Addressing Systemic Barriers to Dermatologic Consultation in Oncology Care

As oncologic therapies become increasingly effective, the focus of comprehensive cancer care must broaden to include the aggressive management of therapy-related adverse effects (AEs). Dermatologic AEs, ranging from radiation dermatitis to permanent hair loss, significantly impact a patient’s quality of life and adherence to treatment. A key finding from a recent study, Perceptions and knowledge of dermatologic side effects of anti-cancer therapies: a pilot survey, coauthored by Adam Friedman, MD, FAAD, confirmed that many patients previously treated for cancer had not been referred to or visited a dermatologist during their treatment course. These data suggested a potential systemic failure in ensuring timely, specialized care for cutaneous toxicities.

Friedman, professor and chair of Dermatology, director of the Residency Program, and director of Translational Research at George Washington Medical Faculty Associates, addressed the key systemic and logistical barriers preventing optimal dermatologic consultation for patients with cancer. Friedman emphasized how these access issues are exacerbated in “dermatology deserts”, citing the geographic and socioeconomic disparities in his own study conducted in Wards 7 and 8 of Washington, DC.

Transcript:

I wasn't surprised by that, and there are a couple of reasons why access to dermatology may not be happening when it absolutely should be, especially in this setting. It also depends on the community and the availability of dermatologists. There is, certainly, a bucket of referrals. Colleagues in the support of the dermatology world have published on this before. One of my colleagues, Beth N. McLellan, MD, who’s chief of dermatology at Montefiore Einstein School of Medicine in the Bronx, published a study looking at the referral rates from radiation oncology to dermatology in the setting of radiation dermatitis, and the numbers were quite low. This was many years ago, so hopefully, that’s better [now]….There’s so much going on in oncology that we have to focus on a bigger picture, and that’s getting rid of the cancer and, hopefully, saving the patient. Sometimes, dermatologic consequences fall by the wayside.

[It is important to] be mindful of the opportunity to refer. Then, on their side, [they must] have somewhere to refer. Access to dermatology is a huge challenge in the US. There are plenty of papers and a lot of evidence supporting that unsettling statement. Knowing even where to send someone and send someone quickly probably fits into that as well.

There are also different socioeconomic and demographic features. Our study specifically took place in Wards 7 and 8 of Washington, DC, which is a dermatology desert. There’s not a single dermatologist in that area, which is why we have created a free dermatology clinic that happens monthly there at a local church in Wards 7 and 8. Cost has to be considered as well.

Reference

Menta N, Vidal SI, Whiting C, Azim SA, Desai S, Friedman A. Perceptions and knowledge of dermatologic side effects of anti-cancer therapies: a pilot survey. J Drugs Dermatol. 2025;24(8):e57-e58.