Tyrosine-kinase inhibitors and epidermal growth factor receptors (EGFRs) such as cetuximab, panitumumab, erlotinib, gefitinib, and lapatinib are known for causing painful and visually disturbing rashes on nearly all patients undergoing treatment for cancer. In fact, rash is often cited as a cause of treatment cessation or dose modification, said Jeanine Gordon, RN, MSN, OCN®, Ambulatory Nursing, Memorial Sloan-Kettering Cancer Center, New York, New York, in a presentation at the Oncology Nursing Society 36th Annual Congress, adding an estimated 8% to 17% of patients change or stop treatment because of moderate or severe cutaneous effects.
These rashes are best diagnosed and treated by a physician who specializes in dermatologic conditions resulting from cancer treatment. Teledermatology can foster timely assessment and management of dermatologic toxicity in patients receiving chemotherapy and improve patients’ quality of life, and early assessment and intervention reduces the likelihood of interruptions in the patient’s treatment schedule. To determine if telemedicine can be used effectively for comprehensive skin assessments, a pilot project at a new ambulatory off-site chemotherapy infusion center in Brooklyn, New York, 6 miles from the main campus of Memorial Sloan-Kettering Cancer Center, was implemented that included nine patient visits. The impact on patient and clinician satisfaction was a secondary outcome measure.
A nurse at the infusion center conducts the patient visit while the dermatologist is located at the main campus. The dermatologist is contacted in real-time and the team conducts the dermatologic assessments using audio and video technology. Post assessment, the dermatologist collaborates with the medical oncologist to manage, treat, and make decisions regarding appropriate treatment. Upon completion of the visit, patients and staff complete surveys to document satisfaction and success with the process.
The dermatologist feedback on the telemedicine visit included it was “easier for the patient time wise;” in addition, he was able to manage symptoms of 8 of the 9 patients (89%) through telemedicine. Patient feedback included a “strong feeling that this is the 21st Century,” and “I could travel to my appointment in my area and didn’t have to travel for a long distance;” all patients agreed with the statement, “Overall, I was very satisfied with today’s telemedicine session.” Feedback from RNs/nurse practitioners reflected more practical considerations, including telemedicine cart malfunction, which resulted in the visit being conducted by telephone; and two telemedicine visits conducted by the physician without nurse intervention because the nurses were otherwise engaged.
Real-time teledermatology eliminates the need for an additional dermatology visit and strengthens clinician collaboration. The potential value of telemedicine use is that it increases patients’ access to subspecialized providers during cancer care. Future plans include to improve technology; have a true mirroring of a dermatology visit with initial patient assessment completed by a dermatology office practice nurse; expansion to other areas and physician practices for more testing; testing wireless stethoscope capability to conduct more in-depth physical assessments; and exploring insurance reimbursement for visits, Gordon concluded.