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Baxi S, Vohra S, Hong A, Mulholland N, Heuschkel M, Dahlhoff G, Cardaci G, Mirzaei S, Sathekge M. Effectiveness and Patient Experiences of Rhenium Skin Cancer Therapy for Nonmelanoma Skin Cancer: Interim Results from the EPIC-Skin Study. J Nucl Med 2024; 65:1450-1455. [PMID: 39025650 DOI: 10.2967/jnumed.124.267988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
Nonmelanoma skin cancer and its treatment represent a significant global cancer burden for health care systems and patients. Rhenium skin cancer therapy (Rhenium SCT) is a novel noninvasive radionuclide nonmelanoma skin cancer treatment, which can be provided in a single outpatient session. The aim of this prospective, multicenter, single-arm, international, phase IV study (EPIC-Skin) is to assess clinic- and patient-reported outcomes of Rhenium SCT as a treatment for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: Eligible patients had biopsy-proven stage I or stage II BCC or SCC lesions no more than 3 mm deep and no larger than 8 cm2 in area. Rhenium SCT resin was applied to an adhesive foil affixed to the target lesion in a single session. Interim efficacy and safety analysis were planned once 50% of target patients had recorded a 6-mo follow-up visit. Primary outcome is the proportion of lesions achieving complete response using modified RECIST. Secondary and other outcome measures include patient-reported quality of life (QoL), treatment comfort, and cosmesis. Results: A total of 182 patients was enrolled and administered Rhenium SCT (50 Gy dose to deepest point of target) to at least 1 BCC or SCC. Of 81 patients who reached the 6-mo posttreatment follow-up, it was found that 97.2% (103/106) of lesions showed complete responses and 2.8% (3/106) had partial responses. Improvements in QoL were also reported, whereas no patients reported any pain or discomfort during treatment. Adverse events were reported in 15.9% (29/182) of patients and were rated grade 1 (n = 19), grade 2 (n = 9), or grade 3 (n = 1). Conclusion: This preliminary analysis of the EPIC-Skin study indicates that Rhenium SCT is safe and effective for the treatment of BCC and SCC and is associated with significant QoL improvements. It will be particularly beneficial for lesions that are difficult to treat surgically because of size and location. It is also beneficial for patients with comorbidities or those unable to receive conventional fractionated radiotherapy.
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Affiliation(s)
- Siddhartha Baxi
- Genesis Cancer Care, John Flynn Hospital, Tugun, Queensland, Australia
| | - Saima Vohra
- Avion Medical Skin Centres, North Melbourne, Victoria, Australia
| | - Angela Hong
- Genesis Cancer Care, North Shore Health Hub, St. Leonards, New South Wales, Australia
- Melanoma Institute Australia, Poche Centre, Crows Nest, New South Wales, Australia
| | - Nicola Mulholland
- Department of Nuclear Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Martin Heuschkel
- Department of Nuclear Medicine, University Medical Center Rostock, Rostock, Germany
| | | | - Giuseppe Cardaci
- Department of Nuclear Imaging, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Siroos Mirzaei
- Clinic Ottakring, Institute of Nuclear Medicine with PET Center, Vienna, Austria; and
| | - Mike Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
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Stundys D, Kučinskaitė A, Gervickaitė S, Tarutytė G, Grigaitienė J, Tutkuviene J, Jančorienė L. Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language. Pragmat Obs Res 2024; 15:103-119. [PMID: 39130527 PMCID: PMC11314512 DOI: 10.2147/por.s471307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose Facial basal cell carcinoma (BCC) poses significant challenges due to its potential for local destruction and impact on quality of life (QoL). Continuous research is necessary to identify novel factors influencing the quality of life within this demographic across diverse cultural settings. The aims of this study were to translate, culturally adapt, and validate the Lithuanian version of Skin Cancer Index, subsequently utilizing this questionnaire in the pilot phase of the study to achieve the following: (1) identify the differences in short- and long-term QoL, (2) establish empirical correlations between SCI scores and aesthetic facial regions, evaluate the potential differences between age, gender, and tumor size groups. Patients and Methods A prospective longitudinal study was conducted with 100 consecutive patients. The SCI was translated into Lithuanian language, with a rigorous assessment of its psychometric properties to confirm validity. Alongside hypothesis testing, a detailed analysis of variables was conducted. Statistical techniques, including t-tests and ANOVA, were employed to compare scores across demographic and clinical groups, with effect size calculations for further interpretation. Results Our findings demonstrate that the Lithuanian SCI successfully fulfills the criteria established by the COSMIN checklist. Surgical treatment for facial BCC notably enhances QoL, particularly evident six months post-surgery. Analysis of SCI scores identified demographic and clinical factors associated with lower QoL, including female gender, treatment with skin plasty, and tumor sites in aesthetically sensitive areas like the cheek, nose, and eyelid. Conclusion The Lithuanian version of the SCI is a reliable and valid tool for assessing QoL in facial BCC patients. Our findings underscore the global relevance of understanding the multifactorial influences on QoL in BCC patients. Early diagnosis, less invasive treatment approaches, and tailored post-operative care are crucial in minimizing the psychological, social, and appearance-related burdens of facial BCC.
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Affiliation(s)
- Domantas Stundys
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
| | | | - Simona Gervickaitė
- Vilnius University, Faculty of Medicine, Department of Anatomy, Histology and Anthropology, Vilnius, 03101, Lithuania
| | - Gabrielė Tarutytė
- Vilnius University, Faculty of Medicine, Department of Research and Innovation, Vilnius, 03101, Lithuania
- Vilnius University, Faculty of Mathematics and Informatics, Institute of Applied Mathematics, Vilnius, 03225, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, 08661, Lithuania
| | - Jūratė Grigaitienė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
| | - Janina Tutkuviene
- Vilnius University, Faculty of Medicine, Department of Anatomy, Histology and Anthropology, Vilnius, 03101, Lithuania
| | - Ligita Jančorienė
- Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Vilnius, 03101, Lithuania
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Collins LG, Minto C, Ledger M, Blane S, Hendrie D. Cost-effectiveness analysis and return on investment of SunSmart Western Australia to prevent skin cancer. Health Promot Int 2024; 39:daae091. [PMID: 39110010 PMCID: PMC11333957 DOI: 10.1093/heapro/daae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
Each year, malignant melanoma accounts for 57 000 deaths globally. If current rates continue, there will be an estimated 510 000 new cases annually and 96 000 deaths by 2040. Melanoma and keratinocyte cancers (KCs) incur a large societal burden. Using a mathematical population model, we performed an economic evaluation of the SunSmart program in the state of Western Australia (WA), a primary prevention program to reduce the incidence of skin cancer, versus no program. A societal perspective was taken combining costs to the health system, patients and lost productivity. The model combined data from pragmatic trial evidence of sun protection, epidemiological studies and national cost reports. The main outcomes modelled were societal and government costs, skin cancer counts, melanoma deaths, life years and quality-adjusted life years. Over the next 20 years, the model predicted that implementing the WA SunSmart program would prevent 13 728 KCs, 636 melanomas and 46 melanoma deaths per 100 000 population. Furthermore, 251 life years would be saved, 358 quality-adjusted life years gained and AU$2.95 million in cost savings to society per 100 000 population would be achieved. Key drivers of the model were the rate reduction of benign lesions from sunscreen use, the costs of purchasing sunscreen and the effectiveness of reducing KCs in sunscreen users. The likelihood of WA SunSmart being cost-effective was 90.1%. For the WA Government, the estimated return on investment was $8.70 gained for every $1 invested. Primary prevention of skin cancer is a cost-effective strategy for preventing skin cancers.
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Affiliation(s)
- Louisa G Collins
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, 300 Herston Rd, Herston QLD 4006, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 20 Weightman St, Herston QLD 4006, Australia
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Level 1, 420 Bagot Rd, Subiaco WA 6008, Queensland, Australia
| | - Carolyn Minto
- Cancer Council Western Australia, Perth, Level 1, 420 Bagot Rd, Subiaco WA 6008, Western Australia, Australia
| | - Melissa Ledger
- Cancer Council Western Australia, Perth, Level 1, 420 Bagot Rd, Subiaco WA 6008, Western Australia, Australia
| | - Sally Blane
- Cancer Council Western Australia, Perth, Level 1, 420 Bagot Rd, Subiaco WA 6008, Western Australia, Australia
| | - Delia Hendrie
- Curtin School of Population Health, Curtin University, Perth, Kent St, Bentley WA 6102, Western Australia, Australia
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Sauer C, Ullerich C, Livingstone E, Tagay S, Bugaj TJ, Skoda EM, Teufel M, Schadendorf D, Friederich HC. Psychosocial distress and psychosocial resources in couples facing non-melanoma skin cancers and malignant melanoma. J Psychosoc Oncol 2024:1-16. [PMID: 38959518 DOI: 10.1080/07347332.2024.2371344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND Skin cancer is the most common cancer worldwide and comprises various non-melanoma skin cancer (NMCS) diagnoses and malignant melanoma (MM). It places a psychological burden on patients and their spouses. The present study aims to investigate psychological distress, temporal changes of psychosocial resources (PR), as well as dyadic dynamics of psychological distress and PR in patients with NMSC or MM and their spouses. METHODS Fifty-four heterosexual couples with different skin cancers, diagnosed within the previous 12 months, participated in this quantitative cross-sectional study. Patients and spouses provided information about depression and anxiety (Hospital Anxiety and Depression Scale), PR within the last four weeks and last three years (Essen Resource Inventory), and partnership quality (Partnership Questionnaire, short version). Dyadic dynamics were analyzed with multiple regression analyses. RESULTS We found similar distress levels in patients and spouses, as well as in patients with different skin cancers. Spouses from patients with MM reported significant higher distress levels than spouses from patient with NMSC. Patients' depression predicted spouses' depression, and spouses' anxiety predicted patients' anxiety. In patients, we found associations between personal resources (within the last four weeks and three years) and depression, and an association between patients' social resources (within the last three years) and spouses' depression. CONCLUSIONS The psychological interdependencies between patients' and spouses' depression and anxiety highlight the importance of considering psychological distress in patients with different skin cancers from a dyadic perspective in clinical contexts. Further, personal resources were indicated as a "distress buffer" for patients' mental health. Our results underline the importance of couple interventions that activate PR in patients with cancer and their spouses.
