Dermatologic complaints prolong hospital stay for hematologic cancer

 

In-hospital dermatologic consults are more than six times more likely to occur in patients with hematologic malignancies than in those with solid tumors and are associated with an increased mean length of hospital stay, according to a large retrospective chart review from a major cancer center.

The substantial burden imposed by dermatologic complications in patients with cancer, particularly a hematologic malignancy, highlights the importance of greater collaboration between oncology and dermatology services to mitigate the impact of these events on both quality of life and outcome, wrote Gregory S. Phillips of Memorial Sloan Kettering Cancer Center, New York, and his associates. The study was published in the Journal of the American Academy of Dermatology.

The data that produced these conclusions were drawn from a retrospective chart review of 11,533 cancer patients treated at the center during 2015. Of these, 412 (3.6%) were referred for a dermatology consultation.

Those who received a dermatology consultation were comparable for median age (60 years) and gender (roughly 50:50 male:female), compared with those who did not. However, the odds ratio (OR) for a dermatology consultation was 6.56 among those with a hematologic malignancy compared with those who had a solid tumor. In those with leukemia, the proportion receiving a dermatologic consult was nearly ninefold greater.

Whether or not undertaken in a patient with a hematologic malignancy, dermatologic consults correlated with significantly greater morbidity, as well as mortality. This included a longer median length of stay (11 vs. 5 days; P less than .0001) and a higher in-hospital rate of death (9% vs. 2%; P less than .0001), compared with patients not needing a dermatology consultation.

Of dermatologic consultations in the total study population, the most common were for inflammatory conditions (27%), infections (24%), and drug reactions (17%). Neoplasm was the dermatologic diagnosis in 10% of the total population, but in 13% of those with hematologic malignancies.

Inpatient dermatology consultations were most frequently ordered by the hematology-oncology service, accounting for 44% of the total, followed by the solid tumor oncology service (27%) and the surgery service (15%). Multiple consultations were more likely in patients with leukemia or lymphoma than other forms of cancer.

 

In the dermatology consult, biopsy was employed for diagnosis in only 18%. As for treatment, 42% received topical therapy alone, and 38% received a systemic therapy. Dermatologic consultations that subsequently involved consultation with another service such as allergy and immunology, were rare, occurring in only 4% of cases.

Previous studies also have found a dermatologic consultation to be associated with increased morbidity and a longer length of hospital stay, according to the investigators, who were led by senior author Mario E. Lacouture, MD, director of the oncodermatology program at the center. The findings of this study underline the substantial burden associated with dermatologic complaints in patients with cancer in general and those with hematologic malignancies, specifically.

Furthermore, they suggested that the data support increased attention to dermatologic complications in cancer. Although the impact of consultations on outcome was not evaluated in this study, the authors cited another recent study in which there was a more than 2-day reduction in hospital stay when a dermatology consultation was employed in noncancer patients with an inflammatory skin disease (JAMA Dermatol. 2017 Jun 1;153[6]:523-8). Moreover, they speculated that a prompt resolution of dermatologic complaints in cancer patients has implications for better outcomes if they result in fewer delays in anti-cancer therapy.

The study was partly funded by the a grant from the National Cancer Institute’s Cancer Centers Program. Dr. Lacouture reported financial relationships with AstraZeneca, Adgero Biopharmaceuticals, Berg, Bristol-Myers Squibb, Foamix, Janssen, Legacy Healthcare, NovoCure, and Quintiles. Another author reported ties with Amgen, Roche, Eaisi, and P Value Communications.

SOURCE: Phillips GS et al. J Am Acad Dermatol. 2018 Jun;78(6):1102-9.

 

In-hospital dermatologic consults are more than six times more likely to occur in patients with hematologic malignancies than in those with solid tumors and are associated with an increased mean length of hospital stay, according to a large retrospective chart review from a major cancer center.

The substantial burden imposed by dermatologic complications in patients with cancer, particularly a hematologic malignancy, highlights the importance of greater collaboration between oncology and dermatology services to mitigate the impact of these events on both quality of life and outcome, wrote Gregory S. Phillips of Memorial Sloan Kettering Cancer Center, New York, and his associates. The study was published in the Journal of the American Academy of Dermatology.

The data that produced these conclusions were drawn from a retrospective chart review of 11,533 cancer patients treated at the center during 2015. Of these, 412 (3.6%) were referred for a dermatology consultation.

Those who received a dermatology consultation were comparable for median age (60 years) and gender (roughly 50:50 male:female), compared with those who did not. However, the odds ratio (OR) for a dermatology consultation was 6.56 among those with a hematologic malignancy compared with those who had a solid tumor. In those with leukemia, the proportion receiving a dermatologic consult was nearly ninefold greater.

Whether or not undertaken in a patient with a hematologic malignancy, dermatologic consults correlated with significantly greater morbidity, as well as mortality. This included a longer median length of stay (11 vs. 5 days; P less than .0001) and a higher in-hospital rate of death (9% vs. 2%; P less than .0001), compared with patients not needing a dermatology consultation.

Of dermatologic consultations in the total study population, the most common were for inflammatory conditions (27%), infections (24%), and drug reactions (17%). Neoplasm was the dermatologic diagnosis in 10% of the total population, but in 13% of those with hematologic malignancies.

