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Kantor J, Aasi SZ, Alam M, Paoli J, Ratner D. Development and Validation of the Oxford Skin Cancer Treatment Scale, a Patient-Reported Outcome Measure for Health-Related Quality of Life and Treatment Satisfaction After Skin Cancer Treatment. Dermatol Surg 2024:00042728-990000000-00886. [PMID: 38996368 DOI: 10.1097/dss.0000000000004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are necessary to assess the value of skin cancer treatment and to better compare therapeutic options. OBJECTIVE To develop and validate the Oxford Skin Cancer Treatment (OxSCanTr) scale, evaluating health-related quality of life and satisfaction after skin cancer treatment. MATERIALS AND METHODS After qualitative patient interviews, international expert consultation, and item reduction, 2 separate patient samples were used to assess the factor structure of the scale. Exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation was performed to establish a factor structure on Group A. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating the root mean squared error of approximation (RMSEA), standardized root mean squared residual (SRMR), and comparative fit index (CFI) was conducted on Group B. Reliability as internal consistency was assessed using McDonald omega. Convergent and discriminant validity were assessed using the Pearson correlation coefficient. RESULTS A total of 480 subjects returned completed surveys (completion rate 96%). A 12-item scale was developed encompassing 4 domains: aesthetic satisfaction, treatment choice satisfaction, treatment experience, and future concerns regarding recurrence/spread. Confirmatory factor analysis showed excellent goodness-of-fit characteristics, with RMSEA = 0.048, SRMR = 0.051, and CFI = 0.962 using the 4-factor model. Reliability was very good (McDonald omega 0.81-0.82), as was convergent validity with the FACE-Q skin cancer module appraisal of scars subscale (r = 0.55). Discriminant validity with a single question regarding being conservative was similarly excellent (r = -0.02). CONCLUSION The OxSCanTr scale is a parsimonious, feasible, and valid PROM for the holistic assessment of the experience of patients who have undergone skin cancer treatment.
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Affiliation(s)
- Jonathan Kantor
- Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, and Center for Global Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Engineering Science & Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
- Florida Center for Dermatology, St. Augustine, Florida
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Murad Alam
- Departments of Dermatology
- Otolaryngology
- Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - John Paoli
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Désirée Ratner
- Department of Dermatology, New York University, New York, New York
- Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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Chen A, Ray P, Rogers H, Bialowas C, Butala P, Chen M, Daveluy SD, Davidson C, Faringer P, Guarda H, Kantor J, Kaweski S, Lawrence N, Lickstein D, Lomax J, Parra S, Retson N, Suryadevara A, Smith R, Tollefson TT, Wisco OJ. Evidence-Based Performance Measures for Reconstruction after Skin Cancer Resection: A Multidisciplinary Performance Measure Set. Plast Reconstr Surg 2024; 153:424e-441e. [PMID: 38266139 DOI: 10.1097/prs.0000000000010916] [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: 01/26/2024]
Abstract
BACKGROUND The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, the American Society for Mohs Surgery, and a patient representative. METHODS Two outcome measures and five process measures were identified. The outcome measures included the following: (1) patient satisfaction with information provided by their surgeon before their facial procedure, and (2) postprocedural urgent care or emergency room use. The process measures focus on antibiotic stewardship, anticoagulation continuation and/or coordination of care, opioid avoidance, and verification of clear margins. RESULTS All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the stakeholder societies. CONCLUSION The work group recommends the use of these measures for quality initiatives, Continuing Medical Education, Continuous Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
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Affiliation(s)
| | - Peter Ray
- East Hills Professional Center and Marshall University Joan C. Edwards School of Medicine
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3
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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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Singh P, Chan K, Dhar S, Ashby I, Krumhuber E, Mosahebi A, Ponniah A. Patient-Reported Outcome Measures in a Facial Reconstruction Case Series Following the Implementation of an Integrated Craniofacial Multidisciplinary Team Clinic, Three-Dimensional Photography, and Computer Modeling. Aesthet Surg J Open Forum 2023; 5:ojad082. [PMID: 37780530 PMCID: PMC10540727 DOI: 10.1093/asjof/ojad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background Facial reconstruction surgery is often a complex and staged process, leading to lengthy reconstructive journeys for patients. The integration of a clinical pathway can give patients a clearer understanding of what to expect at each stage of their reconstructive journey. Objectives The authors demonstrate how the incorporation of multidisciplinary team clinics, three-dimensional (3D) photography, and 3D modeling into an integrated pathway can streamline the process for patients undergoing facial reconstructive surgeries and aid their understanding of their surgeries. Methods A novel clinical pathway was developed for patients undergoing facial reconstructive surgery at a tertiary reconstructive unit in London. A case series was collated of 35 patients who had been through the integrated pathway. Patient-reported outcome measures (PROMs) were assessed using FACE-Q scales, Global Aesthetic Improvement Scale, Self-Perception of Age score, and Ordinal Rank change in facial aesthetic appearance, determined subjectively and objectively. Statistical analysis was performed to calculate mean averages for each scale and PROM. Results High patient satisfaction with overall facial appearance, aging appearance, and the decision-making process was demonstrated. The average perceived improvement in age-related facial appearance was -7.7 years postreconstruction compared with prereconstruction. The Ordinal Rank improvement on facial aesthetic appearance showed considerable improvement, both subjectively and objectively. Conclusions The authors advocate the implementation of an integrated clinical pathway for facial reconstruction, with positive impacts observed in terms of patient satisfaction and objective assessments of facial appearance. Similar principles can be extrapolated to other aspects of reconstructive surgery. Level of Evidence 3