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Affiliation(s)
- Christina Sauer
- Clinic of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Cathrin Ullerich
- Clinic of Psychosomatic Medicine and Psychotherapy, Berlin-Bernau, Germany
| | | | - Sefik Tagay
- Institute for Gender Studies, University of Technology, Arts and Sciences Köln, Köln, Germany
| | - Till J Bugaj
- Clinic of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Eva-Maria Skoda
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases-West (NCT-West), Campus Essen, Essen, Germany
| | - Martin Teufel
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner Site Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
- Comprehensive Cancer Center (CCC), University Hospital Essen, Essen, Germany
- National Center for Tumor Diseases-West (NCT-West), Campus Essen, Essen, Germany
- German Cancer Consortium, Partner Site Essen, Essen, Germany
- University Alliance Ruhr, Research Center One Health, University Duisburg-Essen, Essen, Germany
| | - Hans-Christoph Friederich
- Clinic of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Brorsen LF, McKenzie JS, Tullin MF, Bendtsen KMS, Pinto FE, Jensen HE, Haedersdal M, Takats Z, Janfelt C, Lerche CM. Cutaneous squamous cell carcinoma characterized by MALDI mass spectrometry imaging in combination with machine learning. Sci Rep 2024; 14:11091. [PMID: 38750270 PMCID: PMC11096391 DOI: 10.1038/s41598-024-62023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
Cutaneous squamous cell carcinoma (SCC) is an increasingly prevalent global health concern. Current diagnostic and surgical methods are reliable, but they require considerable resources and do not provide metabolomic insight. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) enables detailed, spatially resolved metabolomic analysis of tissue samples. Integrated with machine learning, MALDI-MSI could yield detailed information pertaining to the metabolic alterations characteristic for SCC. These insights have the potential to enhance SCC diagnosis and therapy, improving patient outcomes while tackling the growing disease burden. This study employs MALDI-MSI data, labelled according to histology, to train a supervised machine learning model (logistic regression) for the recognition and delineation of SCC. The model, based on data acquired from discrete tumor sections (n = 25) from a mouse model of SCC, achieved a predictive accuracy of 92.3% during cross-validation on the labelled data. A pathologist unacquainted with the dataset and tasked with evaluating the predictive power of the model in the unlabelled regions, agreed with the model prediction for over 99% of the tissue areas. These findings highlight the potential value of integrating MALDI-MSI with machine learning to characterize and delineate SCC, suggesting a promising direction for the advancement of mass spectrometry techniques in the clinical diagnosis of SCC and related keratinocyte carcinomas.
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Affiliation(s)
- Lauritz F Brorsen
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 9, 2400, Copenhagen, Denmark.
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.
| | - James S McKenzie
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK
| | - Mette F Tullin
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Katja M S Bendtsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fernanda E Pinto
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 9, 2400, Copenhagen, Denmark
| | - Henrik E Jensen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 9, 2400, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Zoltan Takats
- Department of Digestion, Metabolism and Reproduction, Imperial College London, London, UK
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 9, 2400, Copenhagen, Denmark
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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Marsidi N, Ottevanger R, Demir YE, van Beugen S, Goeman JJ, Genders RE. Patient-reported outcome measurements in facial skin surgery and a comparison between Mohs micrographic surgery and conventional excisions. J Eur Acad Dermatol Venereol 2024. [PMID: 38644735 DOI: 10.1111/jdv.20025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Knowledge of the psychosocial impact of facial skin surgery on patients can help improve counselling strategies. OBJECTIVES The objective was to measure the psychological impact of facial skin cancer surgery on patients over a 1-year period. Secondary objective was to measure the difference between Mohs micrographic surgery (MMS) and conventional excision (CE) on these parameters. METHODS This observational survey study was conducted between March 2019 and July 2020. Patients who had facial skin surgery using MMS or CE were selected. Five surveys were conducted on four timepoints (preoperative, 1 week, 3 months and 1 year post-operative) measuring the quality of life, perceived stigmatization, body image, satisfaction with facial appearance and psychosocial distress. RESULTS A total of 228 patients (MMS 154 patients, CE 74 patients) were included for the analysis. Scores for quality of life did not significantly change, in the year after surgery (PCS-12 mean 50.5, SD 9.3 and MCS-12 50.6, SD 9.4); however, stigmatization (F (3, 235,39) 7,26, p < 0.01, d = -0.07), body image concerns (F (3, 198,28) = 3.75, p < 0.01, d = -0.14), satisfaction with facial appearance (F (3, 205,18) = 10.74, p < 0.01, d = 0.43) and psychosocial distress (F (3, 208,69) = 9.26, p < 0.01, d = -0.15) did change over time. The use of MMS or CE did not significantly affect outcome scores after 1 year. CONCLUSION Patients receiving facial skin cancer surgery exhibited low scores for perceived stigmatization and body image concerns. Their quality of life was not statistically influenced by facial surgery, and their satisfaction with their facial appearance and psychosocial distress even improved after 1 year. The results suggest that the surgical treatment type (MMS or CE) does not influence the outcome. The overall results can help in counselling strategies to improve expectations for patients receiving facial surgery.
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Affiliation(s)
- N Marsidi
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y E Demir
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S van Beugen
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Roosevelt Kliniek, Leiden, The Netherlands
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de Andrade ACDV, Coqueiro RDS, Pithon MM, Leite MF. Peeling with retinoic acid in microemulsion for treatment of melasma: A double-blind randomized controlled clinical study. J Cosmet Dermatol 2024; 23:479-485. [PMID: 37782679 DOI: 10.1111/jocd.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy of peeling with a microemulsion formulation containing 1% retinoic acid. MATERIALS AND METHODS After development of the product, 60 patients with melasma were randomly divided into three groups (n = 20): Group 1-application of conventional 1% retinoic acid peeling (RA 1%). Group 2-application of 1% retinoic acid peeling in microemulsion (RA 1%M). Group 3-Application of placebo. The groups were submitted to four peeling sessions, fortnightly on Days 0, 15, 30, and 45, and analyzed at the time intervals of 0, 15, 30, 45, and 60 days. Evaluation was made by using the Melasma Area and Severity Index (MASI) and Melasma Quality of Life (MelasquoL) instrument. Hemato-biochemical parameters were also evaluated at Days 0 and 60. After obtaining the results, normality was evaluated by means of the Kolmogorov-Smirnov test and afterwards, the following tests were applied: Friedman statistical (to test the effect of the treatments on the MASI index); Wilcoxon, (for comparison between pairs to test the effect of treatments on the MelasQoL index); Kruskal-Wallis, (to test the differences between the groups); and Mann-Whitney, (comparisons between treatments). The level of significance adopted was 5% (α = 0.05). RESULTS The three groups presented a significant reduction in the MASI index, indicating the effect of all the treatments on reducing the melasma (p < 0.001). A significant reduction in the stains was observed with the use of retinoic acid peeling delivered in microemulsion (62%) when compared with the conventional peeling with 1% retinoic acid in a conventional vehicle (26%) and the placebo (12%). There was also a significant reduction in the MelasQoL index (sum of all the aspects) in the three groups, indicating the effect of all the treatments, including the placebo, on the overall quality of life of those with melasma. However, RA 1%M the treatment that promoted the greatest effect on the quality of life of individuals. In percentage terms, the RA 1%M provided a mean reduction of 30% in the MelasQoL index, against 13% of the conventional treatment and only 4% of the placebo. When the hemato-biochemical parameters were compared on Days 0 and 60, there were no significant changes in the results. CONCLUSION The chemical peeling performed with RA 1%M was effective for the treatment of melasma, and was shown to be superior to the peeling performed with retinoic acid in a conventional vehicle, in reducing the stains and improving the quality of life of patients.
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Affiliation(s)
- Ana Carolina Dias Viana de Andrade
- Southwest Bahia State University - UESB, Jequié, Bahia, Brazil
- Biosciences, Federal University of Bahia-UFBA, Vitória da Conquista, Bahia, Brazil
| | - Raildo da Silva Coqueiro
- Center for Studies in Aging Epidemiology, Southwest Bahia State University, Jequié, Bahia, Brazil
| | - Matheus Melo Pithon
- Southwest Bahia State University - UESB, Jequié, Bahia, Brazil
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro-UFRJ, Rio de Janeiro, Rio de Janeiro, Brazil
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Hora EC, Lima MS, Siqueira HFF, Marques AD, de Abreu Costa Brito É, Lessa AL, Lima CA. Cross-cultural adaptation of the Skin Cancer Index into Brazilian Portuguese for patients with cervicofacial nonmelanoma skin cancer. Support Care Cancer 2023; 31:590. [PMID: 37740741 PMCID: PMC10517893 DOI: 10.1007/s00520-023-08051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE This study aimed to translate the Skin Cancer Index (SCI) into Portuguese, adapt it for Brazilian culture, and clinically validate it. METHODS A five-stage cross-cultural adaptation model was followed, with subsequent clinical validation. Inter-rater agreement was assessed using the content validity index (CVI). The hypothesis of the non-inferiority of the CVI at 80% probability level was evaluated using an exact binomial test. We used Spearman's rank-order and Pearson's product-moment correlation analysis, internal consistency using McDonald's ω and Cronbach's α metric, and construct validity using confirmatory factor analysis. The factorial model was validated using the chi-squared test, root mean square error of approximation (RMSEA), comparative fit index (CFI), and standardized root mean square residual (SRMR). RESULTS The first stage yielded two independent translations. After synthesis, back-translation, and review, the prefinal version was tested on 40 patients. Inter-rater agreement indices on content validity were significantly higher than 80% (p < 0.05). The SCI remained stable, and the Spearman's rank-order (rs), Pearson product-moment (r), and intraclass correlation coefficients were > 0.9, indicating excellent reliability. The reliability of McDonald's ω was considered ideal (> 0.8) in all subdimensions and scale. Cronbach's α was considered ideal in the "Emotional" and "Social" subdimensions and scale. Construct validity was observed in all subdimensions and scale through the criteria (χ2) p value > 0.05, RMSEA < 0.08, CFI ≥ 0.9, and SRMR ≤ 0.08. CONCLUSION The cross-cultural adaptation of the SCI to Portuguese for Brazilian culture showed content validity and reliability, contributing to quality of life assessment in patients with NMSC.
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Affiliation(s)
- Evânia Curvelo Hora
- Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil.
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil.
