Quality of life issues in nonmetastatic skin cancer

Patient-reported outcome measures in nonmelanoma skin cancer of the face: a systematic review

Nonmelanoma skin cancer (NMSC) is the most common malignancy in the western world, with an incidence of 98,000 in the U.K. Since 2009 the Department of Health (DoH) has collected patient-reported outcome measure (PROM) data following four common surgical procedures. However, a DoH PROM for NMSC does not exist. A systematic review of questionnaires published on patient concerns due to NMSC of the face was conducted. Keywords relevant to PROMs, NMSC and the facial region were comprehensively searched in medical databases. Inclusion criteria stipulated that questionnaires from relevant papers recruited patients with NMSC for both the item formulation and subsequent validation. Questionnaires were then discussed by a multispecialty skin cancer research team. Initially 2548 papers were found; after exclusion criteria were applied, 73 articles were retrieved. Four patient questionnaires for NMSC featured adequate development and validation according to the inclusion criteria. The Facial Skin Cancer Index (FSCI) was the only PROM specific to facial NMSC. Additional questionnaires identified included the Skin Cancer Quality of Life Impact Tool, Skindex, and Dermatology Life Quality Index. There is a scarcity of data relating to NMSC PROMs and appearance concerns. Only one questionnaire--the FSCI--was specific to patients with facial NMSC. We recommend nationally standardized data collection from patients with NMSC in order to create an evidence-based validated PROM for patients with facial skin cancer.

Skin reactions and quality of life after x-ray therapy of Basal cell carcinoma

Background. Advanced basal cell carcinoma (BCC) is often treated by surgery or X-ray therapy. The consequences of X-ray therapy on the patients' health-related quality-of-life (HRQOL) have so far not been described. Objectives. To quantify quality of life in BCC patients before and after X-ray therapy compared with matched healthy controls. Materials. Twenty-five patients (mean age 69) with BCC completed the Dermatology Life Quality Index (DLQI) before and two weeks and three months after X-ray therapy and their results were compared with the DLQI scores for 25 matched controls. Results. Compared to the healthy controls the patients' DLQI score was significantly higher before and 2 weeks after X-ray therapy (P = 0.005; P = 0.000). The patients' DLQI score decreased significantly from baseline to three months after X-ray therapy (P = 0.024), when it became similar to that of the healthy controls (P = 0.819). Three months after X-ray therapy eight patients had no skin reactions, 11 had slight atrophy, pigmentation change, and/or some hair loss, four had patch atrophy, moderate telangiectasia, and/or total hair loss. Conclusions. BCC has a negative effect on patients' quality of life. The study shows that HRQOL normalises shortly after X-ray therapy, despite minor skin manifestations.

A systematic review of patient-reported outcome instruments of nonmelanoma skin cancer in the dermatologic population

BACKGROUND

Treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) has traditionally focused on minimizing recurrence and complication rates. However, the assessment of patient satisfaction and quality of life (QOL) is also important. These outcomes are best assessed by patient-reported outcome (PRO) instruments.

OBJECTIVES

We sought to conduct a systematic review of published PRO instruments purporting to measure aspects associated with QOL and/or patient satisfaction in the dermatologic BCC/SCC population and evaluate their development, content, and psychometric properties.

METHODS

PubMed, Embase, Cochrane via Wiley, PsycINFO, CINAHL, and HaPI from inception to April 2011 were searched. Articles that discussed the instrument development and validation process were included.

RESULTS

A total of 2212 articles were identified. Twenty met our inclusion criteria resulting in 6 PRO instruments: 3 general dermatology (Skindex, Dermatology Life Quality Index, dermatology quality of life scales), 1 general plastic surgery (Patient Outcomes of Surgery-Head/Neck), and 2 skin cancer-specific (Skin Cancer Index, disease-specific questionnaire). The 6 instruments all underwent some degree of formal development and validation, however, only the Skin Cancer Index was developed and validated in the BCC/SCC population.

LIMITATIONS

The review may not have included all relevant PRO instruments.

CONCLUSIONS

The Skin Cancer Index demonstrates the most evidence of its usefulness in patients with BCC/SCC. The Skindex-16, Dermatology QOL Scales, and Dermatology Life Quality Index target different aspects of QOL and should be used depending on the specific question being investigated. The Patient Outcomes of Surgery-Head/Neck may be beneficial to assess perceptions in appearance before and after surgical intervention.

The Skin Cancer Quality of Life Impact Tool (SCQOLIT): a validated health-related quality of life questionnaire for non-metastatic skin cancers

BACKGROUND

Quality of life (QOL) issues in patients with non-metastatic skin cancer are not satisfactorily demonstrated when using existing QOL questionnaires.

OBJECTIVE

To construct and validate a 10 item disease-specific QOL questionnaire, the Skin Cancer Quality of Life Impact Tool (SCQOLIT), for use in patients following treatment of non-metastatic skin cancer.

METHODS

The SCQOLIT was constructed and administered initially to 120 patients with non-metastatic skin cancer, 60 with malignant melanoma (MM) and 60 with non-melanoma skin cancer (NMSC) following treatment, then repeated in half this cohort at seven days, and the other half at three months. Data was collected on age, gender, skin cancer type and Breslow thickness. Statistical validation was undertaken.