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Affiliation(s)
- Prateush Singh
- Corresponding Author: Mr Prateush Singh, Royal Free Hospital Plastic Surgery Department, Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail:
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Reinhardt ME, Sun T, Pan CX, Schmults CD, Lee EH, Waldman AB. A systematic review of patient-reported outcome measures for advanced skin cancer patients. Arch Dermatol Res 2023; 315:1473-1480. [PMID: 36469125 DOI: 10.1007/s00403-022-02479-0] [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: 11/07/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Many patient-reported outcome measures (PROMs) have been used to study quality of life (QOL) in the skin cancer population. Advanced melanoma and non-melanoma skin cancer (NMSC) may be associated with increased morbidity, mortality, and treatment side effects; however, it is unclear which PROM is valid and appropriate to use in these populations for both clinical and research purposes. We aimed to identify the PROMs that have been used to measure QOL in advanced skin cancer patients and determine which of these PROMs have been validated to assess QOL outcomes in this population. A PubMed and EMBASE search was conducted from its inception to March 2021 according to PRISMA guidelines with a comprehensive list of search terms under three main topics: (1) PROM; (2) advanced skin cancer; and (3) staging and interventions. We included articles utilizing a PROM measuring QOL and having a patient population with advanced skin cancer defined as melanoma stage > T1a or non-melanoma AJCC stage T3 or greater. Advanced skin cancer patients were also defined as those with metastasis or requiring adjuvant therapy (systemic chemotherapy, radiation, and immunotherapy). Studies were excluded according to the following criteria: mix of low-risk and advanced skin cancer patients in the study population without stratification into low-risk and advanced groups, stage T1a melanoma or mix of stages without stratification, low-risk NMSC, no PROM (i.e., study specific questionnaires), non-English publication, review article or protocol paper, conference abstract, or populations including non-skin cancers. A total of 1,998 articles were identified. 82 met our inclusion criteria resulting in 22 PROMs: five generic health-related (QWB-SA, AQoL-8D, EQ-5D, SF-36, and PRISM), six general cancer (EORTC QLQ-C30, EORTC QLQ-C36, LASA, IOC, Rotterdam Symptom Checklist, and FACT-G), nine disease-focused or specialized (EORTC QLQ-H&N35, EORTC QLQ-MEL38, EORTC QLQ-BR23, Facial Disability Index, FACT-H&N, FACT-BRM, FACT-B, FACT-M, and scqolit), and two general dermatology (Skindex-16 and DLQI) PROMs. All PROMs have been generally validated except for EORTC QLQ-MEL38. Only two PROMs have been validated in the advanced melanoma population: FACT-M and EORTC QLQ-C36. No PROMS have been validated in the advanced NMSC population. The PROMs that were validated in the advanced melanoma population do not include QOL issues unique to advanced skin tumors such as odor, bleeding, itching, wound care burden, and public embarrassment. Breast cancer and head and neck cancer instruments were adapted but not validated for use in the advanced skin cancer population due to the lack of an adequate instrument for this population. This study highlights the need for PROM instrument validation or creation specifically geared toward the advanced skin cancer population. Future studies should aim to develop and validate a PROM to assess QOL in this population.
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Affiliation(s)
- Myrna Eliann Reinhardt
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA.
| | - Tiffany Sun
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | | | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
| | - Erica H Lee
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Abigail B Waldman
- Department of Dermatology, Brigham and Women's Hospital, 1153 Centre Street, Suite 4J, Boston, MA, 02130, USA
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Starkings R, Shilling V, Fallowfield L. An online review of informational sources for advanced or high-risk cutaneous squamous cell carcinoma. Support Care Cancer 2021; 29:4199-4207. [PMID: 33558963 PMCID: PMC8236469 DOI: 10.1007/s00520-021-06034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/26/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Cutaneous squamous cell carcinoma (cSCC) is one of the most prevalent non-melanoma skin cancers worldwide. While usually treatable, patients with high-risk or advanced disease have few treatment options and limited resources available. This review assesses what online information resources are available to patients and their families about either high-risk or advanced cSCC. METHODS Searches were run, via Google, using 8 terms such as 'advanced cutaneous squamous cell carcinoma patient information'. Advertisements were removed and the first 3 pages/30 results from each search were screened for duplicates and then against eligibility criteria. Websites needed to have been updated within the past 5 years, be freely accessible, designed specifically for patients and refer to the advanced disease or high-risk setting. Remaining results were assessed using the DISCERN tool. RESULTS Of the final 240 results, 121 were duplicates and 104 were ineligible. The remaining 15 sources were predominantly aimed at American audiences, used variable terminology and revealed differing treatment pathways. Only 3 sites were deemed as 'high'-quality information sources. CONCLUSION There is a lack of accessible online information on high-risk or advanced cSCC for patients. What is available is often too scientific or clinical and lacks clarity about the disease and treatment options. PRACTICE IMPLICATIONS Further work is needed to improve the integrity and accessibility of online sources and to signpost patients to the most reliable information. This should include elements of patient led research, clinical education and information development.
