Quality of life in non‐melanoma skin cancer

Abstract

Basal cell carcinoma and squamous cell carcinoma are the most common malignancies and are classified under the umbrella of non-melanoma skin cancer (NMSC). NMSC exerts a small but appreciable decrement in quality of life (QOL). The impact posed may arise from the tumour itself or as a result of treatment, and through symptoms, functional limitations, cosmetic burden and auxiliary considerations such as cost and disturbance to the activities of daily living. Researchers have evaluated this burden using a variety of outcome measures including generic, dermatology-specific and disease-specific instruments. The skin cancer index represents a promising disease-specific patient-reported outcome measure in this setting. To overcome some of the constraints inherent to disease-specific instruments, and to allow comparisons with other diseases, utility weightings have been developed. Utility weightings represent a cardinal measure for a specific health status and are established through methods such as the standard gamble, willingness-to-pay and time trade-off, and have also been employed to generate utility weightings for NMSC. Utilities are becoming increasingly important as a means of comparing health states across medicine and are of particular importance from a health-care policy perspective as they are used for resource allocation. The small but definite impact on the individual's QOL posed by NMSC should be a clinical consideration for physicians and it should be recognised by researchers as a potential outcome measure.

Use of the Skin Cancer Quality of Life Impact Tool (SCQOLIT) – a feasibility study in non‐melanoma skin cancer

“…In general, SCQOLIT scores were low suggesting that NMSC has a low impact on HRQOL which supports previous studies . However, a few patients reported SCQOLIT scores ≥ 20 suggesting it is a suitable tool to identify patients for which there is significant impact on HRQOL, who may need enhanced support.…”

“…Patient‐reported outcome measures (PROMs) offer potential to improve the quality of dermatology services in the National Health Service (NHS) by providing validated evidence from the patient perspective. The incidence of non‐melanoma skin cancers (NMSCs) is exponentially increasing and although rarely life‐threatening, both disease and treatments can have significant impact on health‐related quality of life (HRQOL) . Evaluating PROMs in NMSC is essential because of the impact on health and the burden on healthcare resources, yet there are few studies to date.…”

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

“…While this represents a massive disease burden on society, NMSC and AK tend to involve lower morbidity and mortality than malignant melanoma and can be treated or managed successfully in many cases. Still, treatment of BCC and SCC routinely involves surgery and –given the predominant occurrence of these cancers in sun‐exposed areas such as the face and scalp –surgical measures can be gruelling, stressful and cosmetically unfavourable for the patients …”

“…The numerous therapeutic options available for the treatment of AK are regarded as a valuable approach to SCC prevention . There is reason to assume that NMSC goes along with a reduction in health‐related quality of life (QL), and various studies have tried to quantify this reduction with various patient‐reported outcome measures (PROMs) . Still, no robust data set is available for German‐speaking countries.…”

Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance

“…Nonmelanoma skin cancer is associated with a small but appreciable decrement in quality of life and accordingly this should be the outcome pursued. 16 Seidler's group used a simple probabilistic decision model to report that MMS was US$292 less expensive and yielded 0.056 additional QALYs compared with TE and was accordingly the dominant intervention. 5 From a health economics perspective, this is the best evidence to date regarding the costeffectiveness of MMS versus TE; however, further refinement such as the use of Markov modelling would improve the validity of the results obtained.…”