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Eichler M, Hönig K, Bergelt C, Faller H, Maatouk I, Hornemann B, Stein B, Teufel M, Goerling U, Erim Y, Geiser F, Niecke A, Senf B, Weis J. 12-Month Trajectories of Health-Related Quality of Life Following Hospitalization in German Cancer Centers-A Secondary Data Analysis. Curr Oncol 2024; 31:2376-2392. [PMID: 38785458 PMCID: PMC11120277 DOI: 10.3390/curroncol31050177] [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: 03/11/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Patient-reported outcomes (PROs) offer a diverse array of potential applications within medical research and clinical practice. In comparative research, they can serve as tools for delineating the trajectories of health-related quality of life (HRQoL) across various cancer types. We undertook a secondary data analysis of a cohort of 1498 hospitalized cancer patients from 13 German cancer centers. We assessed the Physical and Mental Component Scores (PCS and MCS) of the 12-Item Short-Form Health Survey at baseline (t0), 6 (t1), and 12 months (t2), using multivariable generalized linear regression models. At baseline, the mean PCS and MCS values for all cancer patients were 37.1 and 44.3 points, respectively. We observed a significant improvement in PCS at t2 and in MCS at t1. The most substantial and significant improvements were noted among patients with gynecological cancers. We found a number of significant differences between cancer types at baseline, t1, and t2, with skin cancer patients performing best across all time points and lung cancer patients performing the worst. MCS trajectories showed less pronounced changes and differences between cancer types. Comparative analyses of HRQoL scores across different cancer types may serve as a valuable tool for enhancing health literacy, both among the general public and among cancer patients themselves.
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Affiliation(s)
- Martin Eichler
- Medical Faculty, National Center for Tumor Diseases (NCT/UCC), Technical University Dresden, 01307 Dresden, Germany;
| | - Klaus Hönig
- Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Ulm (CCCU), Ulm University Hospital, 89070 Ulm, Germany;
| | - Corinna Bergelt
- Hamburg Hubertus Wald—University Cancer Center (CCC), University Clinic Centre, 20251 Hamburg, Germany;
| | - Hermann Faller
- Department Medical Psychology and Psychotherapy, Comprehensive Cancer Center Mainfranken, University of Würzburg, 97080 Würzburg, Germany;
| | - Imad Maatouk
- Department Internal Medicine and Psychosomatics, University Clinic Centre Heidelberg, 69120 Heidelberg, Germany;
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, 97080 Würzburg, Germany
| | - Beate Hornemann
- Medical Faculty, National Center for Tumor Diseases (NCT/UCC), Technical University Dresden, 01307 Dresden, Germany;
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, General Hospital Nuremberg, Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Martin Teufel
- Department Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Essen (WTZ) and LVR University Hospital, University of Duisburg-Essen, 45122 Essen, Germany;
| | - Ute Goerling
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Yesim Erim
- Department Psychosomatic Medicine, University Clinic Centre Erlangen, 91054 Erlangen, Germany;
| | - Franziska Geiser
- Department Psychosomatic Medicine, University Clinic Centre Bonn, 53127 Bonn, Germany;
| | - Alexander Niecke
- Faculty of Medicine & University Hospital, Department Psychosomatics and Psychotherapy, University of Cologne, 50937 Köln, Germany;
| | - Bianca Senf
- University Cancer Center, University Clinic Centre Frankfurt, 60590 Frankfurt, Germany;
- Protestant College of Darmstadt, University of Applied Sciences, 64293 Darmstadt, Germany
| | - Joachim Weis
- Faculty of Medicine and Medical Center University of Freiburg, Department Self-Help Research, Comprehensive Cancer Center, 79106 Freiburg, Germany;
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Jacobsen K, Ortner VK, Wenande E, Sahu A, Paasch U, Haedersdal M. Line-field confocal optical coherence tomography in dermato-oncology: A literature review towards harmonized histopathology-integrated terminology. Exp Dermatol 2024; 33:e15057. [PMID: 38623958 DOI: 10.1111/exd.15057] [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: 04/26/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 04/17/2024]
Abstract
Non-invasive diagnostics like line-field confocal optical coherence tomography (LC-OCT) are being implemented in dermato-oncology. However, unification of terminology in LC-OCT is lacking. By reviewing the LC-OCT literature in the field of dermato-oncology, this study aimed to develop a unified terminological glossary integrated with traditional histopathology. A PRISMA-guided literature-search was conducted for English-language publications on LC-OCT of actinic keratosis (AK), keratinocyte carcinoma (KC), and malignant melanoma (MM). Study characteristics and terminology were compiled. To harmonize LC-OCT terminology and integrate with histopathology, synonymous terms for image features of AK, KC, and MM were merged by two authors, organized by skin layer and lesion-type. A subset of key LC-OCT image-markers with histopathological correlates that in combination were typical of AK, squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and MM in traditional histopathology, were selected from the glossary by an experienced dermatopathologist. Seventeen observational studies of AK (7 studies), KC (13 studies), MM (7 studies) utilizing LC-OCT were included, with 117 terms describing either AK, KC, or MM. These were merged to produce 45 merged-terms (61.5% reduction); 5 assigned to the stratum corneum (SC), 23 to the viable epidermis, 2 to dermo-epidermal junction (DEJ) and 15 to the dermis. For each lesion, mandatory key image-markers were a well-defined DEJ and presence of mild/moderate but not severe epidermal dysplasia for AK, severe epidermal dysplasia and well-defined DEJ for SCCis, interrupted DEJ and/or dermal broad infiltrative strands for invasive SCC, dermal lobules connected and/or unconnected to the epidermis for BCC, as well as single atypical melanocytes and/or nest of atypical melanocytes in the epidermis or dermis for MM. This review compiles evidence on LC-OCT in dermato-oncology, providing a harmonized histopathology-integrated terminology and key image-markers for each lesion. Further evaluation is required to determine the clinical value of these findings.
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Affiliation(s)
- Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Aditi Sahu
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cao C, Wang N, Liu R, Patel AV, Friedenreich CM, Yang L. Leisure-time physical activity, daily sitting time, and mortality among US skin cancer survivors. Support Care Cancer 2023; 31:718. [PMID: 37999788 PMCID: PMC11121757 DOI: 10.1007/s00520-023-08192-6] [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: 08/18/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate the long-term effect of sitting time and physical activity after a skin cancer diagnosis. METHODS A cohort of a nationally representative sample of skin cancer survivors (n=862) and non-cancer adults (n=13691) ≥50 years from the US National Health and Nutrition Examination Survey. Mortality data were linked through December 31, 2019. RESULTS During up to 13.2 years of follow-up (median, 6.3 years; 94,093 person-years), 207 deaths (cancer: 53) occurred in skin cancer survivors and 1970 (cancer: 414) in non-cancer adults. After adjusting for covariates and skin cancer type, being active was associated with lower risks of all-cause (HR=0.69; 95% CI: 0.47 to 1.00) and non-cancer (HR=0.59; 95% CI: 0.36 to 0.97) mortality compared to being inactive among skin cancer survivors. Meanwhile, sitting 8 h/d was associated with higher risks of all-cause (HR=1.72; 95% CI: 1.11 to 2.67) and non-cancer (HR=1.76; 95% CI: 1.07 to 2.92) mortality compared to sitting <6 h/d. In the joint analysis, inactive skin cancer survivors sitting >8 h/d had the highest mortality risks from all-cause (HR=2.26; 95% CI: 1.28 to 4.00) and non-cancer (HR=2.11; 95% CI,1.10 to 4.17). Additionally, the associations of LTPA and sitting time with all-cause and cause-specific mortality did not differ between skin cancer survivors and non-cancer adults (all P for interaction>0.05) CONCLUSION: The combination of prolonged sitting and lack of physical activity was associated with elevated risks of all-cause and non-cancer deaths among US skin cancer survivors. Skin cancer survivors could benefit from maintaining a physically active lifestyle.
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Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Nan Wang
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Na H, Oakley A. Timeliness of diagnosis and treatment of cutaneous melanoma with dermatology, general practice, plastics surgery collaboration - are we meeting standards? J Prim Health Care 2023; 15:267-273. [PMID: 37756232 DOI: 10.1071/hc23013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Melanoma is a serious type of skin cancer with a high burden in New Zealand. MelNet Quality Statements (2021) guide the timeliness of investigations and management for melanoma patients, who might experience long delays waiting for treatment. Aim To assess compliance of melanoma diagnosis and treatment timeliness with the MelNet Quality Statements at Waikato Hospital and in primary care for melanoma and melanoma in situ (MIS). Methods This is a retrospective clinical audit of patients referred via the Suspected Skin Cancer (SSC) teledermatology pathway between June 2020 and June 2022, and histologically confirmed as having melanoma or MIS. Time intervals between elements of service were analysed. Results For 43 melanomas and 105 MIS, compliance with MelNet Quality Statements across all melanoma services was poor, except for teledermatology response rates (100% compliance). From referral to first cancer treatment (Statement 2.1.1), compliance was 50% in general practice and 7.7% in Waikato Hospital. From teledermatologist response to biopsy (Statement 2.1.3), compliance was 65.2% in general practice and 7.7% in hospital plastics department. Histopathological reporting delays were also identified. Discussion Long delays for melanoma care in hospital likely reflect system failures (such as inadequate funding and human resources) and the increasing burden of skin cancer. In contrast, primary care provided quicker diagnostic biopsies and surgical treatments for melanoma.
