BI37 AERATE-Lung: management of paronychia following epidermal growth factor receptor inhibitor use in lung cancer in the UK

Abstract

Paronychia is a common inflammatory nailfold side effect of epidermal growth factor receptor inhibitors used to treat non-small cell lung cancer (NSCLC). It can impair quality of life and prompt treatment modifications. Despite the existence of guidelines, real-world UK practice shows notable variation across specialties. This study evaluates current practice and variation in the management of paronychia among UK healthcare professionals (HCPs). A medical science liaison-led, cross-sectional survey of UK HCPs involved in NSCLC was conducted and descriptive analysis performed. The HCPs included clinical or medical oncologists (n = 23), specialist nurses (n = 17), cancer pharmacists (n = 10) and dermatologists (n = 10). Overall, 70% of HCPs did not follow guidelines for the management of paronychia. Of those who did follow guidelines, there was variation in what was followed, with the European Society for Medical Oncology guidelines being the most commonly used (56%). Emollients were commonly used by all clinicians. Dermatologists reported higher use of topical steroids (100%), topical antibiotics (100%), oral antibiotics (100%) and acetic acid soaks (90%) relative to oncology teams (45%, 70%, 73% and 36%, respectively). Dermatologists also utilized other agents, such as topical beta blockers, that were less frequently used by oncology teams. Dermatologists used topical steroids twice as often and acetic acid soaks nearly three times more often than oncology teams. All dermatologists recommended oral antibiotics and topical antibiotics, whereas only two-thirds of lung oncology teams did. These findings highlight that oncology teams tend to be less aggressive in prescribing, while dermatologists adopted a more inclusive strategy by considering a wider set of interventions. Early involvement of dermatologists in the development of NHS consensus protocols could help prevent severe paronychia and reduce specialist referrals. For severe cases, clearly defined escalation pathways to podiatry and dermatology are warranted. Funding for this study was provided by Johnson & Johnson Innovative Medicine.