This is the last week of Real World Health Care’s brief hiatus, during which we are re-publishing some of our most popular interviews on oncology-related topics.
The editors of Real World Health Care, along with our sponsor, the HealthWell Foundation, understand that cancer takes a huge toll on patients, their families and loved ones. About 1.6 million new cases of cancer were diagnosed in the United States last year, and nearly 600,000 people died from the disease.
Real World Health Care is pleased to shine a spotlight again on the researchers, clinicians and organizations dedicated to the future of cancer care. We also are proud of the work being done by the HealthWell Foundation, which provides a financial lifeline to underinsured Americans through grants for cancer patients across a variety of funds, such as multiple myeloma, bone metastases, and chronic myeloid leukemia for Medicare patients, to help them afford the medical treatments they so desperately need.
In May, Real World Health Care continued our recognition of Melanoma and Skin Cancer Awareness Month by highlighting the work of the American Academy of Dermatology. We spoke with the AAD’s new President, Henry W. Lim, MD, about the organization’s mission and some of the challenges and opportunities associated with preventing and treating melanoma and other skin diseases.
Real World Health Care: Please tell our readers about the overall mission of the American Academy of Dermatology.
Henry W. Lim, MD, American Academy of Dermatology
Henry Lim: The American Academy of Dermatology promotes leadership in dermatology and excellence in patient care through education, research and advocacy.
As the largest, most influential and representative dermatology group in the United States, and the largest such organization in the world, the AAD works to make sure its values reflect this mission. The AAD’s values include putting patients first, encouraging its members to adhere to an uncompromising code of clinical and ethical standards, fostering an interest in our members to pursue lifelong learning, encouraging collaboration and working within our communities and embracing diversity.
Public Education: Sun Safety
RWHC: How does the AAD’s mission address melanoma?
HL: It is estimated that 161,790 new cases of melanoma will be diagnosed in the U.S. in 2017. That is a staggering number that could be reduced if people incorporated skin cancer detection and prevention behaviors into their lives.
The AAD works to increase public awareness of skin cancer and its risks through its SPOT Skin Cancer™ campaign, which is designed to create a world without skin cancer through public awareness, community outreach programs and services, and advocacy that promote the prevention, detection and care of skin cancer.
The first step toward a world without skin cancer is educating the public about prevention. The Academy has long communicated sun-safety messages to the public about the importance of skin cancer prevention and detection.
In addition, dermatologists have led the medical community in finding and treating skin cancer. For more than 30 years, dermatologists across the country have hosted 2.5 million free SPOTme® skin cancer screenings that have detected 28,822 suspected melanomas and 256,329 suspected skin cancer lesions.
To assist the public with learning more about skin cancer prevention and detection, the AAD offers a variety of free, online videos, downloadable handouts and skin self-exam resources, including a body mole map, as well directories to find a dermatologist and skin cancer screenings.
Melanoma & Skin Cancer Awareness
RWHC: What is the AAD doing in 2017 to recognize Skin Cancer Awareness Month?
HL: The AAD’s 2017 SPOT Skin Cancer campaign, Check Your Partner. Check Yourself, encourages the public to be aware of changes on their skin that could be signs of skin cancer. Research has shown that women are more likely to detect suspicious spots on others. Men over the age of 50 have a higher risk of developing melanoma, than the general population, so the campaign encourages women – often the health care decision makers of a household – to check their partner’s skin regularly, check their own skin, and to visit the AAD’s SpotSkinCancer website to find a free SPOTme® screening in their area.
RWHC: Do you have additional initiatives you’d like to highlight?
HL: In addition to the activities for Skin Cancer Awareness Month in May and the SpotSkinCancer™ website, the AAD works with state dermatology societies and state legislatures to introduce and support laws and regulations that protect consumers and promote awareness about skin cancer prevention and the dangers of indoor tanning. As a result, 42 states have enacted tanning bed restrictions to potentially reduce the risk of melanoma and other forms of skin cancer.
The AAD’s Shade Structure Program awards shade structure grants to schools and non-profit organizations across the country in order to protect children and adolescents from the sun’s harmful rays. Since its launch in 2000, the AAD’s Shade Structure Program has awarded 350 shade structure grants, which provide shade for more than 600,000 individuals each day.
The AAD also has a strategic social media presence on Facebook, Twitter, YouTube and Pinterest, designed to raise awareness about skin cancer detection and prevention. Social media, including paid, promoted posts, reach our targeted audiences – the public, our members and the media – with links to AAD resources. We encourage our followers to like, share and re-tweet our skin cancer awareness videos and tips.
RWHC: Does the AAD underwrite or otherwise support research into melanoma detection and/or treatment?
HL: While AAD is not a research funding organization, the AAD does provide annual awards for Young Investigators in Dermatology. These awards recognize outstanding basic and clinical/translational research by young dermatology investigators and some of the projects are related to melanoma.
The purpose of the award is to acknowledge research contributions by individuals at the start of promising research careers that further the improvement of diagnosis and therapeutics in the practice and science of dermatology.
RWHC: What do you see as the biggest challenges facing researchers studying melanoma treatments and clinicians treating melanoma?