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Affiliation(s)
- Haein Na
- Te Whatu Ora Waitemata, 124 Shakespeare Road, Takapuna, Auckland 0620, New Zealand
| | - Amanda Oakley
- Te Whatu Ora Waikato, 183 Pembroke Street, Hamilton 3204, New Zealand; and Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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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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Lai-Kwon J, Inderjeeth AJ, Lisy K, Sandhu S, Rutherford C, Jefford M. Impact of immune checkpoint inhibitors and targeted therapy on health-related quality of life of people with stage III and IV melanoma: a mixed-methods systematic review. Eur J Cancer 2023; 184:83-105. [PMID: 36907021 DOI: 10.1016/j.ejca.2023.02.005] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) and targeted therapies (TT) have significantly improved disease control and survival in people with stage III and IV cutaneous melanoma. Understanding the impact of therapy on health-related quality of life (HRQL) is vital for treatment decision-making and determining targets for supportive care intervention. We conducted a mixed-methods systematic review to synthesise the impact of ICIs and TT on all domains of HRQL in these populations. METHODS A systematic literature search was conducted in April 2022 on MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review question were extracted and synthesised in tables according to setting (adjuvant versus metastatic), treatment type (ICI versus TT) and HRQL issue. RESULTS Twenty-eight papers describing 27 studies were included: 15 randomised controlled trials (RCTs), four cohort studies, four single arm cross-sectional studies, two qualitative studies, one case control study and one mixed-methods study. In four studies of people with resected stage III melanoma, adjuvant pembrolizumab and dabrafenib-trametinib did not clinically or statistically change HRQL compared to baseline. In 17 studies of people with unresectable stage III/IV melanoma, inconsistencies in the impact of ICI on symptoms, functioning and overall HRQL were noted across different study designs. TT was associated with improvements in symptoms, functioning and HRQL across six studies. CONCLUSION This review highlights the key physical, psychological and social issues experienced by people with stage III and IV melanoma treated with ICI and TT. Inconsistencies in the impact of ICI on HRQL were observed in different study designs. This highlights the need for treatment-specific patient-reported outcome measures for determining the impact of these therapies on HRQL and real-world data to inform treatment decision-making and appropriate supportive care interventions.
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Affiliation(s)
- Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | | | - Karolina Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shahneen Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Claudia Rutherford
- Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Quality of Life Office, School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Toma AO, Boeriu E, Decean L, Bloanca V, Bratosin F, Levai MC, Vasamsetti NG, Alambaram S, Oprisoni AL, Miutescu B, Hemaswini K, Juganaru I, Bondar AC, Moise ML. The Effects of Lack of Awareness in Age-Related Quality of Life, Coping with Stress, and Depression among Patients with Malignant Melanoma. Curr Oncol 2023; 30:1516-1528. [PMID: 36826077 PMCID: PMC9955948 DOI: 10.3390/curroncol30020116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Almost one-third of all malignant melanoma patients exhibit emotional stress indicating the need for professional care. Considering this, patients' psychological needs are routinely overlooked and unfulfilled, even though there is substantial evidence that psychological therapies may enhance psychosocial outcomes for melanoma patients, such as low mood, sadness, and anxiety. Among developing countries and some health systems in developed regions, the lack of awareness and screening methods for skin cancer creates a high risk of psychological issues associated with more advanced diseases. Therefore, the current study aimed to investigate and compare the impact of malignant melanoma awareness for screening, prevention, and treatment on the patient's quality of life and coping with stress and depression, based on patients' age. This cross-sectional study recruited 238 patients with malignant melanoma distributed into two groups, Group A patients between 18 and 65 years and Group B patients older than 65. There were no significant gender differences and cancer staging differences between groups, although self-reported depressed mood and anhedonia were significantly more frequent in younger adults with malignant melanoma (43.8% vs. 28.9%). From the unstandardized surveys, it was observed that significantly fewer patients from Group B knew that melanoma could be caused by sun exposure (34.2% vs. 52.2%), and they were less likely to use sunscreen or visit a doctor to evaluate their skin moles (25.9% vs. 14.5%). Elderly patients preferred television as the main source of information, and only 68.4% of patients from Group B were using smart devices. There was a significantly higher physical score on the SF-12 scale among Group A patients, although patients from Group B scored higher in the mental health assessment, and the perceived helplessness on the PSS-10 scale was significantly higher compared to younger adults with melanoma (2.97 vs. 2.71, p-value = 0.036). Lower scores on the physical and mental SF-12 questionnaire determined a higher presence of depressive symptoms (rho = -0.352, respectively rho = -0.273). Higher scores on the DLQI sexual difficulties and treatment difficulties also correlated significantly with the presence of depressive symptoms and anhedonia (rho = 0.341, respectively rho = 0.264). Awareness campaigns for malignant melanoma should focus on the elderly population, too, using the television as the main communication channel. On the other hand, the more informed and knowledgeable group of adults younger than 65 are more likely to experience psychological problems and should be targeted for psycho-oncological aid.
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Affiliation(s)
- Ana-Olivia Toma
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Estera Boeriu
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Luminita Decean
- Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Strada Gheorghe Marinescu 38, 540139 Targu Mures, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihaela Codrina Levai
- Research Center for Medical Communication, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Neeharika Gayatri Vasamsetti
- Faculty of General Medicine Nizampura, Kaloji Narayana Rao University of Health Sciences, Warangal 506007, India
| | - Satish Alambaram
- Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | - Andrada Licinia Oprisoni
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Kakarla Hemaswini
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Iulius Juganaru
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania
| | - Andrei-Cristian Bondar
- Psychiatry Hospital “Prof. Dr. Alexandru Obregia”, Soseaua Berceni 10, 041914 Bucuresti, Romania
| | - Marius Liviu Moise
- Department of Radiology, “Premiere” Hospital—“Regina Maria”, Calea Aradului 113, 300643 Timisoara, Romania
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Karakok H, Bostanci S, Akay BN, Calıskan D, Ateş C, Köse K. Validation of the Turkish Version of the Skin Cancer Quality of Life Impact Tool (SCQOLIT): A Health-Related Quality of Life Questionnaire for Non-metastatic Melanoma and Non-melanoma Skin Cancer. Dermatol Pract Concept 2023; 13:dpc.1301a1. [PMID: 36892383 PMCID: PMC9946060 DOI: 10.5826/dpc.1301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Skin cancer is the third most common type of cancer worldwide that has increased in incidence. Quality of life (QoL) instruments have been developed to measure the efficacy of treatments of cancers.
Objectives: The only validated tool that can be used in both nonmetastatic skin cancer types is the SCQOLIT. This study aimed to validate the Turkish version of the Skin Cancer Quality of Life Impact Tool (SCQOLIT).
Methods: A total of 141 patients diagnosed and treated for skin cancer within the previous 3 months were included. The tool was translated into Turkish in accordance with International Translation Guidelines. The Dermatology Quality of Life Index that was used for external validation. Patient demographics were recorded.
Results: Question 3 had a factor load of 0.372, indicating the inadequacy of this question in predicting QoL, a point that the original study did not mention. The SCQOLIT had external validity, convergent validity and internal consistency (Cronbach alpha=0.863), and test-repeat-test correlation coefficient was 0.824 (95% confidence interval; 0.644 – 0.918). Patients diagnosed with melanoma had poorer QoL scores. High-risk tumor characteristics in nonmelanoma skin cancer and stage of melanoma had no impact on QoL (p=0.235 for basal cell carcinoma, p=1.00 for squamous cell carcinoma, p=0.635 for melanoma).
Conclusions: The Turkish version of the SCQOLIT is validated. Age was shown to have a statistically significant negative correlation with QoL, while Fitzpatrick skin type, gender, risk classification, stage, history of skin cancer, family history of skin cancer and treatment modality had no effect on QoL.
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Affiliation(s)
- Hilayda Karakok
- Sifa Okulu, Private Practice Office of Dermatology and Venereology, Ataturk Bulvarı, Tasbası Mahallesi, Altınordu - Ordu, Turkey
| | - Seher Bostanci
- Department of Dermatology and Venereology, Ankara University School of Medicine, Turkey
| | - Bengu Nisa Akay
- Department of Dermatology and Venereology, Ankara University School of Medicine, Turkey
| | - Deniz Calıskan
- Department of Public Health, Ankara University School of Medicine, Turkey
| | - Can Ateş
- Department of Biostatistics, Van Yüzüncü Yıl University, School of Medicine
| | - Kenan Köse
- Department of Biostatistics, Ankara University School of Medicine, Turkey
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Tumor Burden and Health-Related Quality of Life in Patients with Melanoma In-Transit Metastases. Cancers (Basel) 2022; 15:cancers15010161. [PMID: 36612157 PMCID: PMC9817978 DOI: 10.3390/cancers15010161] [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: 10/30/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Few studies have investigated the health-related quality of life (HRQOL) in patients with melanoma in-transit metastases (ITM). The aim was to investigate the association between tumor burden and HRQOL, including disparities pertaining to sex and age, in treatment-naïve patients with ITM. METHODS Functional Assessment of Cancer Therapy-Melanoma (FACT-M) questionnaire was used to assess HRQOL Pairwise comparisons using t-tests between clinical cutoffs are presented and multiple linear regression analysis showing the unique associations of gender, age, number of tumors, tumor size, presence of lymph node metastases, and tumor localization. RESULTS A total of 95 patients, 47% females and 53% males (median age 72 years) were included between 2012 and 2021. Women scored significantly lower on emotional well-being (p = 0.038) and lower on FACT-M (p = 0.058). Patients who had ≥10 tumors scored significantly lower on FACT-M (p = 0.015), emotional- and functional well-being (p = 0.04, p = 0.004, respectively), melanoma scale (p = 0.005), and FACT-G (p = 0.027). There was no significant difference in HRQOL depending on age, size of tumors, localization, or presence of lymph node metastases. CONCLUSION For patients with melanoma ITMs, the female sex and higher tumor burden (i.e., number of tumors) were significantly correlated with lower HRQOL. However, these findings do not fully explain HRQOL for this patient population, and future research should consider the possibility that there are specific questions for patients with ITM where current instruments might fail to measure their discomfort to the full extent.