Inpatient dermatology consultations were most frequently ordered by the hematology-oncology service, accounting for 44% of the total, followed by the solid tumor oncology service (27%) and the surgery service (15%). Multiple consultations were more likely in patients with leukemia or lymphoma than other forms of cancer.

 

In the dermatology consult, biopsy was employed for diagnosis in only 18%. As for treatment, 42% received topical therapy alone, and 38% received a systemic therapy. Dermatologic consultations that subsequently involved consultation with another service such as allergy and immunology, were rare, occurring in only 4% of cases.

Previous studies also have found a dermatologic consultation to be associated with increased morbidity and a longer length of hospital stay, according to the investigators, who were led by senior author Mario E. Lacouture, MD, director of the oncodermatology program at the center. The findings of this study underline the substantial burden associated with dermatologic complaints in patients with cancer in general and those with hematologic malignancies, specifically.

Furthermore, they suggested that the data support increased attention to dermatologic complications in cancer. Although the impact of consultations on outcome was not evaluated in this study, the authors cited another recent study in which there was a more than 2-day reduction in hospital stay when a dermatology consultation was employed in noncancer patients with an inflammatory skin disease (JAMA Dermatol. 2017 Jun 1;153[6]:523-8). Moreover, they speculated that a prompt resolution of dermatologic complaints in cancer patients has implications for better outcomes if they result in fewer delays in anti-cancer therapy.

The study was partly funded by the a grant from the National Cancer Institute’s Cancer Centers Program. Dr. Lacouture reported financial relationships with AstraZeneca, Adgero Biopharmaceuticals, Berg, Bristol-Myers Squibb, Foamix, Janssen, Legacy Healthcare, NovoCure, and Quintiles. Another author reported ties with Amgen, Roche, Eaisi, and P Value Communications.

SOURCE: Phillips GS et al. J Am Acad Dermatol. 2018 Jun;78(6):1102-9.

 

In-hospital dermatologic consults are more than six times more likely to occur in patients with hematologic malignancies than in those with solid tumors and are associated with an increased mean length of hospital stay, according to a large retrospective chart review from a major cancer center.

The substantial burden imposed by dermatologic complications in patients with cancer, particularly a hematologic malignancy, highlights the importance of greater collaboration between oncology and dermatology services to mitigate the impact of these events on both quality of life and outcome, wrote Gregory S. Phillips of Memorial Sloan Kettering Cancer Center, New York, and his associates. The study was published in the Journal of the American Academy of Dermatology.

The data that produced these conclusions were drawn from a retrospective chart review of 11,533 cancer patients treated at the center during 2015. Of these, 412 (3.6%) were referred for a dermatology consultation.

Those who received a dermatology consultation were comparable for median age (60 years) and gender (roughly 50:50 male:female), compared with those who did not. However, the odds ratio (OR) for a dermatology consultation was 6.56 among those with a hematologic malignancy compared with those who had a solid tumor. In those with leukemia, the proportion receiving a dermatologic consult was nearly ninefold greater.

Whether or not undertaken in a patient with a hematologic malignancy, dermatologic consults correlated with significantly greater morbidity, as well as mortality. This included a longer median length of stay (11 vs. 5 days; P less than .0001) and a higher in-hospital rate of death (9% vs. 2%; P less than .0001), compared with patients not needing a dermatology consultation.

Of dermatologic consultations in the total study population, the most common were for inflammatory conditions (27%), infections (24%), and drug reactions (17%). Neoplasm was the dermatologic diagnosis in 10% of the total population, but in 13% of those with hematologic malignancies.

Inpatient dermatology consultations were most frequently ordered by the hematology-oncology service, accounting for 44% of the total, followed by the solid tumor oncology service (27%) and the surgery service (15%). Multiple consultations were more likely in patients with leukemia or lymphoma than other forms of cancer.

 

In the dermatology consult, biopsy was employed for diagnosis in only 18%. As for treatment, 42% received topical therapy alone, and 38% received a systemic therapy. Dermatologic consultations that subsequently involved consultation with another service such as allergy and immunology, were rare, occurring in only 4% of cases.

Previous studies also have found a dermatologic consultation to be associated with increased morbidity and a longer length of hospital stay, according to the investigators, who were led by senior author Mario E. Lacouture, MD, director of the oncodermatology program at the center. The findings of this study underline the substantial burden associated with dermatologic complaints in patients with cancer in general and those with hematologic malignancies, specifically.

Furthermore, they suggested that the data support increased attention to dermatologic complications in cancer. Although the impact of consultations on outcome was not evaluated in this study, the authors cited another recent study in which there was a more than 2-day reduction in hospital stay when a dermatology consultation was employed in noncancer patients with an inflammatory skin disease (JAMA Dermatol. 2017 Jun 1;153[6]:523-8). Moreover, they speculated that a prompt resolution of dermatologic complaints in cancer patients has implications for better outcomes if they result in fewer delays in anti-cancer therapy.

The study was partly funded by the a grant from the National Cancer Institute’s Cancer Centers Program. Dr. Lacouture reported financial relationships with AstraZeneca, Adgero Biopharmaceuticals, Berg, Bristol-Myers Squibb, Foamix, Janssen, Legacy Healthcare, NovoCure, and Quintiles. Another author reported ties with Amgen, Roche, Eaisi, and P Value Communications.

SOURCE: Phillips GS et al. J Am Acad Dermatol. 2018 Jun;78(6):1102-9.