HL: The rapidly changing health care environment presents major challenges to researchers and clinicians in all aspects of dermatologic care, not just those studying and treating melanoma.
A significant challenge is the inadequate funding for research, together with the pressure to increase clinical revenue generated by clinician researchers. For many years, the American Academy of Dermatology Association (AADA) has been active in advocating increased research funding by NIH to dermatology research, including through our support of the 21st Century Cures Act.
The current health care system also presents barriers that impede patient access to the best possible care from a qualified physician. To combat this, the AADA is working with all dermatology care providers and other physicians to confront these challenges.
In particular, the AAD recently launched a new specialty positioning campaign, SkinSerious, to raise awareness of the serious impact of skin disease. Our goal is also to improve access to dermatologists’ expertise and increase collaboration with our physician peers to ensure high-quality patient care. We know that when dermatologists work with other physicians as part of the health care team, everyone can benefit from improved patient outcomes and lowered health care costs.
Other concerns within the health care environment that the AADA is closely monitoring include the rise of big data and the growth of teledermatology. We closely follow developments at the federal and state levels and, when appropriate, the AADA will take action on issues that can be influenced positively for dermatology and pursue opportunities to impact health care policy.
Promising Melanoma Treatments
RWHC: What do you see as the most promising or breakthrough melanoma treatments on the horizon?
HL: This is an exciting era in melanoma research. In-depth understanding of the molecular pathways of melanoma development has led to the availability of immune checkpoint inhibitors; combinations of these medications are being looked at in clinical trials. Metabolic manipulation of the peri-tumoral environment to inhibit the growth of melanoma is being actively investigated. Understanding of the genes responsible for melanoma resulted in the availability of gene expression profile (GEP) test that can be used to determine biologic behavior of melanoma.
RWHC: What are the biggest challenges facing the medical community in terms of increasing awareness of and adherence to melanoma prevention efforts among the general public?
HL: The challenges facing the medical community around melanoma prevention are two-fold.
One is the misconception that a tan is a sign of health. Tanning is a protective physiologic response of our skin to damage caused by ultraviolet radiation. There is no such thing as a healthy tan, yet people continue to seek the sun or use indoor tanning, thereby increasing their risk of skin cancer. This is a particularly challenging message to get across to young women and men, who feel peer and societal pressure to be tan.
The AADA was instrumental, along with several other organizations, in having the FDA re-classify tanning lamps from the Class I to Class II medical device category, which requires more supervision and restriction in their purchase and use. For the past several years, the AAD has released a new public service advertisement that focuses on the dangers of tanning, particularly targeting young women. We know that melanoma is the second most common cancer in young women, and this may be due in part to their tanning habits.
The 2016/2017 public service advertisement is called “Arms,” and features two young women comparing their tans at various stages in their lives. The emotional ad concludes with the two friends clasping hands in the hospital as one of them reveals she has advanced stage melanoma. This PSA, and our previous ones, have resonated strongly with young women, especially on social media, where they have liked and shared the video with their friends.
The second challenging misconception is that many people believe that sun exposure is the best source of vitamin D.
While our bodies need vitamin D to build and maintain strong, healthy bodies, the AAD does not recommend getting vitamin D from sun exposure or indoor tanning because of the increased risk of skin cancer. In fact, it has been demonstrated that sun exposure that results in increased vitamin D levels is directly correlated with DNA damage.
Vitamin D from food and dietary supplements offers the same benefits — without the danger of skin cancer — as vitamin D obtained from UV light. Vitamin D cannot be used by the body until it is processed by the liver and the kidneys. The usable form of vitamin D created by this process is the same, regardless of how it enters the body.
The AAD recommends dietary sources (foods naturally rich in vitamin D, fortified foods and beverages) and vitamin supplements as sources of vitamin D that are available year-round and can easily be incorporated into a healthy lifestyle. Good sources include fortified milk, cheeses and yogurt, fortified cereal, and oily fish like salmon and tuna. Research shows that vitamin D supplements are well tolerated, safe, and effective when taken as directed by a physician.
The fact is these myths are harmful because the consequences of this misinformation could be potentially fatal.
RWHC: What personally inspires you to build awareness of the importance of preventing melanoma?
HL: Having been in dermatology practice for 40 years, I see on a regular basis the devastating effects that melanoma has on patients and their family. The risk of developing melanoma can be significantly decreased by sensible photoprotection, and avoidance of tanning beds. The exciting new developments in the treatment and genetic profiling of melanoma reflect the value of investment in scientists and research projects, and I look forward to additional treatments in the future that will benefit patients.
A MESSAGE FROM OUR SPONSOR:
The HealthWell Foundation, sponsor of Real World Health Care, is proud to have supported the melanoma patient community in recent years with copayment and premium assistance. We have helped more than 2,230 melanoma patients afford their treatments since approving our first Melanoma grant in 2011 — thanks to the generous support of our corporate partners. Due to high patient volume, our melanoma fund is temporarily closed until we receive additional funding. We invite corporations and individuals to help us meet this demand by contributing to our Melanoma-Medicare Access Fund, so nobody goes without essential medications because they cannot afford them.