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Affiliation(s)
- Rachel Starkings
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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7
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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: 0] [Impact Index Per Article: 0] [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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Çetinarslan T, Evrenos MK, Bilaç C, Özyurt B, Türel Ermertcan A. Evaluation of the effect of surgical treatment on quality of life with the Dermatology Life Quality Index in patients with facial nonmelanoma skin cancer. Dermatol Ther 2020; 33:e14094. [DOI: 10.1111/dth.14094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Mustafa Kürşat Evrenos
- Faculty of Medicine, Departments of Plastic and Reconstructive Surgery Manisa Celal Bayar University Manisa Turkey
| | - Cemal Bilaç
- Department of Dermatology, Faculty of Medicine Manisa Celal Bayar University Manisa Turkey
| | - Beyhan Özyurt
- Department of Public Health, Faculty of Medicine Manisa Celal Bayar University Manisa Turkey
| | - Aylin Türel Ermertcan
- Department of Dermatology, Faculty of Medicine Manisa Celal Bayar University Manisa Turkey
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Kavanagh KJ, Christophel JJ. Development of a Patient-Reported Outcome Measure for Mohs Reconstruction. Facial Plast Surg Aesthet Med 2020; 22:274-280. [PMID: 32316768 DOI: 10.1089/fpsam.2020.0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: There are currently no validated patient-reported outcome measures (PROMs) to specifically evaluate quality-of-life (QOL) outcomes for patients undergoing Mohs micrographic surgery (MMS) reconstruction. Therefore, the objective of this report was to develop a short PROM that can be used to evaluate the outcome after MMS reconstruction from the patient's perspective. Methods: Following established guidelines for PROM development, a comprehensive literature review, concept elicitation interviews (n = 25), and cognitive debriefing interviews (n = 5) were performed. These data were used to develop a preliminary survey to measure patient QOL throughout the MMS reconstruction process. Results: Participants identified many items from existing validated QOL instruments as being irrelevant to their situation, indicating that the sensitivity of existing instruments may be relatively low for patients undergoing MMS. There was significant overlap between what patients frequently identified and what expert physicians believed would be important in terms of factors that affect patient QOL throughout this process. Cognitive debriefing interviews indicated that the survey can be quickly and easily administered. Conclusions: Following accepted standards, we have created a 12-item disease- and treatment-specific QOL PROM for individuals undergoing the MMS reconstruction process. Given the prevalence of MMS, this PROM could be an important tool for clinicians to assess outcomes in future interventional studies aimed at minimizing morbidity and maximizing QOL for these skin cancer patients. Psychometric testing and validation of this newly developed PROM are currently underway.
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Affiliation(s)
- Kaitlin J Kavanagh
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - J Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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10
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Higgins S, Feinstein S, Hawkins M, Cockburn M, Wysong A. Virtual Reality to Improve the Experience of the Mohs Patient-A Prospective Interventional Study. Dermatol Surg 2019; 45:1009-1018. [PMID: 30883476 DOI: 10.1097/dss.0000000000001854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonmelanoma skin cancer is the most common cancer in the United States with significant quality of life impact. OBJECTIVE To assess the utility of a highly immersive virtual reality (VR) experience in the context of outpatient skin cancer surgery as a means to minimize patient-reported feelings of anxiety or pain. The authors also sought to assess the effects on patient-reported overall satisfaction. MATERIALS AND METHODS Patients completed a pre-VR experience survey after completion of their first Mohs surgery layer, followed by a 10-minute VR experience, and a post-VR experience survey. Differences in the pre-VR survey and post-VR survey were compared using the chi-square test. The anxiety scores were compared using a t-test. RESULTS In all but 2 questions, there was a trend toward improvement of the anxiety-related sensations after completion of the VR experience. There were statistically significant differences for 4 questions: "Are you currently feeling unable to relax" (p = .0013), "are you currently feeling fear of the worst happening" (p < .0001), "are you currently feeling terrified or afraid" (p = .0046), and "are you currently feeling nervous" (p < .0001). CONCLUSION Virtual reality experiences during the Mohs surgical day significantly improved measures of anxiety and patient satisfaction.
