Building Support Systems: Resources and Multidisciplinary Collaboration for Optimizing COCOON Implementation

Opinion
Video

Panelists discuss how keeping management of dermatologic adverse effects “in-house” with oncology teams is often preferable to referring patients to dermatologists, though some patients occasionally benefit from specialized care for nail issues.

Video content above is prompted by the following:

Multidisciplinary Approach to Amivantamab-Related Dermatologic Adverse Effects

Current Management Approach

The discussion highlights a preference for managing amivantamab-related dermatologic adverse effects “in-house” rather than routinely referring to dermatology for several practical reasons:

Limited dermatology appointment availability (typical 2-month wait times)

Patient burden considerations (multiple appointments, additional co-pays)

Better continuity of care when treated by the primary oncology team

Recognition that these adverse effects are treatment-related and predictable

Additional Support Resources

Several supportive care measures were identified:

  • Some patients independently sought specialized care:
  • Podiatry consultation for toenail issues, including curettage for granuloma tissue

  • Occasional dermatology referrals that sometimes-yielded novel management strategies
  • Suggested workflow improvements:
  • Prebuilt order sets for prophylactic oral and topical antibiotics

  • Standardized patient education materials (1-page handout or brochure)

  • Comprehensive supportive care toolkit outlining:

  • Adverse effects to monitor

  • Recommended preventive regimens

  • Management strategies
  • Existing resources:
  • Electronic medical record may already contain standardized order sets

Recommendations for Practice Enhancement

The summary suggests a COCOON regimen approach that appears to be a standardized protocol for managing amivantamab-related dermatologic toxicities, with emphasis on streamlining implementation through:

  • Systematic prophylactic measures
  • Patient education and anticipatory guidance
  • Reducing administrative burden through standardized ordering processes

This approach balances comprehensive toxicity management while minimizing additional appointments and maintaining continuity within the oncology care team.

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