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Health-related quality of life in patients with advanced melanoma treated with ipilimumab: prognostic implications and changes during treatment. ESMO Open 2022; 7:100588. [PMID: 36116420 PMCID: PMC9588897 DOI: 10.1016/j.esmoop.2022.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background We have previously reported that the safety and efficacy of ipilimumab in real-world patients with metastatic melanoma were comparable to clinical trials. Few studies have explored health-related quality of life (HRQL) in real-world populations receiving checkpoint inhibitors. This study reports HRQL in real-world patients receiving ipilimumab and assesses the prognostic value of patient-reported outcome measures. Patients and methods Ipi4 (NCT02068196) was a prospective, multicentre, interventional phase IV trial. Real-world patients (N = 151) with metastatic melanoma were treated with ipilimumab 3 mg/kg intravenously as labelled. HRQL was assessed by the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire at baseline and after 10-12 weeks. Results The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire was completed by 93% (141/151 patients) at baseline, and by 82% at 10-12 weeks. Poor performance status and elevated C-reactive protein (CRP) were associated with worse baseline HRQL. Clinically relevant and statistically significant deteriorations in HRQL from baseline to weeks 10-12 were reported (P <0.05). Baseline physical functioning [hazard ratio (HR) 1.96, P = 0.016], role functioning (HR 2.15, P <0.001), fatigue (HR 1.60, P = 0.030), and appetite loss (HR 1.76, P = 0.012) were associated with poorer overall survival independent of performance status, lactate dehydrogenase (LDH), and CRP. We further developed a prognostic model, combining HRQL outcomes with performance status, LDH, and CRP. This model identified three groups with large and statistically significant differences in survival. Conclusions Systemic inflammation is associated with impaired HRQL. During treatment with ipilimumab, HRQL deteriorated significantly. Combining HRQL outcomes with objective risk factors provided additional prognostic information that may aid clinical decision making. HRQL was independently associated with survival in patients with metastatic melanoma receiving ipilimumab. Patients experienced clinically meaningful and statistically significant deteriorations in HRQL during therapy. A prognostic model combining HRQL and biological markers defined three groups with highly variable life expectancies. This prognostic model may be of use in clinical decision making.
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Adapted Physical Activity Protocol for Lower Limb Functional and Strength Recovery in a Young Athlete with Cutaneous Melanoma: Feasibility and Efficacy during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159590. [PMID: 35954946 PMCID: PMC9367956 DOI: 10.3390/ijerph19159590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
Adapted physical activity (APA) can improve psychophysical wellbeing and quality of life (QoL) in cancer survivors, a vulnerable population requiring a global management, especially during the recent pandemic. On this basis, we investigated for the first time the impact of a tailored APA intervention on a melanoma-affected 18-year-old female athlete to counteract treatment sequelae and promote lower limb functional and strength recovery. Patient was evaluated at baseline and post-protocol by a test battery focusing on mobility, muscle strength measured by dynamometry, and lower limb girths assessed at specific anatomical points. Moreover, health-related QoL, depression/anxiety, psychological distress and pain intensity were evaluated by Functional Assessment of Cancer Therapy–Melanoma (FACT-M), Hospital Anxiety and Depression Scale (HADS), distress thermometer, and numerical rating scale (NRS) questionnaires, respectively. An almost doubled up increase in lower limb strength, along with hip mobility improvement, and post-surgical edema and pain reduction were observed following the protocol. Concerning the QoL assessment, a moderate post-intervention improvement in physical and emotional wellbeing was detected, while depression state worsened though remaining within the normality range. Our findings show that a specialist-supervised structured APA protocol based on a patient-centered multidisciplinary approach may represent an effective strategy to recover functional and psychophysical efficiency, thus promoting a quick return to daily life activities and offering a concrete chance of resuming competitive sport practice.
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Ranieri J, Di Giacomo D, Guerra F, Cilli E, Martelli A, Ciciarelli V, Ventura A, Fargnoli MC. Early Diagnosis of Melanoma and Breast Cancer in Women: Influence of Body Image Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159264. [PMID: 35954618 PMCID: PMC9368107 DOI: 10.3390/ijerph19159264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
The diagnosis of melanoma and breast cancer may impact many aspects of life with significant reductions in emotional functioning and quality of life. The aim of the study was to analyze the emotional traits of female patients with oncological in early-stage diagnosis, investigating predictors for psychological distress and analyzing body image perception. An observational study was conducted, A sample of 84 female cancer patients (age range 30–55 years) with melanoma (n = 42) and breast cancer diagnosis (n = 42). The examined emotional variables were psychological distress; depression, stress, and anxiety; metacognitions; and body self-perception. Findings showed higher psychological distress in breast cancer than in melanoma patients (p = 0.00), which was related to lower positive self-perception of body image (p = 0.03). Furthermore, psychological distress was negatively correlated with consequences of clinical treatment on body image, and low well-being affected the social interaction and well-being with own body. There was no significant difference between cancer staging and timing from diagnosis. Prevention and therapeutic psychological protocols might be adapted and tailored to the unmet needs of the patients in medical treatments to promote and enhance the Quality of Life in survivorship.
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Affiliation(s)
- Jessica Ranieri
- Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, P.le S. Tommasi 1, 67010 L’Aquila, Italy; (J.R.); (D.D.G.); (F.G.); (E.C.)
| | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, P.le S. Tommasi 1, 67010 L’Aquila, Italy; (J.R.); (D.D.G.); (F.G.); (E.C.)
| | - Federica Guerra
- Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, P.le S. Tommasi 1, 67010 L’Aquila, Italy; (J.R.); (D.D.G.); (F.G.); (E.C.)
| | - Eleonora Cilli
- Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, P.le S. Tommasi 1, 67010 L’Aquila, Italy; (J.R.); (D.D.G.); (F.G.); (E.C.)
| | - Alessandra Martelli
- Campus Universitario “Aurelio Saliceti”, University of Teramo, Via Renato Balzarini 1, 64100 Teramo, Italy;
| | - Valeria Ciciarelli
- UOSD Oncological and General Dermatology, Via Lorenzo Natali 1, 67100 Padova, Italy; (V.C.); (A.V.)
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy
| | - Alessandra Ventura
- UOSD Oncological and General Dermatology, Via Lorenzo Natali 1, 67100 Padova, Italy; (V.C.); (A.V.)
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy
| | - Maria Concetta Fargnoli
- UOSD Oncological and General Dermatology, Via Lorenzo Natali 1, 67100 Padova, Italy; (V.C.); (A.V.)
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy
- Correspondence:
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Wang X, Li M, Shi Q, Ji H, Kong S, Zhu L, Zhang HM. Fear of Progression, Anxiety, and Depression in Patients With Advanced Melanoma in the COVID-19 and Post-COVID-19 Era. Front Psychiatry 2022; 13:880978. [PMID: 35558429 PMCID: PMC9086779 DOI: 10.3389/fpsyt.2022.880978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) pandemic causes great disruption to cancer care services, which might bring about psychological problems and further lower both physical and mental life quality in cancer patients. Until now, very few studies focused on the psychological distress of patients with advanced melanoma before or during the epidemic. This study aimed to elucidate the fear of progression (FoP), anxiety, depression, and related independent predictors in patients with advanced melanoma during the COVID-19 outbreak. METHODS Two hundred and seventy-three patients with unresectable stage III or metastatic melanoma were recruited from February 2020 to November 2021, and completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), State Trait Anxiety Inventory (STAI-6), and Patient Health Questionnaire (PHQ-9). RESULTS One hundred and seventy-four (64.7%) patients experienced heighted FoP (FoP-Q-SF: 39.9 ± 11.0), 198 (72.5%) patients reported elevated anxiety (STAI-6: 13.1 ± 3.0), and 62 (22.7%) patients had increased depression (PHQ-9: 6.4 ± 6.1). In multivariate analysis, illness duration (OR = 0.987 for FoP; OR = 0.984 for depression), cancer stage (OR = 14.394 for anxiety) and disease progression (OR = 1.960 for FoP; OR = 23.235 for anxiety; OR = 1.930 for depression) were independent predictors for FoP, anxiety or depression. Additionally, the high levels of FoP, anxiety and depression were significantly positive correlated with each other (r = 0.466 for FoP and anxiety; r = 0.382 for FoP and depression; r = 0.309 for anxiety and depression). CONCLUSION Our study indicates that FoP, anxiety and depression are persisting among patients with advanced melanoma in the COVID-19 and post-COVID-19 era. Effective psycho-oncological interventions are needed for melanoma patients with psychological distress during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Xiaowen Wang
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Min Li
- Department of Neurosurgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Qiong Shi
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongchen Ji
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shengnan Kong
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Hong-Mei Zhang
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Early stage melanoma diagnosis and mental health-related: emotional influence of body self-perception. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Lukowiak TM, Perz AM, Veerabagu SA, Lee MP, Neal D, Aizman L, Miller CJ, Golda N, Albertini JG, Holmes T, Bar A, Leitenberger J, Maher IA, Sobanko JF, Chen D, Aasi S, Sutton A, Higgins HW, Shin TM, Weinberger C, Mattox A, Wysong A, Etzkorn JR. Patient Quality of Life After Interpolated Flap Repair of Nasal Mohs Surgery Defects: A Multicenter Prospective Cohort Study. JAMA Dermatol 2021; 157:1213-1216. [PMID: 34431977 DOI: 10.1001/jamadermatol.2021.3161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Single-center studies have shown that patients report better skin cancer-specific quality of life (QOL) after Mohs micrographic surgery (MMS), but it is unclear whether this improved QOL applies to patients after MMS and complex reconstruction in cosmetically sensitive areas. Objective To evaluate patient QOL after MMS and interpolation flap reconstruction for patients with nasal skin cancers. Design, Setting and Participants This multicenter prospective survey study used the Skin Cancer Index (SCI), a validated, 15-question QOL questionnaire administered at 4 time points: before MMS, 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Patients age 18 years or older with a nasal skin cancer who presented for MMS and were anticipated to undergo 2-stage interpolated flap repair by a Mohs surgeon were recruited from August 9, 2018, to February 2, 2020, at 8 outpatient MMS locations across the United States, including both academic centers and private practices. Main Outcomes and Measures Mean difference in overall SCI score before MMS vs 16 weeks after flap takedown. Results A total of 169 patients (92 men [54.4%]; mean [SD] age, 67.7 [11.4] years) were enrolled, with 147 patients (75 men [51.0%]; mean [SD] age, 67.8 [11.7] years) completing SCI surveys both before MMS and 16 weeks after flap takedown. Total SCI scores improved significantly 16 weeks after flap takedown compared with pre-MMS scores, increasing by a mean of 13% (increase of 7.11 points; 95% CI, 5.48-8.76; P < .001). All 3 SCI subscale scores (emotion, appearance, and social) improved significantly (emotion subscale, increase of 3.27 points; 95% CI, 2.35-4.18; P < .001; appearance subscale, increase of 1.65 points; 95% CI, 1.12-2.18; P < .001; and social subscale, increase of 2.10 points; 95% CI, 1.55-2.84; P < .001) 16 weeks after flap takedown compared with pre-MMS. Conclusions and Relevance Removal of a nasal skin cancer and repair of the resulting defect can be distressing for patients. However, this cohort study suggests that physicians referring patients for MMS can be reassured that their patient's QOL will improve on average after surgery, even when a complex reconstruction is required.
