The importance of caregiving in patients with advanced basal cell carcinoma in treatment with hedgehog-pathway inhibitors: an observational prospective study

Abstract Background Oral target therapy with hedgehog-pathway inhibitors has revolutionized the standard of care for patients with advanced basal cell carcinoma. These patients are frail and elderly patients with various comorbidities and on pharmacological polytherapy. This scenario requires the clinician to manage the adverse events that can have a significant impact on therapeutic adherence. Objectives We evaluated the impact of caregivers in the treatment of patients with advanced BCC under treatment in terms of continuation of therapy over time. Methods All patients included in this observational prospective study have histologically confirmed metastatic or locally advanced basal cell carcinoma and were treated with hedgehog-pathway inhibitors from January 2016 to December 2021 at the Department of Dermatology at the University of Florence, Italy. The collected patient data included age, sex, BCC site and extension, number of cycles, dose, duration and tolerability of the therapy, marital status (single, divorced, married/live-in, widow/widower), and information such as living with someone, and the presence of any caregivers. Results Of the 34 patients included, 33 had a LaBCC and 1 metastatic BCC. There were 11 females (32.4%) and 23 males (67.6%). Among Basal Cell Carcinoma patients treated with hedgehog-pathway inhibitors, patients who were married or lived with a care-giver could better tolerate the therapy relative to single patients who live alone. Indeed, married/live-in patients and/or those with an adequate caregiver experienced greater therapeutic adherence and tolerated adverse events better. Conclusions Given the greater therapeutic adherence of married/live-in patients whose caregiver is the partner, it is essential to consider patient’s marital status. It is advisable to involve the caregiver upon enrollment. There should be a training discussion on the various possible adverse events and the best way to mitigate them. Success in therapy is linked not only to an informed patient but also to a trained caregiver.