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Affiliation(s)
- Shauna Higgins
- Department of Dermatology, Keck Medicine of the University of Southern California, Los Angeles, California.,Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Shera Feinstein
- Department of Dermatology, Keck Medicine of the University of Southern California, Los Angeles, California
| | - Makenzie Hawkins
- Cancer Prevention and Control Program, University of Colorado Cancer Center, University of Colorado, Aurora, Colorado
| | - Myles Cockburn
- Department of Dermatology, Keck Medicine of the University of Southern California, Los Angeles, California.,Cancer Prevention and Control Program, University of Colorado Cancer Center, University of Colorado, Aurora, Colorado.,Department of Dermatology, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ashley Wysong
- Department of Dermatology, Keck Medicine of the University of Southern California, Los Angeles, California.,Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
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11
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Rossi AM, Sobanko J, Lawrence N, Bordeaux J, Cartee T, Armbrecht ES, Behera A, Baum CL, Alam M, Maher IA. Physician-Centered Outcomes for Skin Cancer Treatment: A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management. Dermatol Surg 2019; 45:869-874. [PMID: 30807387 PMCID: PMC6860020 DOI: 10.1097/dss.0000000000001835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care. OBJECTIVE To identify gaps between patient and physician attitudes toward skin cancer outcomes. MATERIALS AND METHODS A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer-related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings. RESULTS A list of 53 skin cancer treatment-related themes and outcomes was generated. Eight items were ranked by physicians as "very high" (>80% importance), 5 as "high" (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance. CONCLUSION Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care.
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Affiliation(s)
- Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Joseph Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naomi Lawrence
- Center for Dermatologic Surgery, Cooper University Hospital, Camden, New Jersey
- Department of Dermatology, Rowan University, Camden, New Jersey
| | - Jeremy Bordeaux
- Department of Dermatology, Case Western Reserve University and University Hospitals, Cleveland, Ohio
| | | | - Eric S Armbrecht
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Anit Behera
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | | | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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Patient-Centered Outcomes for Skin Cancer Management: Utilization of a Patient Delphi Process to Identify Important Treatment Themes. Dermatol Surg 2019; 45:246-253. [PMID: 30726197 DOI: 10.1097/dss.0000000000001756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patient-reported outcomes are critical to research directed at maximizing patient benefit. The outcomes patients consider most relevant in the treatment of skin cancer have not been directly investigated. OBJECTIVE To develop a ranked list of outcomes deemed most important by patients with skin cancer through a proctored Delphi process. METHODS Twenty-one patients with a history of skin cancer volunteered to participate in the patient summit. The patient members participated in a guided discussion to generate a long list of potentially relevant outcomes. The list was then condensed and ranked through 2 rounds of a proctored Delphi process. RESULTS Patients were diverse in their skin cancer histories and complexities, ages, and states of residence. Twelve themes were rated as highly important by 70% or more of participants. Most of these themes related to patient education and the collaborative nature of the physician-patient relationship. Fear of recurrence and cosmetic outcome were also highly rated. Limitations include a preponderance of older patients and patients from the midwest and northeast. CONCLUSION Patients with skin cancer overwhelmingly prioritize a shared decision-making process, in which they are actively engaged and value detailed education regarding their disease. This should inform future research directed at skin cancer treatment and current physician-patient interactions.
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Cameron MC, Lee E, Hibler BP, Giordano CN, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol 2019; 80:321-339. [PMID: 29782901 DOI: 10.1016/j.jaad.2018.02.083] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/21/2022]
Abstract
As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.
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Affiliation(s)
- Michael C Cameron
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cerrene N Giordano
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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14
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Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker I. Patient-reported outcome measures for facial skin cancer: a systematic review and evaluation of the quality of their measurement properties. Br J Dermatol 2018; 180:1018-1029. [PMID: 30362522 DOI: 10.1111/bjd.17342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Skin cancer is the commonest malignancy worldwide, often occurring on the face. Both the condition and treatment can lead to scarring and facial disfigurement, affecting a patient's health-related quality of life (HRQoL), which can be measured using patient-reported outcome measures (PROMs). OBJECTIVES This systematic review identifies PROMs for facial skin cancer and appraises their methodological quality and psychometric properties using up-to-date methods. METHODS MEDLINE, Embase, PsycINFO, Cochrane and CINAHL were searched systematically in accordance with PRISMA guidelines, identifying all PROMs designed for or validated in facial skin cancer. Methodological quality and evidence of psychometric properties were assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist and criteria proposed by Terwee and colleagues. A best-evidence synthesis and assessment of instrument focus on post-resection reconstruction was also performed. RESULTS We included 24 studies on 11 PROMs. Methodological quality and psychometric evidence was variable, with the Patient Outcome of Surgery - Head/Neck (POS-H/N), Skin Cancer Index (SCI), Skin Cancer Quality of Life Impact Tool (SCQOLIT) and Essers and colleagues demonstrating the greatest level of validation. None scored well in their relevance to post-skin cancer reconstruction of the face. CONCLUSIONS This systematic review critically appraises PROMs for facial skin cancer using internationally accepted criteria. The identified PROMs demonstrate a variation in the quality of validation performed, with a need to improve this across all PROMs in the field. Only through improving the quality of available PROMs and their focus on the post-treatment aesthetic and functional outcome will we be able to truly appreciate the concerns of our patients and improve the management of facial skin cancer.