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Affiliation(s)
- Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | | | | | - Donald Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia
| | | | - Todd Holmes
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - David Chen
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Sumaira Aasi
- Department of Dermatology, Stanford University, Stanford, California
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | | | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia.,Associate Editor, JAMA Dermatology
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Lindqvist Bagge AS, Wesslau H, Cizek R, Holmberg CJ, Moncrieff M, Katsarelias D, Carlander A, Olofsson Bagge R. Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review. Eur J Surg Oncol 2021; 48:312-319. [PMID: 34600786 DOI: 10.1016/j.ejso.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since there are no formal definition of health-related quality of life (HRQOL) there may be a lack of coherence and understanding of how to interpret HRQOL-data. The aim of this study is to summarize HRQOL-results that have used the FACT-M questionnaire in patients with melanoma, and specifically to summarize FACT-M between tumor stage. METHODS This review was conducted in accordance with the PRISMA guidelines. INCLUSION CRITERIA original studies on cutaneous melanoma between 2005 and 2020, written in English, containing "Functional Assessment of Cancer Therapy Melanoma" OR "Functional Assessment of Cancer Therapy M" OR FACT-M OR FACT/M OR FACTM OR "FACT M" OR FACT-melanoma OR "FACT Melanoma" together with FACT-M numbered data and basic patient characteristics, using the databases Scopus, Web of Science, PubMed and PsycINFO. RESULTS 16 articles describing 14 patient cohorts published 2008-2020 were included. The majority of the studies did not report subscale scores in accordance with FACT-M guidelines. The results did indicate that FACT-M total scores were inversely correlated with AJCC stage. Subscale analysis demonstrated varying degrees of correlation with AJCC stage. The Melanoma Surgery Subscale score was lowest in stage III patients, probably reflecting more advanced surgical procedures in this group of patients. CONCLUSIONS Though this review is based on a questionnaire limited to the assessment of melanoma patients, it highlights the universal need for clinical studies to describe their selected HRQOL-questionnaires, its definition of HRQOL and its dimensions, as well as comply with the questionnaire's guidelines when reporting HRQOL-data.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Gothenburg University, Gothenburg, Sweden.
| | - Hanna Wesslau
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Roza Cizek
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Carl Jacob Holmberg
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Dimitrios Katsarelias
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Carlander
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; SOM Institute. University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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The impact of the Covid-19 pandemic on quality of life in skin cancer patients. PLoS One 2021; 16:e0255501. [PMID: 34407086 PMCID: PMC8372941 DOI: 10.1371/journal.pone.0255501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
With more than 82 million cases worldwide and almost two million deaths, the Covid-19 global pandemic shows little sign of abating. However, its effect on quality of life (QoL) in skin cancer patients has not been systematically evaluated to date. Given that QoL impairments may be associated with increased psychological morbidity, and may interfere with engagement with cancer therapy and follow-up, we prospectively evaluated quality of life in skin cancer patients using the Covid-19 Emotional Impact Survey (C-19EIS) and the EORTC QLQ-C30 questionnaires. 101 patients (48 females and 53 males) completed both questionnaires. The mean C-19EIS score was 3.8 on a scale from 0 (no impact) to 12 (severe impact). Patients undergoing systemic therapy showed significantly impaired physical (p = 0.006) and social functioning (p = 0.003). However, when compared to the published normative EORTC QLQ-C30 data, there was no evidence that the Covid-19 pandemic had significantly impacted upon overall quality of life. Subscales of the EORTC QLQ-C30 were significantly inversely correlated with the C-19EIS, validating its use in skin cancer patients. Despite the Covid-19 pandemic, skin cancer patients in our tertiary referral center were surprisingly resilient. However, given the geographical variations in the rates of Sars-CoV-2 infection it is possible that the low incidence in Northern Germany may have resulted in a lack of general QoL impairments. Multi-center studies are required to further determine the impact of Covid-19 on psychological wellbeing in skin cancer patients in order to develop supportive interventions and to ensure that engagement with cancer care services is maintained in order to enable early detection of cancer progression and/or recurrence.
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Subasri M, Lemonde M, Mundluru J, Chang J, Koneru R. Assessing the Educational and Supportive Care Needs of Canadian Metastatic Melanoma Patients and Survivors Attending an Outpatient Clinic. J Patient Exp 2021; 8:23743735211033126. [PMID: 34368426 PMCID: PMC8312183 DOI: 10.1177/23743735211033126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The rapid development of metastatic melanoma treatment options has significantly improved overall survival, but paralleled patient educational and supportive care resources have fallen behind. Particularly, the need for grassroots programs targeting environments outside urban centers has grown. Accordingly, an environmental scan of the Durham region in Ontario, Canada, showed the lack of melanoma-specific resources for outpatients. The goal of this study was to identify the needs of metastatic melanoma patients and survivors attending a large outpatient clinic in Durham, and then develop a patient-reviewed intervention plan. Needs were assessed in 5 domains through a melanoma-specific supportive care needs assessment survey. Among 75 surveyed melanoma patients and survivors, high-level needs were identified in 3 domains: psychological, health system information, and melanoma-specific information. Furthermore, domain-specific needs were heightened in specific sociodemographic groups. Based on these survey results, a multifaceted intervention plan was developed to mitigate future needs. The intervention plan was patient-reviewed in focus groups prior to implementation, refining the developed intervention plan.
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Affiliation(s)
- Mathushan Subasri
- Lakeridge Health Oshawa-Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Manon Lemonde
- Lakeridge Health Oshawa-Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Jahnavi Mundluru
- Lakeridge Health Oshawa-Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Jose Chang
- Lakeridge Health Oshawa-Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Rama Koneru
- Lakeridge Health Oshawa-Durham Regional Cancer Centre, Oshawa, Ontario, Canada
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Gogas H, Dummer R, Ascierto PA, Arance A, Mandalà M, Liszkay G, Garbe C, Schadendorf D, Krajsová I, Gutzmer R, Sileni VC, Dutriaux C, Yamazaki N, Loquai C, Queirolo P, Jan de Willem G, Sellier AT, Suissa J, Murris J, Gollerkeri A, Robert C, Flaherty KT. Quality of life in patients with BRAF-mutant melanoma receiving the combination encorafenib plus binimetinib: Results from a multicentre, open-label, randomised, phase III study (COLUMBUS). Eur J Cancer 2021; 152:116-128. [PMID: 34091420 DOI: 10.1016/j.ejca.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In COLUMBUS, treatment with encorafenib plus binimetinib in patients with advanced BRAF-mutant melanoma showed improved progression-free and overall survival with favourable tolerability compared to vemurafenib treatment. Here, results on health-related quality of life (HRQoL) are presented. METHODS COLUMBUS was a two-part, open-label, randomised, phase III study in patients with BRAF-mutant melanoma. In PART-I, 577 patients were randomised (1:1:1) to encorafenib plus binimetinib, encorafenib or vemurafenib. The primary objective was to assess progression-free survival. As a secondary objective, HRQoL was assessed by the EQ-5D, the EORTC QLQ-C30 and the FACT-M questionnaires. Furthermore, time to definitive 10% deterioration was estimated with a Kaplan-Meier analysis and differences in mean scores between groups were calculated with a mixed-effect model for repeated measures. Hospitalisation rate and the impact of hospitalisation on HRQoL were also assessed. RESULTS Patients receiving the combination treatment showed improvement of their FACT-M and EORTC QLQ-C30 global health status scores, compared to those receiving vemurafenib (post-baseline score differences: 3.03 [p < 0.0001] for FACT M and 5.28 [p = 0.0042] for EORTC QLQ-C30), indicative of a meaningful change in patient's status. Furthermore, a delay in the deterioration of QoL was observed in non-hospitalised patients compared to hospitalised patients (hazard ratio [95% CI]: 1.16 [0.80; 1.68] for EORTC QLQ-C30 and 1.27 [0.81; 1.99] for FACT-M) and a risk reduction of 10% deterioration, favoured the combination in both groups. CONCLUSION The improved efficacy of encorafenib plus binimetinib compared to vemurafenib, translates into a positive impact on the perceived health status as assessed by the HRQoL questionnaires. The study is registered with ClinicalTrials.gov, number NCT01909453 and EudraCT number 2013-001176-38.
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Affiliation(s)
- Helen Gogas
- National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
| | - Reinhard Dummer
- University Hospital Zürich Skin Cancer Center, Zürich, Switzerland
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Ana Arance
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Mario Mandalà
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | | | - Claus Garbe
- Eberhard Karls University, Tuebingen, Germany
| | - Dirk Schadendorf
- University Hospital Essen, Essen, Germany; German Cancer Consortium, Heidelberg, Germany
| | - Ivana Krajsová
- University Hospital Prague and Charles University First Medical Faculty, Prague, Czech Republic
| | | | | | - Caroline Dutriaux
- University Hospital Centre Bordeaux, Hôpital Saint-André, Bordeaux, France
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Groot Jan de Willem
- Department of Medical Oncology, Isala Oncological Center, Zwolle, Netherlands
| | | | - Jeanne Suissa
- Pierre Fabre Medicament, Boulogne-Billancourt, France
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20
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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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21
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Guo Y, Shen M, Zhang X, Xiao Y, Zhao S, Yin M, Bu W, Wang Y, Chen X, Su J. Unemployment and Health-Related Quality of Life in Melanoma Patients During the COVID-19 Pandemic. Front Public Health 2021; 9:630620. [PMID: 33692982 PMCID: PMC7937627 DOI: 10.3389/fpubh.2021.630620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.