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil.
| | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Hianga Fayssa Fernandes Siqueira
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe (Lagarto Campus), Lagarto, Sergipe, Brazil
| | - Adriane Dórea Marques
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Ministry of Health (Ministério da Saúde-MS), Aracaju, Sergipe, Brazil
| | - Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Arthur Leite Lessa
- School of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Carlos Anselmo Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- State Department of Health (Secretaria de Estado da Saúde), Aracaju, Sergipe, Brazil
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Chicco M, Borsky K, Goodall R, Harrison C, Rodrigues J. Outcomes of skin cancer excision in frail patients: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2023; 84:32-36. [PMID: 37320949 DOI: 10.1016/j.bjps.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) is the most common cancer type and incidence increases with age. As a consequence, an increasing number of frail patients are being referred for consideration of skin cancer surgery. However, some of these patients may not live long enough to experience benefit from surgery, while being at risk of postoperative complications. OBJECTIVES To investigate the treatment burden of surgical excision of skin cancers in frail individuals. METHODS We conducted a single-center retrospective cohort study analyzing outcomes of skin cancer excision in frail versus non-frail patients. RESULTS Eighty-eight patients were included. The complication rate was higher in frail versus non-frail patients: 12 (27.9%) versus 9 (18.8%), with 5 unplanned postoperative hospital attendances leading to 3 hospital admissions in the frail cohort. Nine patients in the frail group (21%) died within 6 months of their procedure versus no deaths in the non-frail group (p < 0.001 Fisher's Exact test), with no deaths attributed to skin cancer. CONCLUSION Treatment-related complications and mortality are common in frail patients after surgical excision of skin lesions clinically suspicious for skin cancer. Careful consideration should be given, and patients should be adequately counseled about treatment risks and alternative management options, including active surveillance, in particular, if the lesions are expected to remain asymptomatic.
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Affiliation(s)
- M Chicco
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK.
| | - K Borsky
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - R Goodall
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - C Harrison
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - J Rodrigues
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Warwick Clinical Trials Unit, University of Warwick, UK
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10
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The Quality of Life in Surgically Treated Head and Neck Basal Cell Carcinoma Patients: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15030801. [PMID: 36765759 PMCID: PMC9913595 DOI: 10.3390/cancers15030801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
In this review, we examine current literature analyzing the impact of surgical treatment on the QoL in patients with head and neck BCC. A comprehensive literature review was performed using the main databases. As many as six out of 322 articles were selected for the final analysis. The selected articles were published in the period between 2004 and 2021, most published within the last two years. All analyzed studies were prospective. Five out of six studies evaluated NMSC consisting of both BCC and SCC, and only one study selectively evaluated the impact of surgical treatment on QoL in patients with craniofacial BCC. Authors of the selected studies reported that QoL improves following the surgery; however, the effect on QoL varies. Patients' age, gender, marital status, education level, and employment status had a stronger correlation with QoL postoperatively, especially during the late follow-up period. Younger patients were more bothered by appearance-related issues. One study concluded that elderly patients did not experience a statistically significant improvement in QoL. This literature review demonstrated that there is no clear consensus on the use of a single disease-specific QoL measurement tool. Furthermore, there is a lack of studies assessing the impact of surgical treatment on QoL exclusively in patients with head and neck BCC and studies analyzing the multivariate correlation between QoL and tumor type, size, anatomic site, and treatment outcomes.
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11
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Samela T, Raimondi G, Sampogna F, Ricci F, Fania L, Mastroeni S, Fusari R, Salcedo NM, Dattolo A, Papanikolaou ES, Abeni D. Testing some psychometric properties of the Italian version of the Skin Cancer Index: A questionnaire for measuring quality of life in patients with non-melanoma skin cancer. Front Psychol 2022; 13:991080. [PMID: 36483696 PMCID: PMC9723148 DOI: 10.3389/fpsyg.2022.991080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/28/2022] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVES Non-melanoma skin cancers (NMSC) include two main types: basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Generic Health-Related Quality of Life (HRQoL) instruments revealed little to no HRQoL impairment in NMSC patients. Instead, the use of specific skin disease HRQoL tools contradicted those observations. For example, the Skin Cancer Index (SCI) was suggested as a validated instrument for the evaluation of the impact of skin cancers on HRQoL, and has already been validated in several languages, but not in Italian. The aim of this study is to testing some psychometric properties of the Italian version of the SCI questionnaire in a large sample of NMSC patients. METHODS This is a cross-sectional, single-center, observational study. Firstly, different factor models proposed in the literature were compared and the model with the best fit was identified. Secondly, the psychometric properties of the SCI, convergent validity and reliability, were evaluated. RESULTS The sample was composed of 371 NMSC patients. The factor analysis revealed that a revised version of the original model had the best fit [χ2(df = 85) = 354.53, p < 0.001, RMSEA = 0.09, CFI = 0.98, TLI = 0.97, SRMR = 0.03]. The SCI had satisfactory internal consistency for all subscales (Emotional subscale: ordinal alpha = 0.95; Social subscale: ordinal alpha = 0.94; Appearance subscale: ordinal alpha = 0.94). The convergent validity with Skindex-17 psychosocial subscale was adequate for all the SCI subscales (Emotional Subscale: rho = -0.50; Social Subscale: rho = -0.54; Appearance subscale: rho = -0.44; Total Skin Cancer Index: rho = -0.56; and p < 0.001). CONCLUSION The tested psychometric properties of the Italian version of the SCI may suggest that it is an appropriate tool to measure the HRQoL in NMSC patients, however, further studies are needed in order to confirm and tested other psychometric features of this tool.
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Affiliation(s)
- Tonia Samela
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
- Clinical Psychology Unit, IDI-IRCCS, Rome, Italy
| | - Giulia Raimondi
- Department of Human Science, European University of Rome, Rome, Italy
| | | | | | - Luca Fania
- Dermatology Unit, IDI-IRCSS, Rome, Italy
| | | | | | | | - Anna Dattolo
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
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12
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Long J, Rajabi-Estarabadi A, Levin A, Nami N, Nouri K. Perioperative Anxiety Associated With Mohs Micrographic Surgery: A Survey-Based Study. Dermatol Surg 2022; 48:711-715. [PMID: 35438652 DOI: 10.1097/dss.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS)-associated anxiety is an important issue that remains poorly discussed. Identifying risk factors for MMS-associated anxiety will better equip physicians to manage patients' preoperative anxiety and result in improved patient satisfaction and outcomes. OBJECTIVE This study aims in identification of risk factors that may play a role in MMS-associated anxiety among patients with nonmelanoma skin cancer. METHODS A cross-sectional case series was conducted among MMS patients collect information on patient demographics and surgical locations and to measure perioperative anxiety and quality of life (QoL). In addition, adjusted linear and logistic regression analyses were performed to identify potential risk factors that predict MMS-associated anxiety. RESULTS Significant increases in perioperative anxiety were associated with the eyelid area compared with the noneyelid facial area and nonfacial area ( p ≤ .05). Patients with graduate degrees exhibited less anxiety compared with ones who received less education ( p ≤ .05). Higher perioperative anxiety was associated with a greater impact on QoL ( p ≤ .05). CONCLUSION This study identified that surgical location and the patient's educational level are 2 critical predicting factors for perioperative anxiety. Furthermore, perioperative anxiety could negatively affect a patient's quality of life and warrants further investigation into effective management.
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Affiliation(s)
- Jun Long
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Rajabi-Estarabadi
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Department of Dermatology, Broward Health, Fort Lauderdale, Florida; and
| | - Adam Levin
- Island Dermatology, Newport Beach, California
| | - Navid Nami
- Island Dermatology, Newport Beach, California
| | - Keyvan Nouri
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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13
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Al Rahmoun M, Ghiasvand R, Cairat M, Mahamat-Saleh Y, Cervenka I, Severi G, Boutron-Ruault MC, Robsahm TE, Kvaskoff M, Fournier A. Statin Use and Skin Cancer Risk: A Prospective Cohort Study. J Invest Dermatol 2022; 142:1318-1325.e5. [PMID: 34695411 DOI: 10.1016/j.jid.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
Epidemiological studies on statin use in relation to skin cancer risk are scarce and yielded conflicting results. We explored this association in Etude Epidémiologique auprès de femmes de l'Education Nationale, a prospective cohort of French women born in 1925-1950. Health and lifestyle data were self-reported biennially and matched with drug reimbursement data, allowing the identification of participants' statin use since 2004. Multivariable cause-specific hazards regression models adjusted for skin cancer risk factors estimated hazard ratios with 95% confidence intervals. Over 2004-2014, 455 cutaneous melanoma, 1,741 basal cell carcinoma, and 268 squamous cell carcinoma cases were ascertained among 62,473 women. Compared with never use, there were no associations between ever use of statins and melanoma (hazard ratio = 1.16, 95% confidence interval = 0.94-1.44) or squamous cell carcinoma (hazard ratio = 0.89, 95% confidence interval = 0.66-1.19) risks and a decrease in basal cell carcinoma risk with ever use of statins (hazard ratio = 0.89, 95% confidence interval = 0.79-0.996). We found no trend of increasing or decreasing risks with dose, duration of use, time since first use, or age at first use and no statistically significant effect modification by pigmentary traits or residential UVR exposure. Because of the limited number of studies evaluating the associations between the use of statins and the risks of melanoma, basal cell carcinoma, and squamous cell carcinoma, these findings would deserve further investigation in other settings.
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Affiliation(s)
- Marie Al Rahmoun
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France
| | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Manon Cairat
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Yahya Mahamat-Saleh
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France
| | - Iris Cervenka
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Italy
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France
| | - Trude Eid Robsahm
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Marina Kvaskoff
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, F-94805, Villejuif, France.
