- Finding mechanism of cancer treatment induced altered appearance

- Providing evidence-based supportive care and education for intervene altered appearance

- Improving self-esteem and enhancing quality of life for women with breast cancer 

Between 75% and 92% of breast cancer patients receive standard adjuvant chemotherapy, including doxorubicin, cyclophosphamide, fluorouracil, or taxotere (docetaxel). These drugs target rapidly dividing cells and affect all proliferating cells, causing multiple cutaneous side effects such as alopecia, erythema, pruritus, and desquamation. Indeed, dermatologic reactions are the most common side effect reported by cancer patients receiving chemotherapy.

A multidisciplinary research team including members of Cancer Education Center, medical oncologists, surgical oncologist, dermatologists at Samsung Medical Center and Clinical Epidemiology and Behavior Science Lab at SAIHST, and Sungkyunkwan University (Principle Investigator - Juhee Cho, Project manager - Danbee Kang, graduate student at SAIHST) have studied cancer treatment induced altered appearance and its impact on distress and psychosocial well-being since 2008. The team found that more than half of the breast cancer patients experienced higher distress due to altered appearance, during cancer treatment, and this distress was strongly associated with negative body image, overall health status, and psychosocial well-being. However, significant progress has been made during the past two decades in treating many of the side effects associated with cancer chemotherapy, including emesis, hematopoietic cytopenias, xerostomia, infection, pain, and thrombosis.

As a consequence, the team conducted a cohort study to evaluate objective changes in skin composition and associated patient-reported symptoms among breast cancer patients undergoing chemotherapy. Objective parameters included quantitative evaluations of changes in water content, sebum content, transepidermal water loss (TEWL), melanin and hair condition. Patient-reported outcomes included dryness, dullness, blemishes, wrinkles due to loss of elasticity and alopecia due to chemotherapy. They found water content (-6.5%), sebum (-75.5%), and TEWL (-22.4%) significantly decreased during chemotherapy compared to pre-chemotherapy levels. These parameters were lowest at 1 month after completion of chemotherapy and recovered thereafter but did not return to baseline levels after 6 months of follow-ups. Most patients reported dryness (57.9%) and dullness (49.1%) after chemotherapy and patient-reported dryness was significantly associated with decreased sebum content.

Additionally, hair diameter 6th months after chemotherapy had not reverted to baseline levels. Furthermore, 36 out of 60 participants (or 60%) whom we were able to contact at the 24th month after the study initiation, complained about permanent chemotherapy induced hair issues. Permanent chemotherapy-induced alopecia, defined as absent or incomplete hair regrowth at ≥6 months post-chemotherapy, was reported around 30%. Like chemotherapy induced alopecia (CIA), permanent CIA also lacks recognition and has been underserved regardless of patients’ needs.

Professor Cho received the Faculty Research Fund, (Sungkyunkwan University) in 2013 for this study. Ms.Danbee Kang received the best presenter award at Global Breast Cancer Conference 2013 and the Albert M. Kligman Travel Fellowship Award from the Society of Investigative Dermatology in 2014. The results of their studies were published in Psycho-Oncology and Breast Cancer Research and Treatment in 2015 which were top-tier journals in the area. 

The research team are now conducting two clinical trials collaborating with AMOREPACIFIC, Seoul Kore and  Legacy Healthcare, in Lausanne, Switzland improve skin conditions and permanent alopecia due to chemotherapy in breast cancer patients respectively.

Professor Cho proudly said “This is the best example that multiple interest groups work together to find unmet needs of patients and try to bring evidence-based care with well-conducted studies. We are doing this not only for science but also for people. It is possible because of the teams' good-will.”