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Affiliation(s)
- Yeye Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xu Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Mingzhu Yin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbo Bu
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Yan Wang
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
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22
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Moran C, Coroiu A, Körner A. Psychosocial distress in patients with cutaneous melanoma: validation of the Skin Cancer Index (SCI). Support Care Cancer 2021; 29:1005-1014. [PMID: 32556624 DOI: 10.1007/s00520-020-05568-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to examine the factor structure and psychometric properties of the Skin Cancer Index (SCI) in a sample of patients with melanoma. METHODS This study uses data from an observational study with longitudinal follow-up examining predictors of skin self-examination in melanoma patients from Montréal, Canada. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of the 15-item SCI scale. Correlations with other psychosocial measures of anxiety and depression, fear of cancer recurrence, quality of life, and emotional well-being were computed to examine construct validity. RESULTS EFA results with 241 participants revealed a two-factor structure with acceptable fit and no significant cross-loadings. CFA results with a subsample of 173 participants examining the two-factor structure and second-order structure found equivalent fit for the two solutions. Cronbach's alpha for the total scale score and both subscales was high. Both factors showed positive associations with measures of anxiety and depression and fear of cancer and negative associations with quality of life and emotional well-being. CONCLUSION Our study suggests that the SCI functions as a reliable two-factor scale assessing emotional and social distress in patients with melanoma, with the total SCI score assessing overall psychosocial distress.
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Affiliation(s)
- Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada.
| | - Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
- Jewish General Hospital, Lady Davis Institute of Medical Research, Montreal, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Montreal, Canada
- Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
- Department of Oncology, McGill University, Montreal, Canada
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23
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Beesley VL, Hughes MCB, Smithers BM, Khosrotehrani K, Malt MK, von Schuckmann LA, Green AC. Anxiety and depression after diagnosis of high-risk primary cutaneous melanoma: a 4-year longitudinal study. J Cancer Surviv 2020; 14:712-719. [PMID: 32519121 DOI: 10.1007/s11764-020-00885-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To quantify the prevalence of anxiety or depression (overall; melanoma-related) among people with high-risk primary melanoma, their related use of mental health services and medications, and factors associated with persistent new-onset symptoms across 4 years post-diagnosis. METHODS A longitudinal study of 675 patients newly diagnosed with tumor-stage 1b-4b melanoma. Participants completed the Hospital Anxiety and Depression Scale and answered questions about fear of cancer recurrence, use of medication, and support, serially over 4 years. We identified anxiety and depression trajectories with group-based trajectories models and factors associated with persistent symptoms with logistic regression. RESULTS At diagnosis, 93 participants (14%) had melanoma-related anxiety or depression, and 136 (20%) were affected by anxiety and/or depression unrelated to melanoma. After 6 months, no more than 27 (5%) reported melanoma-related anxiety or depression at any time, while the point prevalence of anxiety and depression unrelated to melanoma was unchanged (16-21%) among the disease-free. Of 272 participants reporting clinical symptoms of any cause, 34% were taking medication and/or seeing a psychologist or psychiatrist. Of the participants, 11% (n = 59) had new-onset symptoms that persisted; these participants were more likely aged < 70. CONCLUSIONS Melanoma-related anxiety or depression quickly resolves in high-risk primary melanoma patients after melanoma excision, while prevalence of anxiety or depression from other sources remains constant among the disease-free. However, one-in-ten develop new anxiety or depression symptoms (one-in-twenty melanoma-related) that persist. IMPLICATIONS FOR CANCER SURVIVORS Chronic stress has been linked to melanoma progression. Survivors with anxiety and depression should be treated early to improve patient and, potentially, disease outcomes.
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Affiliation(s)
- Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kiarash Khosrotehrani
- The University of Queensland, UQ Centre for Clinical Research & The University of Queensland Diamantina Institute, Experimental Dermatology Group, QLD, Brisbane, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lena A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Cancer Research UK Manchester Institute, and School of Biology, Medicine and Health, University of Manchester, Manchester, UK
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24
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Koboto DD, Deribe B, Gebretsadik A, Ababi G, Bogale N, Geleta D, Gemechu L, Mengistu K. Quality of Life Among Breast Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center. BREAST CANCER (DOVE MEDICAL PRESS) 2020; 12:87-95. [PMID: 32636670 PMCID: PMC7335303 DOI: 10.2147/bctt.s252030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breast cancer affects the overall quality of life (QOL) among its survivors. Limited evidence is available about the QOL among cases. Therefore, this study was intended to assess the quality of life of breast cancer patients attending the cancer treatment center at Hawassa University Comprehensive Specialized Hospital, Hawassa, southern Ethiopia. METHODS An institution-based cross-sectional study was conducted among breast cancer patients attending cancer treatment at the Hawassa University Comprehensive Specialized Hospital between April and June, 2019. All breast cancer patients attending treatment the center were included in the study by universal sampling. Data were collected using a structured questionnaire containing demographic data, patient clinical factors and Quality of Life Instrument (WHOQOL)-BREF version 3.0. The collected data were entered into EpiData software version 3.1 and analyzed using SPSS Version 20.0. Descriptive statistics were presented in tables. RESULTS A total of 259 respondents with a mean age of (SD) 44.89 (12.56) participated in study. The mean score of overall global health scale was 75.3 (SD±17.1) with the mean health satisfaction was 12.43 (SD±3.98). The highest mean score was observed in environmental domain, 93.31 (SD±19.76), despite social domain being very low, 36.69 (SD±7.62). Most of the participants were highly satisfied with the health care service that was provided, with a mean score of 16.1 (SD±3.1). In contrast, the majority of study participants were disappointed with the need for any medical treatment, body appearance, luxurious activities, and sexual life, with mean scores of 8.93 (SD±3.68), 8.74 (SD±4.26), 9.1 (SD±4.22), and 8.1 (SD±4.14), respectively. CONCLUSION Breast cancer patients in southern Ethiopia suffered from poor social and psychological support that, in turn, highly affected their life value. Therefore, due attention should be given to enhance social and psychological support for breast cancer patients as a whole.
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Affiliation(s)
- Dubale Dulla Koboto
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Bedilu Deribe
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Achamyelesh Gebretsadik
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Girma Ababi
- Fuculty of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Netsanet Bogale
- Fuculty of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Dereje Geleta
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Lalisa Gemechu
- Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
| | - Kurabachew Mengistu
- Fuculty of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, SNNPR, Ethiopia
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25
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Clarke LE, Mabey B, Flake Ii DD, Meek S, Cassarino DS, Duncan LM, High WA, Napekoski KM, Prieto VG, Tetzlaff MT, Vitale P, Elder DE. Clinical validity of a gene expression signature in diagnostically uncertain neoplasms. Per Med 2020; 17:361-371. [PMID: 32915688 DOI: 10.2217/pme-2020-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: Evaluate the accuracy of a 23-gene expression signature in differentiating benign nevi from melanoma by comparing test results with clinical outcomes. Materials & methods: Seven dermatopathologists blinded to gene expression test results and clinical outcomes examined 181 lesions to identify diagnostically uncertain cases. Participants independently recorded diagnoses and responses to questions quantifying diagnostic certainty. Test accuracy was determined through comparison with clinical outcomes (sensitivity and percent negative agreement). Results: Overall, 125 cases fulfilled criteria for diagnostic uncertainty (69.1%; 95% CI: 61.8-75.7%). Test sensitivity and percent negative agreement in these cases were 90.4% (95% CI: 79.0-96.8%) and 95.5% (95% CI: 87.3-99.1%), respectively. Conclusion: The 23-gene expression signature has high diagnostic accuracy in diagnostically uncertain cases when evaluated against clinical outcomes.
