Niacinamide for Metastatic Skin Cancer in Comfort Care

Evidence Assessment

The American Academy of Dermatology guidelines indicate that while there is early evidence from a small trial that oral nicotinamide may reduce the risk for subsequent keratinocyte carcinomas in non-immunosuppressed individuals with a history of such carcinomas, this is primarily for prevention in patients who are not in the terminal stages of disease 1
The American Academy of Dermatology suggests that interventions should focus on symptom management and quality of life rather than preventive measures that may not provide meaningful benefit in patients with metastatic skin cancer on comfort care 1
In patients with advanced disease on comfort care, interventions should focus on symptom management and quality of life rather than preventive measures that may not provide meaningful benefit 2

For patients on comfort care with metastatic skin cancer, the primary goals should be symptom management, pain control, and maintaining quality of life rather than prevention of new skin cancers 2
Adding medications without clear palliative benefit may contribute to pill burden and potential side effects without meaningful improvement in outcomes for patients with limited life expectancy 2

For patients with metastatic skin cancer on comfort care, focus should be on effective pain management 2
For patients with metastatic skin cancer on comfort care, focus should be on symptom control 1
For patients with metastatic skin cancer on comfort care, focus should be on quality of life measures 2
Resources and energy should be directed toward interventions that will provide the most comfort and quality of life improvement rather than preventive measures with uncertain benefit in the advanced disease setting 2