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Affiliation(s)
- T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | | | - S Hughes
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, U.K
| | - H A Hutchings
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K
| | - I Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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15
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Abstract
As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.
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Pomerantz H, Chren MM, Lew R, Weinstock MA. Validation and comparison of quality-of-life measures for topical 5-fluorouracil treatment: results from a randomized controlled trial. Clin Exp Dermatol 2017. [DOI: 10.1111/ced.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. Pomerantz
- Center for Dermatoepidemiology; VA Medical Center; Providence RI USA
- Departments of Dermatology and Epidemiology; Brown University; Providence RI USA
| | - M.-M. Chren
- Dermatology Service; San Francisco VA Medical Center; San Francisco CA USA
- Department of Dermatology; University of California; San Francisco CA USA
| | - R. Lew
- VA Cooperative Studies Coordinating Center; Boston MA USA
| | - M. A. Weinstock
- Center for Dermatoepidemiology; VA Medical Center; Providence RI USA
- Departments of Dermatology and Epidemiology; Brown University; Providence RI USA
- Department of Dermatology; Rhode Island Hospital; Providence RI USA
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17
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Yong AA, Tan V, Craythorne E, Mallipeddi R. Piloting a new patient-related outcome tool to assess cosmetic outcome in Mohs Micrographic surgery. J Eur Acad Dermatol Venereol 2017; 31:e455-e457. [PMID: 28401602 DOI: 10.1111/jdv.14270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A A Yong
- Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, Guys' and St Thomas' NHS Trust, London, UK.,National Skin Centre, Singapore, Singapore
| | - V Tan
- National Skin Centre, Singapore, Singapore
| | - E Craythorne
- Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, Guys' and St Thomas' NHS Trust, London, UK
| | - R Mallipeddi
- Dermatologic Surgery and Laser Unit, St John's Institute of Dermatology, Guys' and St Thomas' NHS Trust, London, UK
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18
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Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, Delamere FM, Eleftheriadou V, Evans N, Firkins L, Greenlaw N, Lansbury L, Lawton S, Layfield C, Leonardi-Bee J, Mason J, Mitchell E, Nankervis H, Norrie J, Nunn A, Ormerod AD, Patel R, Perkins W, Ravenscroft JC, Schmitt J, Simpson E, Whitton ME, Williams HC. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundSkin diseases are very common and can have a large impact on the quality of life of patients and caregivers. This programme addressed four diseases: (1) eczema, (2) vitiligo, (3) squamous cell skin cancer (SCC) and (4) pyoderma gangrenosum (PG).ObjectiveTo set priorities and reduce uncertainties for the treatment and prevention of skin disease in our four chosen diseases.DesignMixed methods including eight systematic reviews, three prioritisation exercises, two pilot randomised controlled trials (RCTs), three feasibility studies, two core outcome initiatives, four funding proposals for national RCTs and one completed national RCT.SettingSecondary care, primary care and the general population.ParticipantsPatients (and their caregivers) with eczema, vitiligo, SCC and PG, plus health-care professionals with an interest in skin disease.InterventionsOur three intervention studies included (1) barrier enhancement using emollients from birth to prevent eczema (pilot RCT); (2) handheld narrowband ultraviolet light B therapy for treating vitiligo (pilot RCT); and (3) oral ciclosporin (Neoral®, Novartis Pharmaceuticals) compared with oral prednisolone for managing PG (pragmatic national RCT).ResultsSystematic reviews included two overarching systematic reviews of RCTs of treatments for eczema and vitiligo, an umbrella review of systematic reviews of interventions for the prevention of eczema, two reviews of treatments for SCC (one included RCTs and the second included observational studies), and three reviews of outcome measures and outcome reporting. Three prioritisation partnership exercises identified 26 priority areas for future research in eczema, vitiligo and SCC. Two international consensus initiatives identified four core domains for future eczema trials and seven core domains for vitiligo trials. Two pilot RCTs and three feasibility studies critically informed development of four trial proposals for external funding, three of which are now funded and one is pending consideration by funders. Our pragmatic RCT tested the two commonly used systemic treatments for PG (prednisolone vs. ciclosporin) and found no difference in their clinical effectiveness or cost-effectiveness. Both drugs showed limited benefit. Only half of the participants’ ulcers had healed by 6 months. For those with healed ulcers, recurrence was common (30%). Different side effect profiles were noted for each drug, which can inform clinical decisions on an individual patient basis. Three researchers were trained to PhD level and a dermatology patient panel was established to ensure patient involvement in all aspects of the programme.ConclusionsFindings from this programme of work have already informed clinical guidelines and patient information resources. Feasibility studies have ensured that large national pragmatic trials will now be conducted on important areas of treatment uncertainty that address the needs of patients and the NHS. There is scope for considerable improvement in terms of trial design, conduct and reporting for RCTs of skin disease, which can be improved through wider collaboration, registration of trial protocols and complete reporting and international consensus over core outcome sets. Three national trials have now been funded as a result of this work. Two international initiatives to establish how best to measure the core outcome domains for eczema and vitiligo are ongoing.Trial registrationCurrent Controlled Trials Barrier Enhancement for Eczema Prevention (BEEP) (ISRCTN84854178 and NCT01142999), Study of Treatments fOr Pyoderma GAngrenosum Patients (STOP GAP) (ISRCTN35898459) and Hand Held NB-UVB for Early or Focal Vitiligo at Home (HI-Light Pilot Trial) (NCT01478945).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tessa Clarke
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Nicholas Evans