RESULTS

There were 113 valid SCQOLIT responses at initial completion (54 in the MM group, and 59 in the NMSC group). Initial SCQOLIT median scores (interquartile range [IQR], range) for the two groups were 10 (12, 0-28) MM, and 4 (5, 0-19) NMSC. Amongst the cohort readministered the SCQOLIT at three months (23 in the MM group, 25 in the NMSC group) median scores (IQR, range) were 6 (6, 0-26) MM and 3 (4, 0-20) NMSC.

CONCLUSIONS

The SCQOLIT is a validated disease-specific QOL questionnaire for use in patients following treatment of non-metastatic skin cancer. Higher SCQOLIT scores are observed in MM patients than NMSC patients, but diminish with time in the MM group. Patients with persistently elevated SCQOLIT scores merit additional attention.

Mapping FACT-melanoma quality-of-life scores to EQ-5D health utility weights

OBJECTIVES

We sought to develop a mapping function from functional assessment of cancer therapy-melanoma (FACT-M) quality of life scores to the EuroQol-5D (EQ-5D) utility scores.

METHODS

FACT-M and EQ-5D scores were collected during a prospective study of melanoma-related quality of life at a tertiary cancer care center in the United States. The study sample was divided into development and validation datasets with equal distributions by cancer stage and treatment status. Censored Least Absolute Deviation (CLAD) and Ordinary Least Squares (OLS) regression analyses were performed using the developmental dataset to derive mapping functions, and model performance was examined through comparisons of residuals and measures of fit in the validation dataset. Exploratory analyses examined the predictive ability of clinical factors and individual subscales.

RESULTS

Of 273 patients, 75 were undergoing treatment with 198 in follow-up surveillance. Relatively even distributions were observed by melanoma stage: I/II (n = 102), III (n = 100), and IV (n = 71). OLS regression resulted in a mapping function of EQ-5D = 0.0037*FACT-M+0.2238 with an R(2) 0.499. CLAD regression resulted in a mapping function of EQ-5D = 0.0042*FACT-M+0.1648 with pseudo R(2) 0.328. When applied to the validation dataset, correlations between observed and predicted values resulted in identical coefficients (r = 0.824, P < 0.001). Though the mapping functions were similar, residuals were smaller at the 20th, 40th, and 60th percentiles using the OLS model. The CLAD derived mapping function resulted in smaller residuals only for patients whose EQ-5D = 1.

CONCLUSIONS

The OLS mapping function demonstrated better predictive ability and will facilitate the derivation of utilities when direct population preference measures are not available.

Efficacy of an educational intervention with kidney transplant recipients to promote skin self-examination for squamous cell carcinoma detection

OBJECTIVES

To develop easily disseminated educational materials that enable early detection of skin cancer, and to examine the effectiveness of the materials to promote skin self-examination (SSE) among kidney transplant recipients (KTRs).

DESIGN

Randomized controlled trial of an educational intervention in comparison with a group that received only the assessment, education, and treatment as part of usual care with a nephrologist.

SETTING

Academic ambulatory nephrology practice.

PATIENTS

Seventy-five KTRs returning for routine care to their nephrologists 1 to 1.2 years or 3 to 7 years after transplantation.

INTERVENTION

Educational workbook.

MAIN OUTCOME MEASURES

Skin self-examination performance and new appointments with a dermatologist if a concerning skin lesion was found.

RESULTS

Twenty-two percent of those in the control group checked their skin after the visit compared with 89% of the treatment condition; thus, KTRs receiving the intervention were significantly more likely to have checked their skin (χ(2); P < .001). Among the 8 control KTRs who checked their skin, none found areas of concern. Of the 34 intervention KTRs who checked their skin, 12 participants (35%) found areas of concern. All 12 of these individuals made appointments with a dermatologist for follow-up.

CONCLUSIONS

The KTRs were receptive to performing SSE and acted on the recommendation made in the workbook to make an appointment with a dermatologist when a concerning lesion was discovered. Printed educational materials can be initiated in the tertiary care center 1 year after transplantation and used across a continuum of time during which KTRs may be transferred from the tertiary care center to community nephrologists.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01127737.

Quality of life in health care of non-melanoma skin cancer - results of a pilot study

BACKGROUND

Modern patient-oriented medicine increasingly involves psychosocial aspects of disease processes in therapy evaluations. We conducted a pilot study on the implementation of a suitable device assessing the quality of life of patients with non-melanoma skin cancer (NMSC) in clinical routine.

PATIENTS AND METHODS

52 patients with NMSC were asked to fill out the German version of the Dermatology Life Quality Index (DLQI) by A.Y. Finlay. Additionally, one-third of the patients were evaluated by the treating physicians.

RESULTS

The questionnaire was well-accepted and completed within a few minutes. Less than 1 % values were missing with respect to individual items. 31 % of patients experienced a moderate to strong impairment of the quality of life. This impairment involved symptoms, emotions, everyday activities, and leisure activities, whereas work and school were of minor importance. The variables age, gender, and diagnosis were of little importance.

CONCLUSIONS

The limited number of publications available necessitates a step-wise introduction of this topic into the German literature. Data on quality of life could be relevant for the inclusion of NMSC onto the list of occupational diseases in occupations with high UV exposure. Sufficient data have to be generated in follow-up studies of longitudinal design that are based on the present pilot study.