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14
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Pinto M, Marotta N, Caracò C, Simeone E, Ammendolia A, de Sire A. Quality of Life Predictors in Patients With Melanoma: A Machine Learning Approach. Front Oncol 2022; 12:843611. [PMID: 35402230 PMCID: PMC8990304 DOI: 10.3389/fonc.2022.843611] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Health related quality of life (HRQoL) is an important recognized health outcome for cancer treatments, but also disease course with slower recovery and increased morbidity. These issues are of implication in melanoma, which maintains a risk of disease progression for many years after diagnosis. This study aimed to explore and weigh factors in the perception of the quality of life and possible relationships with demographic–clinical characteristics in people with melanoma via a machine learning approach. In this observational study, patients with melanoma, without metastatic disease, were recruited from January 2020 to December 2021 with a follow-up of at least one year. Demographic variables and clinics were collected, and the 12-Item Short-Form Health Survey (SF-12) was adopted as the physical and mental aspects of the Health-Related Quality of Life (HRQoL) measure. All the variables were processed in a random forest model to weigh at each node of each tree of this machine learning regression model, their actual weight in SF-12 score. We included 203 melanoma patients, mean aged 59.25 ± 15.1 years: 56 (27%) affecting the upper limbs and 147 (73%) affecting the trunk. The model of 142 patients with no missing value, generating 92 trees (MSE = 0.45, R2 of 0.78), reported that the lesion site was the most influencing variable on HRQoL based on the decrease in Gini impurity in variable weighing at each node intersection in forest generation. In this scenario, we built two distinct models for lesion sites and demonstrated that the variable that most influenced the quality of life in upper limb melanoma was lymphedema, while BMI was in the trunk. Given these results, random forest regressions could play a crucial role in the clinical and rehabilitation approach. The machine-learning model for detecting the HRQoL predictor in melanoma patients indicates that the experienced lymphedema and BMI may influence the HRQoL perception. This study suggests that the prevention and treatment of lymphedema and bodyweight reduction might improve the quality of life in melanoma.
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Affiliation(s)
- Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancer Surgery Unit, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Ester Simeone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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15
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Gordon LG, Leung W, Johns R, McNoe B, Lindsay D, Merollini KMD, Elliott TM, Neale RE, Olsen CM, Pandeya N, Whiteman DC. Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3178. [PMID: 35328865 PMCID: PMC8948716 DOI: 10.3390/ijerph19063178] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023]
Abstract
Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision-analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.
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Affiliation(s)
- Louisa G. Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Cancer and Palliative Care Outcomes Centre and School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - William Leung
- Wellington School of Medicine, University of Otago, Wellington 6242, New Zealand;
| | - Richard Johns
- Kenmore Skin Clinic, Moggill Rd, Brisbane, QLD 4069, Australia;
| | - Bronwen McNoe
- Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin 9016, New Zealand;
| | - Daniel Lindsay
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Katharina M. D. Merollini
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia;
- Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia
| | - Thomas M. Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
| | - Rachel E. Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Catherine M. Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - Nirmala Pandeya
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
| | - David C. Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.M.E.); (R.E.N.); (C.M.O.); (N.P.); (D.C.W.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia;
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16
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García-Montero P, de Gálvez-Aranda MV, Blázquez-Sánchez N, Rivas-Ruíz F, Millán-Cayetano JF, García-Harana C, de Troya Martín M. Quality of Life During Treatment for Cervicofacial Non-melanoma Skin Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:196-202. [PMID: 32500453 DOI: 10.1007/s13187-020-01781-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1 week, 1 month and 6 months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up.
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Affiliation(s)
- Pablo García-Montero
- Dermatology Department, Hospital Costa del Sol, Autovía A7-Km 187, Marbella, Málaga, Spain.
- University of Malaga, Malaga, Spain.
| | | | - Nuria Blázquez-Sánchez
- Dermatology Department, Hospital Costa del Sol, Autovía A7-Km 187, Marbella, Málaga, Spain
| | - Francisco Rivas-Ruíz
- Research Unit, Hospital Costa del Sol, Marbella, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | | | - Cristina García-Harana
- Dermatology Department, Hospital Costa del Sol, Autovía A7-Km 187, Marbella, Málaga, Spain
- University of Malaga, Malaga, Spain
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17
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So C, Cust AE, Gordon LG, Morton RL, Canfell K, Ngo P, Dieng M, McLoughlin K, Watts C. Health utilities for non-melanoma skin cancers and pre-cancerous lesions: A systematic review. SKIN HEALTH AND DISEASE 2021; 1:e51. [PMID: 35663144 PMCID: PMC9060093 DOI: 10.1002/ski2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Non-melanoma skin cancers (NMSCs) are common and consume many healthcare resources. A health utility is a single preference-based value for assessing health-related quality of life, which can be used in economic evaluations. There are scarce data on health utilities for NMSCs. OBJECTIVES Using a systematic review approach, we synthesized the current data on NMSC-related health utilities. METHODS A systematic review of studies of NMSC-related health utilities was conducted in Medline, Embase, and Cochrane databases. Data were extracted based on the protocol and a quality assessment was performed for each study. RESULTS The protocol resulted in 16 studies, involving 121 621 participants. Mean utility values across the studies ranged from 0.56 to 1 for undifferentiated NMSC, 0.84 to 1 for actinic keratosis, 0.45 to 1 for squamous cell carcinoma, and 0.67 to 1 for basal cell carcinoma. There was considerable variability in utilities by type of cancer, stage of diagnosis, time to treatment, treatment modality, and quality of life instrument or method. Utility values were predominantly based on the EuroQol 5-dimension instrument and ranged from 0.45 to 0.96, while other measurement methods produced values ranging from 0.67 to 1. Lower utility values were observed for advanced cancers and for the time period during and immediately after treatment, after which values gradually returned to pre-treatment levels. CONCLUSIONS Most utility values clustered around relatively high values of 0.8 to 1, suggesting small decrements in quality of life associated with most NMSCs and their precursors. Variability in utilities indicates that careful characterization is required for measures to be used in economic evaluations.
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Affiliation(s)
- C. So
- Sydney School of Public HealthFaculty of Medicine and Health, The University of SydneySydneyAustralia
| | - A. E. Cust
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
| | - L. G. Gordon
- Population Health DepartmentQIMR Berghofer Medical Research Institute, Royal Brisbane HospitalBrisbaneAustralia
- School of NursingQueensland University of Technology (QUT)BrisbaneAustralia
- School of MedicineThe University of QueenslandBrisbaneAustralia
| | - R. L. Morton
- Faculty of Medicine and HealthNHMRC Clinical Trials Centre, The University of SydneySydneyAustralia
| | - K. Canfell
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyAustralia
| | - P. Ngo
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyAustralia
| | - M. Dieng
- Faculty of Medicine and HealthNHMRC Clinical Trials Centre, The University of SydneySydneyAustralia
| | - K. McLoughlin
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyAustralia
| | - C. Watts
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyAustralia
- Kirby InstituteThe University of New South WalesSydneyAustralia
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18
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Lyons S, Lorigan P, Green AC, Ferguson A, Epton T. Reasons for indoor tanning use and the acceptability of alternatives: A qualitative study. Soc Sci Med 2021; 286:114331. [PMID: 34438184 DOI: 10.1016/j.socscimed.2021.114331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 07/26/2021] [Accepted: 08/19/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE Using indoor tanning devices is associated with substantial health consequences, such as an increased risk of melanoma and other skin cancers. Many people including minors and some at high risk of skin cancer continue to use these devices. In the absence of effective restrictions on use, it is important that behaviour change interventions are designed to reduce indoor tanning. OBJECTIVE To explore reasons for use of indoor tanning devices and the acceptability of alternatives in adult users residing in North-West England. METHODS Participants were required to be current indoor tanners aged 18 years and above and were recruited online. Twenty-one participants took part in either a focus group or semi-structured interview. An inductive thematic analysis was conducted. RESULTS Six themes were identified: psychological benefits; improving physical health; denial of health risks; alternatives do not meet psychological needs; alternatives do not meet physical needs; and perceived side-effects. Participants used indoor tanning devices to improve their self-esteem and to prevent sun damage to their skin (by gaining a 'base tan'). Participants appeared to justify their usage by responding defensively to avoid accepting they were at risk, exaggerating the benefits of indoor tanning, and discounting alternatives to indoor tanning. Alternatives to indoor tanning were perceived as risky for health, inadequate to provide the desired aesthetic, and incapable of meeting their self-esteem needs. CONCLUSIONS Interventions to reduce indoor tanning behaviour should increase sources of self-esteem other than appearance, increase media literacy and address defensive responses to information around indoor tanning and alternatives. Further research is needed to develop these interventions and assess their feasibility.
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Affiliation(s)
- Stephanie Lyons
- Manchester Centre for Health Psychology, The University of Manchester, Oxford Road, M13 9PL, UK
| | - Paul Lorigan
- Division of Cancer Sciences, The University of Manchester, UK; Christie NHS Foundation Trust, Manchester, UK
| | - Adele C Green
- Cancer Research UK Manchester Institute, The University of Manchester, UK; QIMR Berghofer Medical Research Institute, Australia
| | - Ashley Ferguson
- Cancer Research UK Manchester Institute, The University of Manchester, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, The University of Manchester, Oxford Road, M13 9PL, UK.
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El Abbadi S, Susok L, Stockfleth E, Bechara FG, Gambichler T, Herbrandt S, Goldschmidtböing L, Sand M. Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma. Dermatol Ther (Heidelb) 2021; 11:929-940. [PMID: 33847880 PMCID: PMC8163937 DOI: 10.1007/s13555-021-00522-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/26/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Few studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure. Methods A total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure (“Hautkrebs”). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment. Results Ninety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05). Conclusion Impaired health-related quality of life is correlated with a patient with skin cancer’s age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.
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Affiliation(s)
- Sam El Abbadi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital OWL, Campus Klinikum Bielefeld Center, Bielefeld, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Egger Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk Georges Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Swetlana Herbrandt
- Department for Statistical Consulting and Analysis, Center for Higher Education, Technical University of Dortmund, Dortmund, Germany
| | - Lisa Goldschmidtböing
- Department for Statistical Consulting and Analysis, Center for Higher Education, Technical University of Dortmund, Dortmund, Germany
| | - Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany. .,Department of Plastic, Reconstructive and Aesthetic Surgery, St. Josef Hospital, Essen, Germany.
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20
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Factors related to the evolution of quality of life in patients with cervicofacial non-melanoma skin cancer. Support Care Cancer 2021; 29:5187-5195. [PMID: 33629186 DOI: 10.1007/s00520-021-06087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution. METHODS This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received. RESULTS A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up. CONCLUSIONS The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic).
