Perspectives on treatment decision-making in cutaneous squamous cell carcinoma, particularly regarding who is involved in selecting therapy.
PUBLISHED February 06, 2020
Todd E. Schlesinger, M.D., FAAD: The multidisciplinary team is important, and that really should be employed any time major decisions are being made as far as major inflection points in a patient’s care, when you’re making a big decision about what you’re going to do for a patient. The team players are typically dermatology, medical oncology, radiation oncology, and head and neck surgery. General surgery sometimes is involved as well. And then oftentimes, a patient advocate may be involved as well. And then of course the center of that is the patient. The patient’s in the middle of the multidisciplinary team because they’re the person who’s being affected by all of this.
That is the typical team. That may vary from site to site. For example, in the community you may not have access to all of these different players. In the academic center, typically the multidisciplinary team has already formed, and it might meet on a regular schedule so patients’ cases can be discussed. It’s important that for community physicians, and for patients, to be aware that even a community physician can create a multidisciplinary team by having those players in their back pocket so they can discuss cases with them, which is very important.
It’s very important not to make decisions, big decisions, for patients by yourself because there may be other options that may not be considered; not that the physician wouldn’t know all the things, because I’m sure they’re very up to date on care if they are using this kind of medicine. But all the options should be presented to the patients so they can make an informed decision.
That’s important to be able to reach out to a radiation oncologist, or to your head and neck surgeon. Call your oncologist and talk about the patient, or maybe call another member of the team, maybe a Mohs surgeon. If you’re a dermatologist or if you’re an oncologist, you may call a Mohs surgeon and talk about the surgical options. And again, there are also combinations. And so combination therapy, or what we call adjuvant therapy, has not been studied in squamous cell carcinoma very well yet. It’s just a little bit of information coming out, but that’s when you combine different therapies, and that’s more what physicians may do when they know all the different pieces of data. They can decide if more than one therapy might be useful for a patient, used in combinations together. But unfortunately, there’s no FDA [Food and Drug Administration] approval for what we call adjuvant therapy when it comes to immunotherapy for squamous cell carcinoma.
What’s the patient’s role? Well the patient’s role is everything. They are the ones affected. The patient’s role is to receive the information from the different physicians that they have and ask questions and understand the care that they’re receiving. If they need help, they ask a family member or a patient advocate or do their homework and research to make sure that they’re getting what they’re looking for. But the patients’ role is to seek the highest quality care they can and to make sure that they’re getting the best out of the health care system to help them be cured, if that’s possible.
In advanced disease, how does the health care professional determine if a patient receives palliative care or if they’re going to have medication? I think that’s a joint decision between the health care provider and the patient. I think every patient sits in their own space in the health care system, and within their body and within their disease state. I think as far as palliative care, generally there are guidelines for palliative care as to a patient if they choose not to have further therapy, or maybe the determination might be made between the patient and physician that their life expectancy is not longer than six months, or whatever that guideline might be. But I think that’s one of those decisions that unfortunately can’t be answered just in a general sense. It’s going to be a decision made between the patient and their health care team.
How are treatments evolving? It’s pretty incredible actually. In our space in oncology/dermatology, the rate of advancement in pharmacology is incredible. There are so many new therapies that are coming down in the market. There is a tremendous amount of research being done by multiple companies. We’ve gotten better and better at understanding the immune system and finding targets that are either receptors on tumors or certain types of cells or things like that, and being able to tune the immune system to fight cancer in a more efficient way.
I think that patients have to look forward to a lot of innovation in dermatology and oncology and surgery and drugs in the general sense. So I think for patients, rest assured, there’s a lot of innovation going on, and they will benefit from that. We will all benefit in that over time. It’s a great time for us to be learning in our space.