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Affiliation(s)
- Loren E Clarke
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Brent Mabey
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Darl D Flake Ii
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Stephanie Meek
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - David S Cassarino
- Kaiser Permanente, Los Angeles Medical Center Bldg., Los Angeles, CA 90027, USA
| | - Lyn M Duncan
- Pathology Associates, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Whitney A High
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Victor G Prieto
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Vitale
- Departments of Dermatology and Pathology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - David E Elder
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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26
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Lindqvist Bagge AS, Carlander A, Fahlke C, Olofsson Bagge R. Health-related quality of life (FACT-GP) in Sweden. Health Qual Life Outcomes 2020; 18:172. [PMID: 32513181 PMCID: PMC7278202 DOI: 10.1186/s12955-020-01420-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Many studies have used disease-specific instruments, such as the Functional Assessment of Cancer Therapy (FACT), when studying health-related quality of life (HRQOL) in patients. Few studies however, have described normative HRQOL values in the general population using FACT - General Population (FACT-GP). The general aim of the present study is thus to describe the normative HRQOL values in the general Swedish population by using the FACT-GP instrument and to investigate to what degree sociodemographic factors and status of self-rated health (SRH) correlate with HRQOL. Methods The participants consisted of a pre-stratified (gender, age and education) sample of Swedish citizens that previously had enrolled to be a part of a web panel hosted by a research institute (SOM Institute) at the University of Gothenburg in Sweden. The HRQOL was assessed by using the FACT-GP and SRH. Results A higher FACT-GP score was mainly associated with males, higher age, higher income and better SRH. The results showed that the Swedish sample scored lower on FACT-GP than previous studies. Conclusions Since HRQOL is frequently used as an important endpoint in healthcare research, there is an increasing need for normative data. The results from this study serve as a general population standard against which other studied HRQOL-data could be evaluated.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Department of Psychology, University of Gothenburg, Box 500, Gothenburg, Sweden. .,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
| | | | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Box 500, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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27
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Joseph RW, Liu FX, Shillington AC, Macahilig CP, Diede SJ, Dave V, Harshaw Q, Saretsky TL, Pickard AS. Health-related quality of life (QoL) in patients with advanced melanoma receiving immunotherapies in real-world clinical practice settings. Qual Life Res 2020; 29:2651-2660. [PMID: 32405921 PMCID: PMC7561540 DOI: 10.1007/s11136-020-02520-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
Background Pembrolizumab (PEMBRO) and ipilimumab + nivolumab (IPI + NIVO) are approved advanced melanoma (AM) immunotherapies. To address limited health-related quality of life (QoL) real-world evidence with immunotherapies in AM, we compared QoL in AM patients receiving either treatment in clinical practice. Methods A prospective US observational study enrolled adult AM patients initiating first-line PEMBRO or IPI + NIVO between June 2017 and March 2018. Endpoints included the QLQ-C30 global health score (GHS) and EuroQol visual analog scale (EQ-VAS) scores. Mean changes were compared using repeated measures mixed-effects models and are presented covariate adjusted. Results 225 PEMBRO and 187 IPI + NIVO patients were enrolled. From baseline through week 24, PEMBRO was associated with 3.2 mean GHS score increase (95% CI 0.5, 5.9; p = .02), while no change was observed with IPI + NIVO; 0.2 (95% CI − 2.6, 3.0; p = 0.87). Among objective treatment-responders, GHS scores associated with PEMBRO increased 6.0 (95% CI 3.1, 8.8; p < .0001); IPI + NIVO patients increased 3.8 (95% CI 0.8, 6.9; p = .01). In treatment non-responders, IPI + NIVO was associated with GHS/QoL deterioration of − 3.7 (95% CI − 6.8, − 0.6; p = .02), PEMBRO non-responders demonstrated no change; 0.7 (95% CI − 2.3, 3.7; p = 0.6). Between treatments, PEMBRO patients increased 2.6 greater in EQ-VAS (95% CI 0.6, 4.5; p = .01) vs IPI + NIVO at 24 weeks. Conclusions PEMBRO was associated with better 24-week QoL compared to IPI + NIVO in actual clinical practice settings. Real-world data has known limitations, but with further confirmation these results may have implications for treatment selection. Electronic supplementary material The online version of this article (10.1007/s11136-020-02520-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard W Joseph
- Department of Oncology (Medical), Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | | | - Vaidehi Dave
- Medical Data Analytics (MDA), Parsippany, NJ, USA
| | | | | | - Alan Simon Pickard
- Pharmacy Systems, Outcomes and Policy, College of Pharmacy, 833 South Wood Street, Chicago, IL, 60612, USA
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28
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Fu H, Teleni L, Crichton M, Chan RJ. Supportive care and unmet needs in patients with melanoma: a mixed-methods systematic review. Support Care Cancer 2020; 28:3489-3501. [DOI: 10.1007/s00520-020-05464-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
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29
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Mori S, Blank NR, Connolly KL, Dusza SW, Nehal KS, Rossi AM, Lee EH. Association of Quality of Life With Surgical Excision of Early-Stage Melanoma of the Head and Neck. JAMA Dermatol 2019; 155:85-89. [PMID: 30422228 DOI: 10.1001/jamadermatol.2018.3409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance Surgical excision is the standard-of-care treatment for Tis and T1a melanomas of the head and neck. Currently, however, the association of diagnosis and surgical treatment of these typically slowly progressive and nonfatal melanomas with a patient's health-related quality of life (HRQoL) is unknown. Objective To characterize and assess HRQoL in patients with Tis and T1a head and neck melanoma, evaluate changes in HRQoL over the surgical treatment course, and identify patient characteristics associated with lower HRQoL. Design, Setting, and Participants This longitudinal, prospective cohort study involved patients with Tis or T1a melanoma of the head and neck who underwent staged excision at a single tertiary care center (Memorial Sloan Kettering Cancer Center, New York, New York) and were recruited from June 1, 2016, to February 28, 2017. Patients were followed up for 1 year after their surgical procedure. Participants were asked to complete 2 patient-reported outcome measure questionnaires, Skindex-16 and Skin Cancer Index (SCI), at 4 time points: baseline, perioperative (1 to 2 weeks after surgery), and 6-month and 1-year follow-up. Main Outcomes and Measures Scores on the Skindex-16 and SCI questionnaires. Results In total, 56 patients were included in the study, among whom 24 (43%) were female and 32 (57%) were male, with a mean (range) age of 67.2 (32-88) years; all patients self-identified as white. Forty-one (73%) questionnaires at perioperative, 49 (88%) at 6-month postoperative, and 41 (73%) at 1-year postoperative time points were completed. At baseline, female patients and those younger than 65 years had statistically significantly worse HRQoL on the Skindex-16 questionnaire (mean score, 14.2 [95% CI, 9.1-21.9] and 16.1 [95% CI, 9.8-26.4]) and on the SCI questionnaire (mean score, 57.2 [95% CI, 48.3-67.6] and 53.2 [95% CI, 44.1-64.3]) compared with males (mean Skindex-16 score, 7.0 [95% CI, 4.8-10.3]; mean SCI score, 73.5 [95% CI, 66.0-81.7]) and those aged 65 years or older (mean Skindex-16 score 7.1 [95% CI, 5.0-10.0]; mean SCI score, 74.3 [95% CI, 67.7-81.6]). Questions that demonstrated the worst scores at baseline were worry about skin condition (Skindex-16) and worry about future skin cancers (SCI). The emotions subscale scores on the Skindex-16 questionnaire showed the greatest improvement from baseline to 1-year follow-up levels (26.6 vs 15.3; P < .001) and so did the appearance subscale scores on the SCI questionnaire (64.0 vs 84.6; P < .001). The score difference in HRQoL by sex diminished over time, whereas the score difference by age persisted through the first year. Conclusions and Relevance Improvement in HRQoL at the 6-month and 1-year follow-up was associated with surgical excision in patients with early-stage head and neck melanoma, and younger and female patients experienced worse HRQoL. These results may be used in tailoring counseling for this patient population.
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Affiliation(s)
- Shoko Mori
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,State University of New York Downstate College of Medicine, Brooklyn, New York
| | - Nina R Blank
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen L Connolly
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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McKinley SK, Boland GM. The Patient Speaks: Importance of Patient Perspectives in Clinical Decision-Making. Ann Surg Oncol 2019; 26:2665-2666. [PMID: 31250344 DOI: 10.1245/s10434-019-07575-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | - Genevieve M Boland
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
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31
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Miniotti M, Zeneli A, Bassino S, Pavan S, Ribero S, Leombruni P. Prevalence and correlates of the supportive care needs of Italian early-stage melanoma patients in follow-up. J Psychosoc Oncol 2019; 37:746-757. [DOI: 10.1080/07347332.2019.1612973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marco Miniotti
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Anita Zeneli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Stefania Bassino
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Pavan
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Paolo Leombruni
- “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
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32
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Dieng M, Kasparian NA, Cust AE, Costa DSJ, Tran A, Butow PN, Menzies SW, Mann GJ, Morton RL. Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma. JAMA Dermatol 2019; 154:52-59. [PMID: 29188268 DOI: 10.1001/jamadermatol.2017.4701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. Objective To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. Design, Setting, and Participants This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. Main Outcomes and Measures The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. Results A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, -0.19 to -0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, -0.05 to -0.01) as measured by the FACT-M. Conclusions and Relevance For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.
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Affiliation(s)
- Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia
| | - Nadine A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.,Melanoma Institute Australia, University of Sydney, North Sydney, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Anh Tran
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Graham J Mann
- Melanoma Institute Australia, University of Sydney, North Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia
| | - Rachael L Morton
- National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia
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Mujica-Mota R, Varley-Campbell J, Tikhonova I, Cooper C, Griffin E, Haasova M, Peters J, Lucherini S, Talens-Bou J, Long L, Sherriff D, Napier M, Ramage J, Hoyle M. Everolimus, lutetium-177 DOTATATE and sunitinib for advanced, unresectable or metastatic neuroendocrine tumours with disease progression: a systematic review and cost-effectiveness analysis. Health Technol Assess 2019; 22:1-326. [PMID: 30209002 DOI: 10.3310/hta22490] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neuroendocrine tumours (NETs) are a group of heterogeneous cancers that develop in cells in the diffuse neuroendocrine system. OBJECTIVES To estimate the clinical effectiveness of three interventions [everolimus (Afinitor®; Novartis International AG, Basel, Switzerland), lutetium-177 DOTATATE (177Lu-DOTATATE) (Lutathera®; Imaging Equipment Ltd, Radstock, UK) and sunitinib (Sutent®; Pfizer Inc., New York, NY, USA)] for treating unresectable or metastatic NETs with disease progression and establish the cost-effectiveness of these interventions. DATA SOURCES The following databases were searched from inception to May 2016: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Daily, Epub Ahead of Print, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. REVIEW METHODS We systematically reviewed the clinical effectiveness and cost-effectiveness literature on everolimus, 177Lu-DOTATATE and sunitinib for treating advanced, unresectable or metastatic progressive NETs. The following NET locations were considered separately: pancreas, gastrointestinal (GI) tract and lung, and GI tract (midgut only). We wrote a survival partition cohort-based economic evaluation in Microsoft Excel® 2013 (Microsoft Corporation, Redmond, WA, USA) from the UK NHS and Personal Social Services perspective. This comprised three health states: (1) progression-free survival (PFS), (2) progressed disease and (3) death. RESULTS Three randomised controlled trials (RCTs), RADIANT-3 [RAD001 in Advanced Neuroendocrine Tumors, Third Trial; pancreatic NETs (pNETs): everolimus vs. best supportive care (BSC)], A6181111 (pNETs: sunitinib vs. BSC) and RADIANT-4 (RAD001 in Advanced Neuroendocrine Tumors, Fourth Trial; GI and lung NETs: everolimus vs. BSC), met the inclusion criteria for the clinical effectiveness systematic review. The risk of bias was low. Although the NETTER-1 (Neuroendocrine Tumors Therapy) RCT, of 177Lu-DOTATATE plus 30 mg of octreotide (Sandostatin®, Novartis) compared with 60 mg of octreotide, was excluded from the review, we nonetheless present the results of this trial, as it informs our estimate of the cost-effectiveness of 177Lu-DOTATATE. The pNETs trials consistently found that the interventions improved PFS and overall survival (OS) compared with BSC. Our indirect comparison found no significant difference in PFS between everolimus and sunitinib. Estimates of OS gain were confounded because of high rates of treatment switching. After adjustment, our indirect comparison suggested a lower, but non-significant, hazard of death for sunitinib compared with everolimus. In GI and lung NETs, everolimus significantly improved PFS compared with BSC and showed a non-significant trend towards improved OS compared with BSC. Adverse events were more commonly reported following treatment with targeted interventions than after treatment with BSC. In the base case for pNETs, assuming list prices, we estimated incremental cost-effectiveness ratios (ICERs) for everolimus compared with BSC of £45,493 per quality-adjusted life-year (QALY) and for sunitinib compared with BSC of £20,717 per QALY. These ICERs increased substantially without the adjustment for treatment switching. For GI and lung NETs, we estimated an ICER for everolimus compared with BSC of £44,557 per QALY. For GI (midgut) NETs, the ICERs were £199,233 per QALY for everolimus compared with BSC and £62,158 per QALY for a scenario analysis comparing 177Lu-DOTATATE with BSC. We judge that no treatment meets the National Institute for Health and Care Excellence's (NICE) end-of-life criteria, although we cannot rule out that sunitinib in the A6181111 trial does. LIMITATIONS A RCT with included comparators was not identified for 177Lu-DOTATATE. The indirect treatment comparison that our economic analysis was based on was of a simple Bucher type, unadjusted for any differences in the baseline characteristics across the two trials. CONCLUSIONS Given NICE's current stated range of £20,000-30,000 per QALY for the cost-effectiveness threshold, based on list prices, only sunitinib might be considered good value for money in England and Wales. FUTURE WORK Further analysis of individual patient data from RADIANT-3 would allow assessment of the robustness of our findings. The data were not made available to us by the company sponsoring the trial. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041303. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ruben Mujica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Irina Tikhonova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Ed Griffin
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Marcela Haasova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Jaime Peters
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Stefano Lucherini
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Juan Talens-Bou
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Linda Long
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - David Sherriff
- Plymouth Oncology Centre, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Mark Napier
- Exeter Oncology Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - John Ramage
- Neuroendocrine Tumour Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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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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35
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Smithers BM. Conclusions from quality of life studies in patients with resected high-risk melanoma: one part of the full story. Lancet Oncol 2019; 20:611-612. [PMID: 30928621 DOI: 10.1016/s1470-2045(19)30176-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Affiliation(s)
- B Mark Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane 4102, QLD, Australia.