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Abstract
BACKGROUND The increasing burden from basal cell carcinoma (BCC) has stimulated the development of alternative treatments for these tumors. OBJECTIVE This review focuses on upcoming laser treatments for BCC and highlights the limitations of these therapies. METHODS A PUBMED search was conducted for articles on laser therapy of BCC. Key studies involving lasers to treat BCC were reviewed. Novel approaches to BCC are also described. RESULTS Vascular-specific laser therapy has increasingly been studied as an addition in the therapeutic armamentarium of BCC. Although these studies demonstrate efficacy for nonaggressive BCC, optimization of this technique is ongoing to minimize scarring. A more targeted approach to the treatment of BCC, such as immunized photothermal therapy or laser-assisted chemotherapeutic delivery, may result in less scarring, while maintaining efficacy similar to that of lasers targeting tumor vasculature. CONCLUSION Vascular-specific laser therapies show promise in treating low-risk BCC; however, scarring is not an uncommon adverse event. Although only animal studies have been performed to date, laser-activated gold nanoparticle therapy and laser-assisted drug delivery of vismodegib are potential therapies that theoretically confer a more selective approach. Laser modalities demonstrate promise in the treatment of nonaggressive BCC, although long-term studies have yet to be published.
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22
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High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities. Adv Radiat Oncol 2020; 6:100616. [PMID: 33912732 PMCID: PMC8071728 DOI: 10.1016/j.adro.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face. Methods and Materials Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos were reviewed at multiple time points: start of treatment, end of treatment, short-term (2 week) follow-up, 3-month follow-up, and if needed at 6 months. Radiation toxicity was graded using the Radiation Therapy Oncology Grading (RTOG) acute toxicity scale. Median (range) toxicity grades at follow-up intervals were calculated. Clinical outcomes including local recurrence were evaluated for all patients. Results The study included 19 patients and 20 KCs. The median radiation dose was 42 Gy (39-42 Gy) over 6 fractions. The median toxicity at completion of treatment was RTOG grade 2 (85% of patients). At short-term follow-up, 50% of patients (n = 10) improved to RTOG grade 1 (0-2). At 3 months, 70% of patients (n = 14) had RTOG grade 0, and by 6 months, 100% of patients (n = 18) had RTOG grade 0. No RTOG grade 3 or higher skin toxicity was observed. With a median follow-up of 7.2 months (range, 1.3-54.4 months), the local recurrence-free survival was 95%. Conclusions We demonstrate that HDR-BT can be used as definitive treatment of KCs of the face with excellent cosmetic outcomes and local control. Acute and subacute skin toxicities were most commonly RTOG grade 2 or less with resolution of patient's skin toxicity by 3 months.
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23
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Piipponen M, Nissinen L, Kähäri VM. Long non-coding RNAs in cutaneous biology and keratinocyte carcinomas. Cell Mol Life Sci 2020; 77:4601-4614. [PMID: 32462404 PMCID: PMC7599158 DOI: 10.1007/s00018-020-03554-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/29/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
Long non-coding RNAs (lncRNAs) are a largely uncharacterized group of non-coding RNAs with diverse regulatory roles in various biological processes. Recent observations have elucidated the functional roles of lncRNAs in cutaneous biology, e.g. in proliferation and differentiation of epidermal keratinocytes and in cutaneous wound repair. Furthermore, the role of lncRNAs in keratinocyte-derived skin cancers is emerging, especially in cutaneous squamous cell carcinoma (cSCC), which presents a significant burden to health care services worldwide and causes high mortality as metastatic disease. Elucidation of the functions of keratinocyte-specific lncRNAs will improve understanding of the molecular pathogenesis of epidermal disorders and skin cancers and can be exploited in development of new diagnostic and therapeutic applications for keratinocyte carcinomas. In this review, we summarize the current evidence of functionally important lncRNAs in cutaneous biology and in keratinocyte carcinomas.
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Affiliation(s)
- Minna Piipponen
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland
| | - Liisa Nissinen
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Hämeentie 11 TE6, 20520, Turku, Finland.
- Cancer Research Laboratory, Western Cancer Centre of the Cancer Center Finland (FICAN West), University of Turku and Turku University Hospital, Turku, Finland.
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24
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Kant SB, Mosterd K, Kelleners-Smeets NWJ, Van der Hulst RRWJ, Piatkowski A. Measuring aesthetic results after facial skin cancer surgery by means of the FACE-Q. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01625-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Skin cancer is the most commonly occurring type of cancer. However, the influence of facial skin cancer surgery on patients’ perceived aesthetic appearance is poorly understood. The objective of this study was to provide an insight into how patients perceive the aesthetic outcome of facial skin cancer surgery by means of a specialised patient-reported outcome measure designed for the aesthetic evaluation of the face: the FACE-Q.
Methods
A total of 47 patients with non-melanoma skin cancer who were scheduled for Mohs’s micrographic surgery (MMS) or standard surgical excision (SE) were included. These patients filled out three different FACE-Q questionnaires: satisfaction with facial appearance, social function, and satisfaction with outcome. Follow-up was conducted after baseline at 1 month and 3 months post-surgery.
Results
No significant differences were detected between baseline and follow-up regarding social function and satisfaction with facial appearance. However, after 3 months, patients were significantly more satisfied with the result of surgery when compared with the 1-month post-surgery follow-up.
Conclusions
The perceived aesthetic appreciation of patients does not seem to be significantly influenced by facial skin cancer SE or MMS surgery in this 3-month follow-up study.
Level of evidence: Not ratable.
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Metastatic Basal Cell Carcinoma of the Skin: A Comprehensive Literature Review, Including Advances in Molecular Therapeutics. Adv Anat Pathol 2020; 27:331-353. [PMID: 32618586 DOI: 10.1097/pap.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Basal cell carcinoma (BCC) of the skin is the most common type of malignant human tumor. In Europe, the incidence of BCC ranges from 44.6 to 128 cases per 100,000 inhabitants annually, whereas in the United States, the yearly incidence rate ranges between 500 and 1500. The global incidence has been calculated to be as high as 10 million cases of BCC per year. There are 2 main clinical patterns of BCC-the familial BCC in basal cell nevus syndrome and sporadic BCC. The etiology of cutaneous BCC is usually the result of the interaction between solar ultraviolet radiation and genetic factors. Somatic or germline mutations in the effector components of the hedgehog signaling pathway (ie, PTCH1, PTCH2, SMO or SUFU genes) are responsible for ∼90% of the cases of both sporadic and familial BCC, all causing a constitutive activation of the hedgehog pathway. Cutaneous BCC very rarely metastasizes, and diagnosis in metastatic sites can be very difficult. Metastatic BCC has weakly effective therapeutic options with a poor prognosis until few years ago. In 2012, small-molecule therapies, involving inactivation of the hedgehog signaling pathway, and capable of reducing tumor growth and progression have been introduced into clinical practice for advanced (locally advanced or metastatic) BCC. We performed a comprehensive literature review on metastatic BCC and found at least 915 cases reported to date. In addition, we extensively discussed the differential diagnosis of metastatic BCC, and outlined the advances in clinical therapeutics involving these small molecules.
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26
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Butner-Kozimor LM, Savla J. Couples Facing Skin Cancer in Old Age: A Dyadic Investigation of Partner Support and Quality of Life. Int J Aging Hum Dev 2020; 93:746-766. [PMID: 32715770 DOI: 10.1177/0091415020940193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated perceived support received by partners and its association with quality of life (QOL) in older couples facing skin cancer. Thirty couples (n = 60; M Age = 70) in which one partner had a skin cancer diagnosis (PwSC) completed either online or paper surveys about their skin cancer diagnosis, perceived partner support, and overall QOL. Actor-partner interdependence models revealed that when PwSCs reported overprotection from their healthy partners (HPs), they were more likely to report lower QOL. Protective buffering received by HPs was negatively associated with their QOL as well as their PwSCs QOL. Active engagement support, however, was not associated with either partner's QOL. While couples may use all three styles of relationship-focused support, protective buffering and overprotection affected each partner's QOL. Implications of the study findings for interventions for couples facing illnesses like skin cancer are discussed.
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Affiliation(s)
| | - Jyoti Savla
- 184761 Department of Human Development and Family Science, Virginia Tech, Blacksburg, USA.,1757 Center for Gerontology, Virginia Tech, Blacksburg, USA
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27
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Gordon L, Olsen C, Whiteman DC, Elliott TM, Janda M, Green A. Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study. BMJ Open 2020; 10:e034388. [PMID: 32107270 PMCID: PMC7202703 DOI: 10.1136/bmjopen-2019-034388] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths. DESIGN Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses. SETTING Queensland, Australia. PARTICIPANTS Men and women with a mean age 50 years modelled for 30 years. INTERVENTIONS Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo. PRIMARY AND SECONDARY OUTCOMES Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years. RESULTS Per 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%). CONCLUSIONS Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.
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Affiliation(s)
- Louisa Gordon
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Olsen
- Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - David C Whiteman
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Thomas M Elliott
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adele Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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28
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Răducu L, Avino A, Purnichescu Purtan R, Balcangiu-Stroescu AE, Bălan DG, Timofte D, Ionescu D, Jecan CR. Quality of Life in Patients with Surgically Removed Skin Tumors. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E66. [PMID: 32050413 PMCID: PMC7074335 DOI: 10.3390/medicina56020066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.
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Affiliation(s)
- Laura Răducu
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
| | - Raluca Purnichescu Purtan
- Department of Mathematical Methods and Models, Faculty of Applied Sciences, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Andra-Elena Balcangiu-Stroescu
- Department of Dialysis, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (A.-E.B.-S.); (D.T.)
- Discipline of Physiology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, 020021 Bucharest, Romania;
| | - Daniela Gabriela Bălan
- Discipline of Physiology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, 020021 Bucharest, Romania;
| | - Delia Timofte
- Department of Dialysis, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (A.-E.B.-S.); (D.T.)
| | - Dorin Ionescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Cristian-Radu Jecan
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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29
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Fan S, Hackett J, Lutz K, Heaton G, Symonette C, Grant A. Regional Wait Times for Patients With Nonmelanoma Skin Cancer in Southwestern Ontario. Plast Surg (Oakv) 2019; 28:5-11. [PMID: 32110640 DOI: 10.1177/2292550319880918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Nonmelanoma skin cancer (NMSC) affects many Canadians. Although morbidity and mortality are rare, the burden to patients and the health-care system is significant. This study aims to evaluate current plastic surgery wait times and care pathways for patients with NMSC in Southwestern Ontario. Methods A retrospective chart review of 225 patients treated in Ontario from 2015 to 2018 was conducted. Inclusion criteria included patients with an NMSC managed with surgical excision. Referral information was compared. Primary outcomes were wait times: from referral to consultation, referral to excision, and consultation to excision. Data were analyzed using Student t test with equal variance. Results One-hundred forty-three patients were included from the academic cohort and 82 from the community cohort. Referrals to academic and community surgeons included lesion location (90% and 97.6%, respectively), but less frequently included size (18% and 29.2%, respectively). Most referrals to academic surgeons included biopsy results (78.6%), as opposed to community referrals (25.6%). Patients in the academic cohort waited 15.3 ± 12.7 weeks from referral to consultation, and 15.7 ± 13 weeks from referral to excision. Patients from the community cohort waited significantly shorter periods of 4.9 ± 3.1 (P < .001) and 11.7 ± 9.9 weeks (P = .016), respectively. However, patients of the academic cohort waited 2.4 ± 7.1 weeks from consultation to excision, while patients in the community cohort waited 6.7 ± 9.6 weeks (P < .001). Rates of negative peripheral margins on pathology were similar between groups, at 89.5% of the academic cohort and 88.9% of the community cohort. Deep margins were positive 5.7% of the time at the academic sites and 6.2% of the time in the community. Conclusions Patients referred to academic centres waited significantly longer periods of time in several parameters compared to those referred to a community surgeon. However, academic surgeons often had expedited consultation-to-excision time frame. This study provides important data for future quality improvement initiatives in NMSC care.