- Trust Headquarters, West Hertfordshire Hospital NHS Trust, Hemel Hempstead, UK
| | - Lester Firkins
- Strategy and Development Group, James Lind Alliance, Oxford, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Nunn
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Ramesh Patel
- Radcliffe-on-Trent Health Centre, Nottingham, UK
| | - William Perkins
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane C Ravenscroft
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Katusiime B, Corlett S, Reeve J, Krska J. Measuring medicine-related experiences from the patient perspective: a systematic review. Patient Relat Outcome Meas 2016; 7:157-171. [PMID: 27785116 PMCID: PMC5063133 DOI: 10.2147/prom.s102198] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is an increasing drive to measure and so improve patients' experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients' experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients' experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. METHODS Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID®, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. RESULTS Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation. CONCLUSION There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences of using prescription medicines among adult patients living with chronic illnesses. There is a need for further development and/or validation of existing instruments suitable for use in this population.
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Affiliation(s)
- Barbra Katusiime
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
| | - Sarah Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
| | - Joanne Reeve
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Krska
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
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20
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Lee EH, Klassen AF, Lawson JL, Scott AM, Pusic AL. Patient experiences and outcomes following facial skin cancer surgery: A qualitative study. Australas J Dermatol 2016; 57:e100-4. [PMID: 25833383 PMCID: PMC5461874 DOI: 10.1111/ajd.12323] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Abstract
Early melanoma and non-melanoma skin cancer of the facial area are primarily treated with surgery. Little is known about the outcomes of treatment for facial skin cancer patients. The objective of the study was to identify concerns about aesthetics, procedures and health from the patients' perspective after facial skin surgery. Semi-structured in-depth interviews were conducted with 15 participants. Line-by-line coding was used to establish categories and develop themes. We identified five major themes on the impact of skin cancer surgery: appearance-related concerns; psychological (e.g., fear of new cancers or recurrence); social (e.g. impact on social activities and interaction); physical (e.g. pain and swelling) concerns and satisfaction with the experience of care (e.g., satisfaction with surgeon). The priority of participants was the removal of the facial skin cancer, as this reduced their overall worry. The aesthetic outcome was secondary but important, as it had important implications on the participants' social and psychological functioning. The participants' experience with the care provided by the surgeon and staff also contributed to their satisfaction with their treatment. This conceptual framework provides the basis for the development of a new patient-reported outcome instrument.
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Affiliation(s)
- Erica H. Lee
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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21
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Hanke WC, Norlin JM, Mark Knudsen K, Larsson T, Stone S. Quality of life in treatment of AK: Treatment burden of ingenol mebutate gel is small and short lasting. J DERMATOL TREAT 2016; 27:450-5. [DOI: 10.3109/09546634.2016.1160024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Engaging Patients as Partners in Developing Patient-Reported Outcome Measures in Cancer—A Review of the Literature. Support Care Cancer 2016; 24:3543-9. [DOI: 10.1007/s00520-016-3151-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
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23
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Bates A, Knepil G. Systematic review and meta-analysis of the efficacy of hilotherapy following oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2016; 45:110-7. [DOI: 10.1016/j.ijom.2015.08.983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 06/23/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
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Körner A, Garland R, Czajkowska Z, Coroiu A, Khanna M. Supportive care needs and distress in patients with non-melanoma skin cancer: Nothing to worry about? Eur J Oncol Nurs 2015; 20:150-5. [PMID: 26236032 DOI: 10.1016/j.ejon.2015.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 06/16/2015] [Accepted: 07/13/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE There is a paucity of psychosocial research on non-melanoma skin cancer (NMSC) despite the fact that these malignancies mainly develop on the head and neck, frequently recur, and are associated with an increased risk for other cancers. The current study aims to respond to this gap in the scholarship by determining the prevalence of supportive care needs and examining the relationship between patients' needs and distress. METHOD A cross-sectional research protocol included a consecutive sample of 60 patients with squamous and/or basal cell carcinomas who completed a survey comprised of the Skin Cancer Index (SCI), the Hospital Anxiety and Depression Scale (HADS), the Supportive Care Needs (SCNS) Survey, an inquiry about informational needs regarding skin cancer prevention, and a socio-demographic questionnaire. RESULTS More than half of the patients indicated unmet needs, most frequently endorsing moderate and high needs for help with: the prevention of future skin cancers, the health system and informational matters. Psychological needs were strongly associated with skin cancer-specific and general distress. Higher levels of anxious and depressive symptoms were related to greater patient needs across all domains. CONCLUSIONS Despite NMSC not being life threatening in most cases, there is a significant proportion of patients, who have unmet supportive care needs and experience heightened distress levels. This study raises awareness for health care professionals to be vigilant about the supportive care needs and the psychological health of patients with non-melanoma skin cancer.
