Back in 2015, the NEJM published this trial evaluating using nicotinamide (vitamin B3) for non-melanoma skin cancer (NMSC) in patients who had at least two NMSC in the past 5 years. The results were positive, with the intervention group having a 23% lower risk of NMSC than the placebo group (p=0.02). A previous case-control study (admittedly far lower quality of evidence) showed a decrease in actinic keratosis rates with nicotinamide use in transplant recipients.
One of our colleagues at the London Lambeth Family Health Organization has a focused practice in dermatology, and made us aware that some dermatologists have begun implementing the results of the NEJM study in routine practice.
Given the quality of data we have in primary care, we began efforts to identify potential eligible patients in our practice, and designed a program to disseminate the information to our patients.
Using our Telus PS Suite EMR, we ran the following search to find potential patients:
Of the patients identified by this search, each physician went through the list to identify which of these patients met the high-risk criteria of at least two NMSC in the past 5 years.
The resulting list of 137 high-risk patients was exported from Telus into the HealthMyself patient portal as a custom patient group, and the following broadcast was sent to the 80/137 patients who have signed up for our free patient portal:
We have reviewed our records, and have identified you as being high risk for non-melanoma skin cancer, because of your previous history.
We thought you would be interested in a study that we have come across, showing that daily nicotinamide (an over the counter vitamin) reduced the risk of non-melanoma skin cancer by 23%. Here is the link to the study https://www.nejm.org/doi/full/10.1056/NEJMoa1506197
Pharmacies don’t typically carry this vitamin, but we have spoken to local pharmacies who can order it and have it in within a few days.
You need to ask the pharmacist for “Nicotinamide”, and you will take a 500mg tablet twice daily (90 tabs should be around $15). Make sure they DON’T give you niacin. If they have any questions, they can contact our office.
The nicotinamide should be used indefinitely, and remember that sun protection with clothes and sunscreen is still vitally important.
You know that typically we discourage most vitamin and supplement use (with the exception of vitamin D), but we felt that this was strong enough evidence to make this recommendation to our patients.
For the 57 high-risk patients who are not registered for our portal, an alert was put into their chart labelled “Discuss nicotinamide”, and at their next visit, a custom stamp we created in the Telus PS Suite EMR called “Nicotinamide” was inserted into a letter and printed for the patient to take home (content the letter identical to the message sent through the portal).
This is a very easy program to implement, and really highlights the incredible capacity of patient portals to disseminate information quickly and efficiently to a defined patient population.
Be sure to contact me if you have any questions about implementing this program in your office.