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Affiliation(s)
- Stacy Fan
- Division of Plastic Surgery, Western University, London, Ontario, Canada
| | - Jesse Hackett
- Division of Plastic Surgery, Western University, London, Ontario, Canada
| | - Kristina Lutz
- Division of Plastic Surgery, Western University, London, Ontario, Canada.,Division of Plastic Surgery, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Graham Heaton
- Division of Plastic Surgery, Western University, London, Ontario, Canada.,Department of Surgery, Stratford General Hospital, Stratford, Ontario, Canada
| | - Caitlin Symonette
- Division of Plastic Surgery, Western University, London, Ontario, Canada
| | - Aaron Grant
- Division of Plastic Surgery, Western University, London, Ontario, Canada
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30
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Wali GN, Gibbons E, Kelly L, Reed JR, Matin RN. Use of the Skin Cancer Quality of Life Impact Tool (SCQOLIT) - a feasibility study in non-melanoma skin cancer. J Eur Acad Dermatol Venereol 2019; 34:491-501. [PMID: 31419362 DOI: 10.1111/jdv.15887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Incidence of non-melanoma skin cancers (NMSCs) is increasing and can significantly impact on quality of life (QOL), yet there are few studies evaluating patient-reported outcome measures (PROMs) in NMSC populations. We undertook a prospective feasibility study to evaluate a skin cancer-specific PROM, the Skin Cancer Quality of Life Impact Tool (SCQOLIT), in patients with a new diagnosis of NMSC. OBJECTIVES (i) To establish acceptability of SCQOLIT in dermatology clinics, (ii) a descriptive analysis of SCQOLIT scores in NMSC. METHODS Patients with histologically confirmed NMSC completed SCQOLIT, EQ-5D and a transition item. Questionnaires were completed at baseline and 3 months for group 1 ('low-risk' NMSC) and group 2 ('high-risk' NMSC) with additional questionnaires at 6-9 months for group 2. Patients participated in structured interviews. Clinician experience was captured through staff evaluation forms and a focus group. Acceptability and psychometric properties of SCQOLIT were assessed. RESULTS Overall, 318 patients consented to participate. Mean SCQOLIT score at baseline was 5.33, with 2.6% of patients scoring ≥20. No ceiling effects were observed, whilst 13.9% scored 0. Validity was demonstrated against EQ-5D. Cronbach's alpha 0.84 demonstrated internal consistency. Thirteen patients were interviewed and thought SCQOLIT was comprehensive, captured impact on health-related QOL and helped express their needs to clinicians. Most clinicians found SCQOLIT 'very useful' or 'useful to some extent' in facilitating discussions. CONCLUSIONS This feasibility study demonstrates that SCQOLIT is acceptable to patients and staff in dermatology skin cancer clinics. The psychometric properties of SCQOLIT confirm its utility in NMSC populations.
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Affiliation(s)
- G N Wali
- Dermatology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - L Kelly
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J R Reed
- Dermatology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R N Matin
- Dermatology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Long-Term Efficacy of Vismodegib After its Withdrawal and Patients' Health-Related Quality of Life Using the Dermatology Life Quality Index (DLQI). Dermatol Ther (Heidelb) 2019. [PMID: 31506916 DOI: 10.1007/s13555‐019‐00323‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Although non-melanoma skin cancers (NMSCs) are associated with a very low mortality risk, they have been reported to have a major impact on patients' health-related quality of life (HRQoL). Vismodegib is a therapy for patients who are affected by locally advanced basal cell carcinoma (BCC) or metastatic BCC who are ineligible for surgery and/or radiotherapy. The aim of the present clinical study was to assess the long-term efficacy of vismodegib after its withdrawal by evaluating the recurrence rate of advanced BCC, assessing also patients' HRQoL after 3 and 6 months from drug withdrawal. METHODS A retrospective study was performed to analyze patients with advanced and/or multiple BCCs that had been treated with vismodegib (150 mg daily) at the Non-Melanoma Skin Cancer Unit of the University of Naples Federico II (Italy) and had obtained a complete regression in 6 months. At the end of the 6-month treatment cycle, patients that reported total remission of the skin tumor were visited monthly in order to assess their therapeutic response. Moreover, to assess the specific impact of vismodegib on HRQoL, DLQI was administered before vismodegib treatment (baseline), at the end of the therapy cycle (6 months), as well as after 3 and 6 months from vismodegib discontinuation. RESULTS Thirty-five patients (27 male, 8 female), with a complete regression of their advanced BCC after vismodegib treatment, were included in the study. The duration of treatment for all patients was 6 months as set by study inclusion criteria. A BCC recurrence rate of 31% (11/35) was reported after a 6-month follow-up. The average reported Dermatology Life Quality Index (DLQI) score increased from a value of 0 at the end of the 6-month vismodegib treatment to a mean value of 2.4 after 3 months from drug withdrawal and 3.6 after 6 months from treatment discontinuation. CONCLUSION The results of this exploratory analysis of vismodegib withdrawal are consistent with a substantial link between treatment response and patients' HRQoL. Furthermore, 11 out of 35 (31%) patients that reported a complete remission of the disease after 6 months of vismodegib treatment reported BCC recurrence. These data highlight the importance of continuous follow-up and perhaps different regimens of treatment, such as an alternate dose regimen to maintain disease control and reduce the adverse events as previously described in the literature.
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Villani A, Megna M, Fabbrocini G, Cappello M, Luciano MA, Costa C, Scalvenzi M. Long-Term Efficacy of Vismodegib After its Withdrawal and Patients' Health-Related Quality of Life Using the Dermatology Life Quality Index (DLQI). Dermatol Ther (Heidelb) 2019; 9:719-724. [PMID: 31506916 PMCID: PMC6828856 DOI: 10.1007/s13555-019-00323-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction Although non-melanoma skin cancers (NMSCs) are associated with a very low mortality risk, they have been reported to have a major impact on patients’ health-related quality of life (HRQoL). Vismodegib is a therapy for patients who are affected by locally advanced basal cell carcinoma (BCC) or metastatic BCC who are ineligible for surgery and/or radiotherapy. The aim of the present clinical study was to assess the long-term efficacy of vismodegib after its withdrawal by evaluating the recurrence rate of advanced BCC, assessing also patients’ HRQoL after 3 and 6 months from drug withdrawal. Methods A retrospective study was performed to analyze patients with advanced and/or multiple BCCs that had been treated with vismodegib (150 mg daily) at the Non-Melanoma Skin Cancer Unit of the University of Naples Federico II (Italy) and had obtained a complete regression in 6 months. At the end of the 6-month treatment cycle, patients that reported total remission of the skin tumor were visited monthly in order to assess their therapeutic response. Moreover, to assess the specific impact of vismodegib on HRQoL, DLQI was administered before vismodegib treatment (baseline), at the end of the therapy cycle (6 months), as well as after 3 and 6 months from vismodegib discontinuation. Results Thirty-five patients (27 male, 8 female), with a complete regression of their advanced BCC after vismodegib treatment, were included in the study. The duration of treatment for all patients was 6 months as set by study inclusion criteria. A BCC recurrence rate of 31% (11/35) was reported after a 6-month follow-up. The average reported Dermatology Life Quality Index (DLQI) score increased from a value of 0 at the end of the 6-month vismodegib treatment to a mean value of 2.4 after 3 months from drug withdrawal and 3.6 after 6 months from treatment discontinuation. Conclusion The results of this exploratory analysis of vismodegib withdrawal are consistent with a substantial link between treatment response and patients’ HRQoL. Furthermore, 11 out of 35 (31%) patients that reported a complete remission of the disease after 6 months of vismodegib treatment reported BCC recurrence. These data highlight the importance of continuous follow-up and perhaps different regimens of treatment, such as an alternate dose regimen to maintain disease control and reduce the adverse events as previously described in the literature.
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Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Milena Cappello
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Antonietta Luciano
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudia Costa
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Villani A, Fabbrocini G, Cappello M, Costa C, Scalvenzi M. Real-Life Effectiveness of Vismodegib in Patients with Metastatic and Advanced Basal Cell Carcinoma: Characterization of Adverse Events and Assessment of Health-Related Quality of Life using the Dermatology Life Quality Index (DLQI) Test. Dermatol Ther (Heidelb) 2019; 9:505-510. [PMID: 31165365 PMCID: PMC6704212 DOI: 10.1007/s13555-019-0303-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Non-melanoma skin cancer (NMSC) is the most common type of human tumor, with an estimated five million new cases each year. NMSC has been described as having a major impact on the health-related quality of life of the patient. Vismodegib is a hedgehog pathway inhibitor therapy for patients who are affected by locally advanced basal cell carcinoma (laBCC) and metastatic basal cell carcinoma and are ineligible for surgery and/or radiotherapy. The objective of this study was to assess treatment-emergent adverse events reported by patients with advanced BCC who were undergoing hedgehog pathway inhibitor therapy with vismodegib, and to quantify their health-related quality of life using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS Patients with advanced and/or multiple basal cell carcinomas treated with vismodegib at the Non-Melanoma Skin Cancer Unit of the University of Naples Federico II (Italy) were consecutively enrolled. Each patient was evaluated every month until the end of the treatment cycle to assess adverse events related to the drug and the patient's quality of life. RESULTS 48 patients (35 males and 13 females) with advanced BCC were included in the study. Muscle spasms, alopecia, and dysgeusia were the most frequently reported adverse events. 41 patients completed the DLQI questionnaire at the baseline visit and after 6 months of treatment. The average reported DLQI score decreased from a mean value of 5.7 at the baseline visit to 0.4 after 6 months of treatment. CONCLUSION This is the first study to demonstrate a significant change in patient health-related quality of life from baseline to 6 months after hedgehog pathway inhibitor therapy initiation using the DLQI test. Interestingly, patients with BCC in visible areas such as the face or neck presented an overall DLQI score that was higher than that of patients with BCC located on the trunk and legs at the baseline visit, but the DLQI scores of these two groups were almost the same after 6 months of vismodegib therapy.
