Transcript: Anna C. Pavlick, DO: I really think that this is a disease, like a majority of cutaneous malignancies, that really deserves to have a multidisciplinary team manage it. Can you talk a little about how your multidisciplinary team works at Memorial Sloan Kettering Cancer Center?
Anthony Rossi, MD, FAAD: Sure. When we are presented with these advanced or metastatic squamous cells, we normally bring this to our multidisciplinary cancer-management team. That consists of dermatologists, head and neck surgical oncologists, of course our medical oncologists, radiation oncologists and plastic surgeons, because we want everyone’s opinion to see how we best approach this patient and what to use first line, or thinking down the road, what would they need to later.
I do think it really helps to get everyone’s opinion because there are nuances. If there’s going to be reconstruction associated with the surgery, how will that factor in if the patient gets radiation? Will they heal? If we try immunotherapy up front, what are our goals and what are our plans later on? Bringing these patients to a tumor board is quite powerful because it gives a really nice plan, and the patient knows that a lot of people are thinking about how to best approach this.
Anna C. Pavlick, DO: Yeah, I agree. My patients get very excited when they know that they are at the topic of discussion.
Anthony Rossi, MD, FAAD: Yeah.
Anna C. Pavlick, DO: To know that there’s a roomful of people who are really ping-ponging back and forth about what’s the best thing to do in what sequence. I agree that we do very much the same thing. Now everything has become virtual, so we actually get more participation because everybody can log in and see this. We present the slides, we present pictures and patients are very comforted in knowing so many people gave an opinion without them having to go to those multiple physicians.
Anthony Rossi, MD, FAAD: Definitely. I think they really actually appreciate the amount of time that goes into their individual decisions.
Anna C. Pavlick, DO: Yeah, I agree. There are some people who unfortunately will not respond and develop progressive disease, metastatic disease. I guess this is more a medical oncology question, but how do you choose between palliative care and hospice or supportive care versus a therapeutic intervention? For me it really is patient dependent. It’s based on how many comorbidities the patient has, how sick the patient is and the extent of the patient’s disease. Other than immunotherapy, there are therapeutic options, like chemotherapy and radiation, we had talked about for palliation. EGFR inhibitors also can be looked at as a way to manage patients.
There are enough options that patients can be offered something other than immunotherapy if that doesn’t help. However, if you’re talking about a very old patient who you know is going to become further debilitated because of chemotherapy or because of radiation therapy, then it really becomes a very honest talk between the oncologist and the patient. What is our end goal? Are you looking to buy yourself more time? Are you looking for quality time? When it comes to my opinion, I would much rather give people quality time than being miserable for a longer quantity of time. I think most people are really on that page.
That’s when the discussion comes up between palliative care with therapy or interventions versus palliative care and supportive therapy, manage my pain, keep me comfortable and let me live out whatever time I have left in a comfortable manner at home with my family.
Transcript Edited for Clarity