SAN ANTONIO, Tex.–Incorporating a modified Multinational Association of Supportive Care in Cancer (MASCC) grading tool for evaluating epidermal growth factor receptor inhibitor (EGFRI) toxicities and quality of life improved the rate of skin assessments and documentation, a study presented at the ONS 41st Annual Congress has shown.1

EGFRIs, such as cetuximab, are an important targeted therapy for patients with EGFR-mutant solid malignancies.

“About 85% of patients receiving EGFRIs develop papulopustular rash and 10% to 20% are grades 3 or 4,” said Sonia D. Sims, BSN, RN, OCN, oncology nurse at Arlington Cancer Center in Grand Prarie, TX. “They occur within several days after administration and affect visible areas of the body.”

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In addition to rash, EGFRI dermatologic toxicities may include erythema, generalized pruritus, and hair changes.

These particular toxicities can also negatively impact patients’ self-image, self-esteem, and physical health, as well as cause financial burden and cancer treatment disruption.

“Approximately 60% of patients who experience EGFRI dermatologic toxicities require dose reductions and 32% have to discontinue treatment,” Sims explained.

“At Arlington Cancer Center, assessment of dermatologic toxicities was poorly documented,” Sims said. “There were also incomplete skin assessments and delays in treatment related to dermatologic toxicities. If it is not documented, it did not occur.”

Therefore, Sims sought to investigate if using a modified MASCC skin assessment tool would be more effective at identifying and grading skin toxicities and quality of life issues than the current chart-by exception electronic health record (EHR). First, she conducted a baseline chart review of 70 patients receiving EGFRs and found that 18.5% of skin assessments were documented with no information about pain, pruritus, or quality of life.

After educating staff about EGFRI toxicities and implementing the MASCC tool, skin assessments were completed for 48% of 52 patient visits and included toxicity grading in addition to effects on physical and social functioning.

Because of the positive results of using the MASCC tool, it has been incorporated into their EHR system.

“Using the MASCC tool, we are improving our skin assessments and identifying opportunities for patient education and supportive care,” Sims concluded.


1. Sims S. More than skin deep: assessing the dermatologic toxicities of epidermal growth factor receptor inhibitors. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.