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Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Milena Cappello
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudia Costa
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Quinn PL, Oliver JB, Mahmoud OM, Chokshi RJ. Cost-Effectiveness of Sentinel Lymph Node Biopsy for Head and Neck Cutaneous Squamous Cell Carcinoma. J Surg Res 2019; 241:15-23. [DOI: 10.1016/j.jss.2019.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/19/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
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Abedini R, Nasimi M, Noormohammad Pour P, Moghtadaie A, Tohidinik HR. Quality of Life in Patients with Non-melanoma Skin Cancer: Implications for Healthcare Education Services and Supports. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:755-759. [PMID: 29705894 DOI: 10.1007/s13187-018-1368-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer among Caucasian populations worldwide. The purpose of this work was to measure quality of life (QOL) of the patients with diagnosis of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) who were referred to our cancer clinic. During 1 year, 95 patients were selected and asked to complete Dermatology Life Quality Index (DLQI) questionnaires. Ninety-five patients with NMSC (74 men and 21 women) with mean age of 64.6 ± 12.5 participated in this cross-sectional study. From 95 patients, 75 had BCC, 15 had SCC, and 5 patients had both SCC and BCC. The total DLQI scores of the all participants were between 0 and 16; the mean was 4.1 ± 4.25 and median was 2. Variables which were associated with impaired QOL were marital status (P = 0.03) and tumor location (P = 0.02). By using general dermatology QOL questionnaire, it had been demonstrated that patients with NMSC faced with minimal QOL impairment; also, this handicap was more pronounced in younger patients and singles and patients with tumors located in exposed areas. Our findings demonstrated a need to educate our patients to improve patients' knowledge about different aspects of disease.
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Affiliation(s)
- Robabeh Abedini
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Razi Hospital-Vahdate Eslami Street, Tehran, 1199663911, Iran
| | - Maryam Nasimi
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Razi Hospital-Vahdate Eslami Street, Tehran, 1199663911, Iran.
| | - Pedram Noormohammad Pour
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Razi Hospital-Vahdate Eslami Street, Tehran, 1199663911, Iran
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An evaluation of techniques used in superficial radiotherapy for non-melanoma skin cancer to replicate the planned treatment area: A prospective study. Radiography (Lond) 2019; 25:280-287. [PMID: 31582233 DOI: 10.1016/j.radi.2019.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/30/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Accuracy of superficial radiotherapy for non-melanoma skin cancer is dependent on replicating the original clinical mark-up. Responses from 18 UK Radiotherapy centres identified the four most common replication techniques; the accuracy and time-efficiency of each was evaluated, as well as participant preference and confidence. METHODS A 2.0 cm × 2.5 cm ellipse field was drawn around the nasal ala of a surrogate patient. Templates for each replication method (1-4) were created, and skin marks removed. Twenty-five therapeutic radiographers used each method to replicate the mark-up. Measurements were recorded for lateral and longitudinal displacement, ellipse diameter and time taken. A post-study questionnaire recorded participant preference and perceived confidence. RESULTS Comparison of the mean ellipse areas for methods 1-4 identified no statistically significant differences (ANOVA test; p = 0.579 to p = 0.999). Lateral and longitudinal displacements for method 1-4 showed a statistically significant difference between method 3 and each of methods 1, 2, 4 for lateral and longitudinal respectively (ANOVA; lateral: p = 0.008, p = 0.002, p = 0.05; longitudinal: p = 0.036, p = 0.000, and p = 0.000). Mean time taken was longest for method 3, and was compared using a Friedman test (p = 0.000) identifying a statistically significant difference. Twenty-two participants completed the questionnaire. 48% favoured method 2, 41% method 4. Method 3 was least favourite. A Likert scale (1-10) measured confidence. Participants had most confidence in methods 2 and 4. CONCLUSION In this study, method 3 was least accurate, most time consuming, and was least favoured by users. The clinical significance of these results will depend on the margins used in local practise.
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Venning VL, Thomas CL, Consuegra Romero G, Castro Gutiérrez B, St George G, Fernandez-Peñas P. Keratinocyte carcinoma as a chronic disease in Australia and Spain: The importance of avoidance of perceived visible scars. Australas J Dermatol 2019; 60:284-287. [PMID: 30968391 DOI: 10.1111/ajd.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Keratinocyte cancer impacts health-related quality of life (HRQL). Disease progression and treatment can lead to adverse physical and psychosocial consequences. The skin cancer index (SCI) is a validated tool with higher scores reflecting greater HRQL. Our objectives were to assess and compare the impact of keratinocyte cancer using the SCI in two diverse populations. METHODS A total of 120 patients were prospectively recruited from dermatology clinics in Sydney, Australia, and Santander, Spain, providing demographics and completing the SCI. RESULTS About 61.1% of Australians reported ≥2 skin cancers (vs 20% P = <0.001), 44.4% resulting visible scars (vs 14.8% P = <0.001). Visible scars were associated with poorer HRQL, across total SCI (68.3 vs 81.5 P = <0.001), social (76.0 vs 86.7 P = 0.003) and emotional (54.2 vs 69.7 P = 0.003) domains. Interestingly, perceived visible scars were not associated with appearance scores. The Spanish population reported greater appearance (88.0 vs 75.6 P = 0.008) and emotional (70.7 vs 60.5 P = 0.034) HRQL. Surprisingly, incidence of cancer, recent disease, gender and education were not associated with HRQL impairment. CONCLUSIONS Australians with keratinocyte cancer experience poorer HRQL compared to a Spanish population. Offering non-surgical means when amenable and consideration of psychosocial needs during clinical course is emphasised. While our study highlights the importance of HRQL tools, our results question the sensitivity of the SCI across populations. Further research is required to substantiate its ongoing use.
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Affiliation(s)
- Victoria L Venning
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Charlotte L Thomas
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Gayathri St George
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Fernandez-Peñas
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
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Chernyshov PV, Lallas A, Tomas-Aragones L, Arenbergerova M, Samimi M, Manolache L, Svensson A, Marron SE, Sampogna F, Spillekom-vanKoulil S, Bewley A, Forsea AM, Jemec GB, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in skin cancer patients: literature review and position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer. J Eur Acad Dermatol Venereol 2019; 33:816-827. [PMID: 30963614 DOI: 10.1111/jdv.15487] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
The European Academy of Dermatology and Venereology (EADV) Task Forces (TFs) on Quality of Life (QoL) and Patient Oriented Outcomes, Melanoma and Non-Melanoma Skin Cancer (NMSC) present a review of the literature and position statement on health-related (HR) QoL assessment in skin cancer patients. A literature search was carried out to identify publications since 1980 that included information about the impact of SC on QoL. Generic, dermatology-specific, cancer-specific, SC-specific, facial SC-specific, NMSC-specific, basal cell carcinoma-specific and melanoma-specific QoL questionnaires have been used to assess HRQoL in SC patients. HRQoL was assessed in the context of creation and validation of the HRQoL instruments, clinical trials, comparison of QoL in SC and other cancers, other diseases or controls, HRQoL assessment after treatment, comorbidities, behaviour modification, predictors of QoL and survival, supportive care needs, coping strategies and fear of cancer recurrence. The most widely used instruments for HRQoL assessment in SC patients are the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Melanoma (FACT-M), Skin Cancer Index (SCI), Short Form 36 Item Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI). The TFs recommend the use of the cancer-specific EORTC QLQ-C30, especially in late stages of disease, and the melanoma-specific FACT-M and SC-specific SCI questionnaires. These instruments have been well validated and used in several studies. Other HRQoL instruments, also with good basic validation, are not currently recommended because the experience of their use is too limited. Dermatology-specific HRQoL instruments can be used to assess the impact of skin-related problems in SC. The TFs encourage further studies to validate HRQoL instruments for use in different stages of SC, in order to allow more detailed practical recommendations on HRQoL assessment in SC.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - M Arenbergerova
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Samimi
- Dermatology Department, University of Tours, Tours, France
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Rome, Italy
| | - S Spillekom-vanKoulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - A M Forsea
- Department of Oncologic Dermatology and Allergology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Goto H, Kiyohara Y, Shindo M, Yamamoto O. Symptoms of and Palliative Treatment for Unresectable Skin Cancer. Curr Treat Options Oncol 2019; 20:34. [DOI: 10.1007/s11864-019-0626-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Aguilar-Bernier M, Rodríguez-Barón D, Rivas-Ruiz F, Segura-Palacios JM, de Troya Martín M. Long-term efficacy of photodynamic therapy with methyl aminolevulinate in treating Bowen's disease in clinical practice: A retrospective cohort study (2006-2017). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:208-213. [DOI: 10.1111/phpp.12453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/15/2018] [Accepted: 01/18/2019] [Indexed: 12/20/2022]
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Bali G, Kárpáti S, Sárdy M, Brodszky V, Hidvégi B, Rencz F. Association between quality of life and clinical characteristics in patients with morphea. Qual Life Res 2018; 27:2525-2532. [DOI: 10.1007/s11136-018-1897-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/19/2022]
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Mofidi A, Tompa E, Spencer J, Kalcevich C, Peters CE, Kim J, Song C, Mortazavi SB, Demers PA. The economic burden of occupational non-melanoma skin cancer due to solar radiation. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:481-491. [PMID: 29695213 DOI: 10.1080/15459624.2018.1447118] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Solar ultraviolet (UV) radiation is the second most prevalent carcinogenic exposure in Canada and is similarly important in other countries with large Caucasian populations. The objective of this article was to estimate the economic burden associated with newly diagnosed non-melanoma skin cancers (NMSCs) attributable to occupational solar radiation exposure. Key cost categories considered were direct costs (healthcare costs, out-of-pocket costs (OOPCs), and informal caregiver costs); indirect costs (productivity/output costs and home production costs); and intangible costs (monetary value of the loss of health-related quality of life (HRQoL)). To generate the burden estimates, we used secondary data from multiple sources applied to computational methods developed from an extensive review of the literature. An estimated 2,846 (5.3%) of the 53,696 newly diagnosed cases of basal cell carcinoma (BCC) and 1,710 (9.2%) of the 18,549 newly diagnosed cases of squamous cell carcinoma (SCC) in 2011 in Canada were attributable to occupational solar radiation exposure. The combined total for direct and indirect costs of occupational NMSC cases is $28.9 million ($15.9 million for BCC and $13.0 million for SCC), and for intangible costs is $5.7 million ($0.6 million for BCC and $5.1 million for SCC). On a per-case basis, the total costs are $5,670 for BCC and $10,555 for SCC. The higher per-case cost for SCC is largely a result of a lower survival rate, and hence higher indirect and intangible costs. Our estimates can be used to raise awareness of occupational solar UV exposure as an important causal factor in NMSCs and can highlight the importance of occupational BCC and SCC among other occupational cancers.