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Affiliation(s)
- Annett Körner
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Suite 614, Montreal, Quebec, H3A 1Y2, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, Quebec, H3T 1E2, Canada; Psychosocial Oncology Program, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada; Department of Oncology, McGill University, 546 Pine Avenue West, Montreal, Quebec, H2W 1S6, Canada.
| | - Rosalind Garland
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada.
| | - Zofia Czajkowska
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Suite 614, Montreal, Quebec, H3A 1Y2, Canada.
| | - Adina Coroiu
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Suite 614, Montreal, Quebec, H3A 1Y2, Canada.
| | - Manish Khanna
- Department of Medicine, McGill University, 1650 Cedar Avenue, Room D6.237, Montreal, Quebec, H3G 1A4, Canada; Dermatology-Oncology Unit, Segal Cancer Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, Quebec, H3T 1E2, Canada.
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25
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Mathias SD, Chren MM, Crosby RD, Colwell HH, Yim YM, Reyes C, Chen DM, Fosko SW. Reliability and validity of the Advanced Basal Cell Carcinoma Index (aBCCdex). Br J Dermatol 2015; 173:713-9. [PMID: 25939524 DOI: 10.1111/bjd.13877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) questionnaires were recently developed specifically for use with patients with advanced basal cell carcinoma (aBCC) and basal cell carcinoma naevus syndrome (BCCNS). OBJECTIVES To evaluate the measurement properties of PRO questionnaires for use in patients with aBCC or BCCNS. METHODS In total 129 patients from 10 clinical sites in the U.S.A. and the BCCNS Support Network completed the two newly developed questionnaires multiple times over 3 months. Patients also completed the Skindex-16 and the 12-Item Short-Form Health Survey as collateral measures. Psychometric properties of the questionnaires were evaluated, including internal consistency and test-retest reliability, construct and known-groups validity, and responsiveness. RESULTS Based on the results of exploratory factor analysis and clinical input, the two newly developed questionnaires were combined into a single questionnaire, called the aBCCdex, which is relevant for patients with both aBCC and BCCNS. The internal consistency reliability was acceptable, and all aBCCdex scale scores correlated significantly with conceptually similar scales. When divided into groups that differed based on scores from collateral measures, aBCCdex scale scores differentiated between groups (known-groups validity) and were responsive to change. CONCLUSIONS The aBCCdex is a brief and comprehensive questionnaire appropriate for use with patients with aBCC and BCCNS. Its reliability and validity have been confirmed. Further research is necessary to estimate the minimally important difference in a larger patient population.
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Affiliation(s)
- S D Mathias
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - M M Chren
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - R D Crosby
- Health Outcomes Solutions, Neuropsychiatric Research Institute, and University of North Dakota School of Medicine and Health Sciences, Fargo, ND, U.S.A
| | - H H Colwell
- Health Outcomes Solutions, 2351 Via Tuscany, Winter Park, FL, 32789, U.S.A
| | - Y M Yim
- Genentech, San Francisco, CA, U.S.A
| | - C Reyes
- Genentech, San Francisco, CA, U.S.A
| | - D M Chen
- Genentech, San Francisco, CA, U.S.A
| | - S W Fosko
- Departments of Dermatology, Internal Medicine, Head and Neck Surgery-Otolaryngology and Ophthalmology, Saint Louis University Cancer Center, Saint Louis University School of Medicine, St Louis, MO, U.S.A
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Abstract
BACKGROUND Physical appearance influences nearly every aspect of human life-impacting how people are judged and subsequently treated by others. OBJECTIVE To summarize the literature that addresses the psychosocial impact of facial scarring, with a particular emphasis on scarring after skin cancer treatment. MATERIALS AND METHODS A comprehensive PubMed search was conducted to find articles related to scarring and appearance in the contexts of cutaneous oncology and surgical reconstruction. References from retrieved articles were also considered for review. RESULTS Scars, especially on the head and neck, change physical appearance and can negatively impact psychosocial functioning. Medical professionals may underestimate the importance of physical appearance for patients with skin cancer. Validated patient-reported outcome (PRO) tools may prove better than objective scar ratings to identify patients who may experience psychosocial impairment from scarring. CONCLUSION Scarring after skin cancer surgery can profoundly affect psychosocial functioning. Perioperative use of validated PRO tools can help to identify patients with scar concerns. Heightened awareness of patients' psychosocial status will allow practitioners to offer appropriate counseling or support.
