, nursing diagnosis, implementing and evaluating care—they must be attentive to detail and effective communicators as there can be over 50 services a dermatology patients can be referred to for evaluation and management of their care (Sasaki & Koo, 2015).

Oncology Nursing

The American Cancer Society reports that the oldest record of cancer dates to the 3rd millennium BC. It is no surprise that over centuries, our knowledge of cancer has exponentially grown and research in genetics, viral, and chemical/physical/biological carcinogens has provided insight on the causes of cancer as well as methods to implement for the prevention of cancer. The 1970s was a particularly important decade in the discovery of oncogenes and tumor suppressor genes. As the understanding of cancer expanded, advances were seen in the screening, early detection and cancer treatments (American Cancer Society, 2014).

According to the American Cancer Society, projected incidence of leading sites of cancer diagnoses for prostate, breast, lung & bronchus in 2016 is approximately 585,630 cases (2016). In addition, other estimates of cancers in 2016 including childhood cancers, colorectal, kidney & renal pelvis, leukemia, hepatic, lymphoma, oral cavity, and pharynx, ovarian, pancreas, thyroid, urinary bladder, uterine cervix & corpus total a projected additional 763,160 cases in 2016. Non-melanoma skin cancer cases in 2012 were reported at 5.4 million cases (American Cancer Society, 2016). There is no shortage in the number of cases that plague the U.S. population, however attention to importance of dermatologic care in cancer patients is only recently becoming a hot topic (Balagula, Rosen & Lacouture, 2011). It is vital to appropriately evaluate and manage cancer patient’s dermatologic status to promote adherence to cancer treatments. Thus, the approach to cancer care evolved greatly, requiring multidisciplinary team members to modify their approach to care (CiccolEHini, 2013).

Oncology nursing encompasses cancer-specific assessment, diagnosis, outcomes/planning, evaluation, and implementation. In addition, oncology nurses are avid advocates and utilize patient education as a very important tool in helping patients transition and adhere to treatment plans, and help establish expectations. Further, oncology nurses coordinate and direct care and are involved in symptomatology management and supportive services (Rieger & Yarbro, 2003). Oncology nurses specialize in a broad spectrum of specialties and are on the forefront of patients’ oncologic care.

Memorial Sloan Kettering Cancer Center - Oncodermatology Nursing:

At Memorial Sloan Kettering Cancer Center (MSK), there lies a unique nursing role within the dermatology service: Oncodermatology Clinical Nurse. Sparse in nature, nurses in this specialty are privy to exclusive knowledge, skill, expertise and access to this patient population, and therefore must be experts in both difficult comprehensive fields.

As nursing specialists at MSK, we have defined oncodermatology nursing standards in terms of nursing policies, procedures, patient education, assessment, documentation, telephone triaging, and practice. Through relationship-based care professional practice model, oncodermatology nurses unite to fulfill the MSK nursing mission to “provide compassionate, evidence-based nursing care to patients and families living with cancer in a healing and innovative environment."

In our future postings, we plan to shed more light on the clinical intricacies of the unique oncodermatology specialty through peer-reviewed research and primary experience. We aim to increase awareness of the expert knowledge required of oncodermatology nurses.

References:

American Cancer Society. (2014). The history of cancer. Retrieved from:

http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf

American Cancer Society. (2016). Cancer facts & figures 2016. Retrieved from:

http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf

Balagula, Y., Rosen, S.T., Lacouture, M.E. (2011). The emergence of supportive oncodermatology: the study of

dermatologic adverse events to cancer therapies. J Am Acad Dermatol. 65(3), 624-635.

Ciccolini, K. (2013). Interdisciplinary Approach to Managing Skin Toxicities. Retrieved from:

http://www.onclive.com/insights/derm-Aes/Interdisciplinary-Approach-to-Managing-Skin-Toxicities

Dermatology Nursing Association. (2011). About DNA. Retrieved from:

http://www.dnanurse.org/about/about-dna

Franks Jr., A.G. (2009). Skin Manifestations of Internal Disease. Med Clin N Am 93, 1265—1282.

High, W.A., Tomasini, C.F., Argenziano, G., & Zaludek, I. (2012). E. Book Chapter 1: Basic Principles of

Dermatology. In Dermatology Third Edition (Ed. Bolognia, J.L., Jorizzo, J.L., & Schaffer, J.V.).

Elsevier Saunders. Philadelpha, London

Johannsen, L.L. (2003). Chapter 2 Part 1: Skin Assessment and Diagnostic Techniques Part 1. Skin Assessment.

In. Dermatology Nursing Essentials: A Core Curriculum Second Edition (Ed. Hill, M.J). Anthony J.

Jannetti Inc. New Jersey

Lindblad, A.K., Kjellgren, K.I., Ring, L., Maroti, M, & Serup, J. (2006). The Role of Dermatologists, Nurses

and Pharmacists in Chronic Dermatological Treatment: Patient and Provider Views and Experiences.

Acta Derm Venereol 2006; 86: 202—208

Nicol. N.H. (2003). Chapter 1: Anatomy and Physiology of the Skin. In. Dermatology Nursing Essentials: A

Core Curriculum Second Edition (Ed. Hill, M.J). Anthony J. Jannetti Inc. New Jersey

Owen, C.E., & Callen, J.P. (2014). Section 2 Cancer-Related Dermatologic Disorders. In. Dermatological

Principles and Practice in Oncology (Ed. Lacouture, M.E.) Wiley. Hoboken, New Jersey.

Rieger, P.T., Yarbro, C.H. (2003). Role of the oncology nurse. In: Kufe, D.W., Pollock, R.E., Weichselbaum,

R.R., et al., (Eds.). Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker. Available

from: http://www.ncbi.nlm.nih.gov/books/NBK13570/

Sasaki, J.L., Koo, J.Y. (2015). Skin therapies: dermatologic perspective on the rheumatology-dermatology

interface. Retrived from: http://www.ncbi.nlm.nih.gov/pubmed/26472228