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Affiliation(s)
- Amirabbas Mofidi
- a Department of Occupational Health Engineering , School of Medical Sciences, Tarbiat Modares University , Tehran , Iran
- b Institute for Work and Health , Toronto , Ontario , Canada
| | - Emile Tompa
- b Institute for Work and Health , Toronto , Ontario , Canada
- c Department of Economics , McMaster University , Hamilton , Ontario , Canada
| | - James Spencer
- c Department of Economics , McMaster University , Hamilton , Ontario , Canada
| | | | - Cheryl E Peters
- d Department of Health Sciences , Carleton University , Ottawa , Ontario , Canada
- e CAREX Canada, Simon Fraser University , Burnaby , British Columbia , Canada
| | - Joanne Kim
- f Occupational Cancer Research Centre , Toronto , Ontario , Canada
| | - Chaojie Song
- f Occupational Cancer Research Centre , Toronto , Ontario , Canada
| | - Seyed Bagher Mortazavi
- a Department of Occupational Health Engineering , School of Medical Sciences, Tarbiat Modares University , Tehran , Iran
| | - Paul A Demers
- f Occupational Cancer Research Centre , Toronto , Ontario , Canada
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Zhang J, Miller CJ, O'Malley V, Etzkorn JR, Shin TM, Sobanko JF. Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience. J Am Acad Dermatol 2018. [PMID: 29518455 DOI: 10.1016/j.jaad.2018.02.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment. OBJECTIVE To measure QOL before and after MMS and to identify risk factors associated with impaired QOL. METHODS Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS. RESULTS QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P = .0007). Age younger than 65 years (P = .0001), female sex (P = .0001), and tobacco use (P = .03) were associated with lower QOL scores at all assessment points. LIMITATIONS Single-site observational study. Significant loss to follow-up at both time points after MMS. CONCLUSION Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL.
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Affiliation(s)
- Junqian Zhang
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria O'Malley
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Philipp-Dormston WG, Müller K, Novak B, Strömer K, Termeer C, Hammann U, Glutsch JW, Krähn-Senftleben G, Lübbert H, Koller M, Szeimies RM. Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression. J Eur Acad Dermatol Venereol 2018; 32:1138-1146. [PMID: 29150868 PMCID: PMC6032898 DOI: 10.1111/jdv.14703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L. METHODS The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data. RESULTS A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011. CONCLUSIONS While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.
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Affiliation(s)
| | - K Müller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - B Novak
- Biofrontera Pharma GmbH, Leverkusen, Germany
| | - K Strömer
- Professional Association of German Dermatologists (BVDD), Mönchengladbach, Germany
| | - C Termeer
- Hautarztpraxis am Löwenmarkt, Dematology Practice, Stuttgart, Germany
| | - U Hammann
- Hautarztpraxis Dr. med. Urte Hammann, Dermatology Practice, Stade, Germany
| | - J W Glutsch
- Hautarztpraxis Dr. med. J. W. Glutsch, Dermatology Practice, Karlsruhe, Germany
| | | | - H Lübbert
- Biofrontera Pharma GmbH, Leverkusen, Germany
| | - M Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - R M Szeimies
- Department of Dermatology and Allergology, Vest Clinic, Recklinghausen, Germany
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Elliott TM, Whiteman DC, Olsen CM, Gordon LG. Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:805-816. [PMID: 28756584 DOI: 10.1007/s40258-017-0341-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted. OBJECTIVE To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis. METHODS We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses. RESULTS The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million. CONCLUSION With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.
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Affiliation(s)
- Thomas M Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- Menzies Health Institute Queensland, Centre for Applied Health Economics, Griffith University, Logan Campus, University Dr, Meadowbrook, Q4131, Australia
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia
| | - Catherine M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Q4006, Australia.
- Centre for Research Excellence in Sun and Health Queensland, University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Q4059, Australia.
- School of Public Health, The University of Queensland, Brisbane, Australia.
- School of Nursing, Queensland University of Technology, Brisbane, Australia.
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Poór AK, Brodszky V, Péntek M, Gulácsi L, Ruzsa G, Hidvégi B, Holló P, Kárpáti S, Sárdy M, Rencz F. Is the DLQI appropriate for medical decision-making in psoriasis patients? Arch Dermatol Res 2017; 310:47-55. [PMID: 29128966 DOI: 10.1007/s00403-017-1794-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/28/2017] [Accepted: 11/06/2017] [Indexed: 12/24/2022]
Abstract
Dermatology Life Quality Index (DLQI) is the most commonly applied measure of health-related quality of life (HRQoL) in psoriasis patients. It is among defining criteria of moderate-to-severe psoriasis and present in treatment guidelines. Our objective was to estimate preference-based HRQoL values (i.e., utilities) for hypothetical health states described by the 10 items of the DLQI in psoriasis patients. Moreover, we compare results to findings of a similar study previously conducted among the general public. A cross-sectional survey was carried out among 238 psoriasis patients. Seven hypothetical DLQI-defined health states with total scores of 6, 11, and 16 (3-3 and 1 states, respectively) were evaluated by time trade-off method. The difference in DLQI scores between hypothetical health states was set at 5 points, as it exceeds the minimal clinically important difference (MCID). Utility scores were found to be homogenous across the seven hypothetical health states (range of means for the 6-point states 0.85-0.91, range of means for the 11-point states 0.83-0.85, and mean of 0.84 for the 16-point state). Overall, mean utilities assessed by psoriasis patients were higher for all seven states compared with the general public (mean difference 0.16-0.28; p < 0.001). In 11 out of the 15 comparisons between health states with DLQI scores differing larger than the MCID, there was no statistically significant difference in utility. Thus, in clinical settings, patients with DLQI scores differing more than the MCID may have identical HRQoL. Improving the definition of moderate-to-severe disease and reconsideration of the DLQI in clinical assessment of psoriasis patients are suggested.
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Affiliation(s)
- Adrienn Katalin Poór
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária utca 41, 1085, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Gábor Ruzsa
- Institute of Psychology, Doctoral School of Psychology, Eötvös Loránd University of Sciences, Izabella utca 46, 1064, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária utca 41, 1085, Budapest, Hungary
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária utca 41, 1085, Budapest, Hungary
| | - Sarolta Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária utca 41, 1085, Budapest, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária utca 41, 1085, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary.
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Quality of life assessment in patients with nonmelanoma skin cancer - psychometric validation of the EORTC QLQ-C30 questionnaire. J Dtsch Dermatol Ges 2017; 15:1090-1100. [DOI: 10.1111/ddg.13357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Karolina Müller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Sigrid Karrer
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology; Klinikum Vest; Recklinghausen Germany
| | - Julia Steinbauer
- Dermatology Practice; Regensburger Straße 36a; 93133 Burglengenfeld Germany
| | - Elisabeth Kohl
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Dominik Steinbauer
- General Medicine Practice; Kallmünzer Straße 2; 93133 Burglengenfeld Germany
| | - Florian Zeman
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center Regensburg; Regensburg Germany
| | - Michael Koller
- Center for Clinical Studies; University Medical Center Regensburg; Regensburg Germany
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Müller K, Karrer S, Szeimies RM, Steinbauer J, Kohl E, Steinbauer D, Zeman F, Berneburg M, Koller M. Beurteilung der Lebensqualität bei Patienten mit nicht-melanozytärem Hautkrebs - psychometrische Validierung des EORTC QLQ-C30-Fragebogens. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13357_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karolina Müller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Rolf-Markus Szeimies
- Klinik für Dermatologie und Allergologie; Klinikum Vest, Recklinghausen; Deutschland
| | - Julia Steinbauer
- Dermatologische Praxis; Regensburger Straße 36a; 93133 Burglengenfeld Deutschland
| | - Elisabeth Kohl
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Dominik Steinbauer
- Allgemeinmedizinische Praxis; Kallmünzer Straße 2; 93133 Burglengenfeld Deutschland
| | - Florian Zeman
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie; Universitätsklinikum Regensburg; Regensburg Deutschland
| | - Michael Koller
- Zentrum für Klinische Studien; Universitätsklinikum Regensburg; Regensburg Deutschland
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Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance. Dermatol Surg 2017; 42:633-8. [PMID: 27110895 DOI: 10.1097/dss.0000000000000756] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The literature provides mixed results regarding cost comparisons of Mohs micrographic surgery (MMS) and traditional excision (TE). OBJECTIVE To complete a prospective cohort study comparing true costs of MMS with projected costs of TE for head and neck basal cell carcinoma (BCC). METHODS Patients referred for MMS of biopsy-proven BCC were eligible for inclusion. For each case, surgery with TE was planned before the patient proceeded to MMS. The true costs of MMS were compared with projected costs of TE. All TE patients with inadequate excision were assumed to have subsequent TE, and the cost of the subsequent procedure was assumed to be equal to the first. RESULTS The mean cost of MMS was $628.47 (95% CI: $617.73-$639.21) compared with $587.51 (95% CI: $558.42-$616.59) for TE. This difference of $40.96 to initial margin clearance was significant (z = 4.48, p < .001). CONCLUSION On average, MMS was found to be $40.96 more expensive than TE in treating BCC-a small but appreciable difference. This being the case, any fiscal comparison must also be tempered with a consideration of effectiveness. Accordingly, further work in the form of a cost-utility study is required to truly define the cost-effectiveness of MMS compared with TE in this setting.
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