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de Troya-Martín M, Rivas-Ruiz F, Blázquez-Sánchez N, Fernández-Canedo I, Aguilar-Bernier M, Repiso-Jiménez JB, Toribio-Montero JC, Jones-Caballero M, Rhee J. A Spanish version of the Skin Cancer Index: a questionnaire for measuring quality of life in patients with cervicofacial nonmelanoma skin cancer. Br J Dermatol 2014; 172:160-8. [PMID: 24910357 DOI: 10.1111/bjd.13173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Skin Cancer Index (SCI) is the first specific patient-reported outcome measure for patients with cervicofacial nonmelanoma skin cancer. To date, only the original English version has been published. OBJECTIVES To develop a Spanish version of the SCI that is semantically and linguistically equivalent to the original, and to evaluate its measurement properties in this different cultural environment. MATERIAL AND METHODS A cross-sectional study was conducted of the cultural adaptation and empirical validation of the questionnaire, analysing the psychometric properties of the new index at different stages. RESULTS Of 440 patients recruited to the study, 431 (95%) completed the Spanish version of the SCI questionnaire, in a mean time of 6·3 min (SD 2·9). Factor analysis of the scale revealed commonality and loading values of < 0·5 for three of the 15 items. The remaining 12 items converged into two components: appearance/social aspects (seven items) and emotional aspects (five items). Both domains presented a high level of internal consistency, with Cronbach's alpha values above 0·8. The convergent-discriminant validity analysis produced correlations higher than 0·3 for the mental component of the Short Form Health Survey-12v2 Health Questionnaire (correlation coefficient 0·39) and the Dermatology Quality of Life Index (correlation coefficient -0·30). In the test-retest, nine of the 12 items produced a weighted kappa value exceeding 0·4, and for the remaining three items, the absolute agreement percentage exceeded 60%. CONCLUSIONS The Spanish version of the SCI quality of life scale has been satisfactorily adapted and validated for use in Spanish-speaking countries and populations.
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Affiliation(s)
- M de Troya-Martín
- Department of Dermatology, Hospital Costa del Sol, Marbella, Spain; Spanish Research Network on Health Care in Chronic Diseases (REDISSEC), Spain
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Lansbury L, Bath-Hextall F, Perkins W, Stanton W, Leonardi-Bee J. Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies. BMJ 2013; 347:f6153. [PMID: 24191270 PMCID: PMC3816607 DOI: 10.1136/bmj.f6153] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effects of treatments for non-metastatic invasive squamous cell carcinoma (SCC) of the skin using evidence from observational studies, given the paucity of evidence from randomised controlled trials. DESIGN Systematic review of observational studies. DATA SOURCES Medline, Embase, to December 2012. REVIEW METHODS Observational studies of interventions for primary, non-metastatic, invasive, SCC of the skin that reported recurrence during follow-up, quality of life, initial response to treatment, adverse events, cosmetic appearance, or death from disease. Studies were excluded if data for primary cutaneous SCC was not separable from other data. Data were extracted independently by two reviewers. Meta-analysis was performed where appropriate using a random effects model to estimate the pooled proportion of an event with 95% confidence intervals. RESULTS 118 publications were included, covering seven treatment modalities. Pooled estimates of recurrence of SCCs were lowest after cryotherapy (0.8% (95% confidence interval 0.1% to 2%)) and curettage and electrodesiccation (1.7% (0.5% to 3.4%)), but most treated SCCs were small, low risk lesions. After Mohs micrographic surgery, the pooled estimate of local recurrence during variable follow-up periods from 10 studies was 3.0% (2.2% to 3.9%), which was non-significantly lower than the pooled average local recurrence of 5.4% (2.5% to 9.1%) after standard surgical excision (12 studies), and 6.4% (3.0% to 11.0%) after external radiotherapy (7 studies). After an apparently successful initial response of SCCs to photodynamic therapy, pooled average recurrence of 26.4% (12.3% to 43.7%; 8 studies) was significantly higher than other treatments. Evidence was limited for laser treatment (1 study) and for topical and systemic treatments (mostly single case reports or small non-comparative series with limited follow-up). CONCLUSIONS Many observational studies have looked at different treatment modalities for SCC, but the evidence base for the effectiveness of these interventions is poor. Comparison of outcomes after different treatments should be interpreted cautiously owing to biases inherent in the types of study included, and lack of direct comparisons to enable the estimation of relative treatment effect. Further evidence is needed to develop a prognostic model and stratify individuals at high risk of developing SCC, to improve the evidence base for this common cancer and to optimise clinical management. PROTOCOL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42011001450.
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Affiliation(s)
- Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham NG7 2NR, UK
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Affiliation(s)
- N. Black
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; 15-17 Tavistock Place; London; WC1H 9SH; U.K
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