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36
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Hasanvand S, Rassouli M, Mandegari Z, Salmani N, Moghimkhan F. A Critical Review of Instruments Measuring the Quality of Life of Cancer Patients in Iranian Studies and Their Psychometrics
Properties. Asian Pac J Cancer Prev 2019; 20:333-343. [PMID: 30803191 PMCID: PMC6897017 DOI: 10.31557/apjcp.2019.20.2.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/26/2018] [Indexed: 11/25/2022] Open
Abstract
Objective: Over the past three decades, more than 100 instruments have been developed that measure the quality of life. In order to ensure accuracy and authenticity of the measurements, it is essential to utilize the instruments that have proper psychometric properties. Therefore, this critical review study aimed at comparing the instruments that measured the life quality of cancer patients in Iranian studies. Methods: In this study, Persian articles published in Iranian databases (IranMedex, Irandoc Magiran, SID) from 2006 to 2016 were searched, using the following keywords: nursing, cancer, tools, scale, and quality of life. A total number of 159 articles were obtained, of which 33 articles complied with the inclusion criteria of this study and thereby were reviewed. Results: Sixty nine percent of the articles explored the life quality of adult females with breast cancer, and the most-commonly used instrument was a quality-of-Life instrument for use in international clinical trials in oncology belonging to the European Organization for Research and Treatment of Cancer. More than half of the studies referred solely to Iranian studies to address psychometric properties. Though, no method was introduced in order to address the validity and reliability of instruments in the articles under consideration. Conclusion: According to the findings, the studies which explored the validity and reliability of instruments concerning the life quality of cancer patients were scarce. Therefore, the researchers should pay further attention to the validity and reliability of instruments for selection of an appropriate instrument in this area of research. Also, the researchers are encouraged to further study the psychometric properties of relevant instruments so that optimal generalizability and authenticity of their findings can be attained.
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Affiliation(s)
- Shirin Hasanvand
- School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mandegari
- Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Naiire Salmani
- Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzaneh Moghimkhan
- Medical Library and Information Sciences, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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37
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Krajewski C, Benson S, Elsenbruch S, Schadendorf D, Livingstone E. Predictors of quality of life in melanoma patients 4 years after diagnosis: Results of a nationwide cohort study in Germany. J Psychosoc Oncol 2018; 36:734-753. [PMID: 30321123 DOI: 10.1080/07347332.2018.1499691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In this multicenter, cross-sectional study, 561 melanoma patients completed a questionnaire battery 4 years after primary diagnosis. The proportion of melanoma patients with clinically relevant anxiety (p < .001) or depression (p = .001) symptoms was significantly greater compared to the general population. Lower QoL was predicted by higher depression (ß = -.329, p < .001) and anxiety (ß = -.257, p < .001), older age (ß = -.147, p = .002), and body mass index (ß = -.093, p = .036). Clinical parameters including tumor stage and comorbidity index did not enter the model. Overall, the model explained 32.2% of total variance (F = 43.66, p < .001, corrected R2 = .322). The proportion of patients with clinically relevant anxiety symptoms requires attention. Anxiety and depression symptoms contribute to impaired QoL, calling for appropriate screening.
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Affiliation(s)
- Christin Krajewski
- a Institute of Medical Psychology and Behavioral Immunobiology , University Hospital Essen, University of Duisburg-Essen , Essen , Germany
| | - Sven Benson
- a Institute of Medical Psychology and Behavioral Immunobiology , University Hospital Essen, University of Duisburg-Essen , Essen , Germany
| | - Sigrid Elsenbruch
- a Institute of Medical Psychology and Behavioral Immunobiology , University Hospital Essen, University of Duisburg-Essen , Essen , Germany
| | - Dirk Schadendorf
- b Department of Dermatology , University Hospital Essen, University of Duisburg-Essen , Essen , Germany
| | - Elisabeth Livingstone
- b Department of Dermatology , University Hospital Essen, University of Duisburg-Essen , Essen , Germany
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38
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Buchhold B, Arnold A, Lutze S, Jülich A, Winkler M, Bahlmann J, Eggert C, Jünger M, Hannich HJ. Psychosocial distress and desire for support among inpatients with skin cancer. J Dtsch Dermatol Ges 2018; 15:791-799. [PMID: 28763595 DOI: 10.1111/ddg.13294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regular assessment of psychosocial distress is an important component of adequate psycho-oncological and social support in cancer patients. To date, relevant studies on skin cancer patients have primarily included individuals with melanoma. OBJECTIVES (1) Does the need for psychosocial support vary with the type of skin cancer? (2) Do mentally distressed patients desire support? (3) From the various individuals in the treatment team, whom do patients choose as potential contact person? PATIENTS UND METHODS Inpatients with skin cancer were asked to self-assess their psychosocial situation using the Hornheide questionnaire. In addition, they were asked about their desire for psychosocial support and the preferred potential contact person. RESULTS The need for support among the 116 patients surveyed varied significantly depending on the diagnosis (p = 0.007). However, the direct comparison between patients with melanoma (n = 38; 32.8 %) and squamous cell carcinoma (n = 9; 7.8 %) (p = 0.724) or other types of skin cancer (n = 20; 17.2 %) (p = 0.366) revealed no such difference. The prevalence of psychosocial distress (n = 49; 42.2 %) and the desire for support (n = 20; 17.4 %) showed considerable differences. Patients primarily chose a physician (n = 14/35) or a psychologist (n = 13/35) as potential "go-to" person for their mental distress. CONCLUSIONS Apart from psychosocial distress, the desire for support should be assessed, and patients should be provided access to additional psychosocial care options. With respect to the need for psychosocial support, it does not seem to be justified to preferentially - or even exclusively - consider melanoma patients in clinical practice and research.
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Affiliation(s)
- Britta Buchhold
- Institute of Medical Psychology, Greifswald University School of Medicine
| | - Andreas Arnold
- Department of Dermatology, Greifswald University School of Medicine
| | - Stine Lutze
- Department of Dermatology, Greifswald University School of Medicine
| | - Andreas Jülich
- Department of Internal Medicine (C), Greifswald University School of Medicine
| | | | - Johannes Bahlmann
- Department of Psychiatry and Psychotherapy, HELIOS Hanse-Klinikum Stralsund
| | - Claudia Eggert
- Department of Dermatology, Greifswald University School of Medicine
| | - Michael Jünger
- Department of Dermatology, Greifswald University School of Medicine
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Buchhold B, Lutze S, Arnold A, Jülich A, Daeschlein G, Wendler M, Jünger M, Hannich HJ. Psychosoziale Belastung und Unterstützungswunsch von Hauttumorpatienten - Einfluss des Behandlungs-Settings. J Dtsch Dermatol Ges 2018; 16:861-872. [PMID: 29989378 DOI: 10.1111/ddg.13578_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/29/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Britta Buchhold
- Universitätsmedizin Greifswald, Institut für Medizinische Psychologie
| | - Stine Lutze
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten
| | - Andreas Arnold
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten
| | - Andreas Jülich
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin C
| | - Georg Daeschlein
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten
| | - Martin Wendler
- Universitätsmedizin Greifswald, Institut für Mathematik und Informatik
| | - Michael Jünger
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten
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Buchhold B, Lutze S, Arnold A, Jülich A, Daeschlein G, Wendler M, Juenger M, Hannich HJ. Psychosocial distress and desire for support among skin cancer patients - impact of treatment setting. J Dtsch Dermatol Ges 2018; 16:861-871. [DOI: 10.1111/ddg.13578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Britta Buchhold
- Institute of Medical Psychology; University Medical Center; Greifswald Germany
| | - Stine Lutze
- Department of Dermatology; University Medical Center; Greifswald Germany
| | - Andreas Arnold
- Department of Dermatology; University Medical Center; Greifswald Germany
| | - Andreas Jülich
- Department of Internal Medicine C; University Medical Center; Greifswald Germany
| | - Georg Daeschlein
- Department of Dermatology; University Medical Center; Greifswald Germany
| | - Martin Wendler
- Institute of Mathematics and Computer Science; University Medical Center; Greifswald Germany
| | - Michael Juenger
- Department of Dermatology; University Medical Center; Greifswald Germany
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Risica PM, Matthews NH, Dionne L, Mello J, Ferris LK, Saul M, Geller AC, Solano F, Kirkwood JM, Weinstock MA. Psychosocial consequences of skin cancer screening. Prev Med Rep 2018; 10:310-316. [PMID: 29868385 PMCID: PMC5984251 DOI: 10.1016/j.pmedr.2018.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 01/01/2023] Open
Abstract
Screening for melanoma may save lives, but may also cause patient distress. One key reason that preventative visual skin examinations for skin cancer are not currently recommended is the inadequate available evidence to assess potential harm to psychosocial wellbeing. We investigated potential psychological harms and benefits of skin examinations by conducting telephone surveys in 2015 of 187 screened participants; all were ≥35 years old. Participants had their skin examined by practitioners who had completed INFORMED, a validated web-based training for detection of skin cancers, particularly melanoma. Participants underwent the Spielberger State-Trait Anxiety Inventory (STAI), Psychological Consequences of Screening (PCQ), Hospital Anxiety and Depression (HAD) scale, and the 12-Item Short Form Health Survey (SF-12). Analyses were conducted in 2017. Of the entire study sample, 40% were thoroughly screened as determined by patient-reported level of undress and skin areas examined. Participants who were thoroughly screened: did not differ on negative psychosocial measures; scored higher on measures of positive psychosocial wellbeing (PCQ); and were more motivated to conduct monthly self-examinations and seek annual clinician skin examinations, compared to other participants (p < 0.05). Importantly, thoroughly screened patients were more likely to report skin prevention practices (skin self-examinations to identify a concerning lesion, practitioner provided skin exam), recommend skin examinations to peers, and feel satisfied with their skin cancer education than less thoroughly screened individuals (p < 0.01). Our results suggest that visual screening for skin cancer does not worsen patient psychosocial wellbeing and may be associated with improved skin cancer-related practices and attitudes.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown School of Public Health, Providence, RI, United States
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, United States
- Department of Epidemiology, Brown School of Public Health, Providence, RI, United States
| | - Natalie H. Matthews
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Laura Dionne
- Center for Health Equity Research, Brown School of Public Health, Providence, RI, United States
| | - Jennifer Mello
- Center for Health Equity Research, Brown School of Public Health, Providence, RI, United States
| | - Laura K. Ferris
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francis Solano
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - John M. Kirkwood
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Martin A. Weinstock
- Department of Epidemiology, Brown School of Public Health, Providence, RI, United States
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Dermatology, Veterans Medical Center, Providence, RI, United States
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Wilson ECF, Usher-Smith JA, Emery J, Corrie P, Walter FM. A Modeling Study of the Cost-Effectiveness of a Risk-Stratified Surveillance Program for Melanoma in the United Kingdom. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:658-668. [PMID: 29909870 DOI: 10.1016/j.jval.2017.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Population-wide screening for melanoma is unlikely to be cost-effective. Nevertheless, targeted surveillance of high-risk individuals may be. OBJECTIVES To estimate the cost-effectiveness of various surveillance strategies in the UK population, stratified by risk using a simple self-assessment tool scoring between 0 and 67. METHODS A decision model comparing alternative surveillance policies from the perspective of the UK National Health Service over 30 years was developed. The strategy with the highest expected net benefit for each risk score was identified, resulting in a compound risk-stratified policy describing the most cost-effective population-wide strategy. The overall expected cost and quality-adjusted life-years (QALYs), the incremental cost-effectiveness ratio, and associated uncertainty were reported. RESULTS The most cost-effective strategy is for those with a Williams score of 15 to 21 (relative risk [RR] of 0.79-1.60 vs. a mean score of 17 in the United Kingdom) to be offered a one-off full-body skin examination, and for those with a score of 22 or more (RR 1.79+) to be enrolled into a quinquennial monitoring program, rising to annual recall for those with a risk score greater than 43 (RR 20.95+). Expected incremental cost would be £164 million per annum (~0.1% of the National Health Service budget), gaining 15,947 additional QALYs and yielding an incremental cost-effectiveness ratio of £10,199/QALY gained (51.3% probability <£30,000). CONCLUSIONS The risk-stratified policy would be expensive to implement but cost-effective compared with typical UK thresholds (£20,000-£30,000/QALY gained), although decision uncertainty is high. Phased implementation enrolling only higher risk individuals would be substantially less expensive, but with consequent foregone health gain.
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Affiliation(s)
- Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- Department of General Practice, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Science, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Pippa Corrie
- Cambridge Cancer Centre, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Weitman ES, Perez M, Thompson JF, Andtbacka RHI, Dalton J, Martin ML, Miller T, Gwaltney C, Sarson D, Wachter E, Zager JS. Quality of life patient-reported outcomes for locally advanced cutaneous melanoma. Melanoma Res 2018; 28:134-142. [PMID: 29261570 PMCID: PMC5844587 DOI: 10.1097/cmr.0000000000000425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
Locally advanced cutaneous melanoma has marked quality-of-life implications; however, the patient experience of symptom management and subsequent impact on quality of life has not been well described. This study aims to address the impact on patients of advanced cutaneous melanoma through qualitative interviews. Adults with stage IIIB, IIIC, or IV (M1a) cutaneous melanoma were recruited from two cancer centers in the USA and one in Australia. Telephone interviews were conducted to assess how locoregionally advanced cutaneous melanoma impacted everyday life. Interviews were recorded, transcribed, and coded for qualitative analysis. Twenty-two melanoma patients were interviewed, mean age 69.7 years (range: 52-83), 64% male. The study included stage IIIB (36%), stage IIIC (59%), and stage IV M1a (5%) patients. Emotional health/self-perception issues were the most commonly identified (41% of patient impact expressions), including worry, concern, embarrassment, self-consciousness, fear, and thoughts of death. Limitations of lifestyle and activities were also identified (28% of expressions) including leisure and social activities, physical functioning, general functioning, and personal care. Coping strategies such as modified clothing choices, increased use of pain and/or anti-inflammatory medications, and avoidance/protection from the sun represented 20% of all impact expressions. Ratings of the degree of difficulty patients experienced (using an 11-point numerical rating scale) ranged from 0.0 to 10.0 (mean 5.7, SD 2.9). Condition-related and treatment-related factors were well characterized in patients with locally advanced cutaneous melanoma. This provides a strong foundation for assessment of how cutaneous melanoma impacts quality of life.
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Affiliation(s)
| | | | | | | | - Jo Dalton
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | | | - Chad Gwaltney
- eResearch Technology Inc., Pittsburgh, Pennsylvania, USA
- Gwaltney Consulting
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Pilch M, Scharf SN, Lukanz M, Wutte NJ, Fink-Puches R, Glawischnig-Goschnik M, Unterrainer HF, Aberer E. Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma. J Dtsch Dermatol Ges 2018; 14:717-28. [PMID: 27373247 DOI: 10.1111/ddg.12715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Religious/spiritual (R-S) well-being is associated with greater vitality and lower depression scores. In this study, we investigated strategies for coping with disease and the role of religiosity/spirituality with respect to improving subjective well-being. PATIENTS AND METHODS One hundred and forty-nine patients (107 women), 44 of whom with systemic sclerosis (SSc), 48 with lupus erythematosus (LE), and 57 with stage I or II malignant melanoma (MM) were surveyed using a self-designed questionnaire, which addressed subjective well-being and disease-related circumstances, as well as the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB). RESULTS At the time of diagnosis, disease burden is greater in LE patients than in patients with SSc and MM. Only after several years are SSc and LE patients able to accept their disease. Compared with healthy individuals, the overall score of R-S well-being is significantly lower in LE patients. In LE, photosensitivity and joint pain are inversely correlated with the ability to forgive. SSc patients with facial lesions and pulmonary involvement show greater religiosity. MM patients display significantly higher values for transcendental hope. CONCLUSION Talks about the disease and psychological support are the most important needs of patients with SSc, LE, and MM. At present, programs aimed at improving R-S coping skills do not seem to play a significant role, but could be an important resource that should be addressed in the future.
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Affiliation(s)
- Michaela Pilch
- Department of Dermatology, Medical University Graz, Austria
| | | | - Martin Lukanz
- Department of Psychology, Karl-Franzens University Graz, Austria
| | | | | | | | - Human-Friedrich Unterrainer
- Department of Psychology, Karl-Franzens University Graz, Austria.,Center for Integrative Addiction Research (Grüner Kreis), Vienna, Austria
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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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Cheng KKF, Lim EYT, Kanesvaran R. Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review. BMJ Open 2018; 8:e018101. [PMID: 29371271 PMCID: PMC5786145 DOI: 10.1136/bmjopen-2017-018101] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The measurement of quality of life (QoL) in elderly cancer population is increasingly being recognised as an important element of clinical decision-making and the evaluation of treatment outcome. This systematic review aimed to summarise the evidence of QoL during and after adjuvant therapy in elderly patients with cancer. METHODS A systematic search was conducted of studies published in CINAHL plus, CENTRAL, PubMed, PsycINFO and Web of Science from the inception of these databases to December 2016. Eligible studies included RCTs and non-RCTs in which QoL was measured in elderly patients (aged 65 years or above) with stage I-III solid tumours who were undergoing adjuvant chemotherapy and/or radiotherapy. Because of the heterogeneity and the insufficient data among the included studies, the results were synthesised narratively. RESULTS We included 4 RCTs and 14 non-RCTs on 1785 participants. In all four RCTs, the risk of bias was low or unclear for most items but high for detection. Of the 14 non-RCTs, 5 studies were judged to have a low or moderate risk of bias for all domains, and the other 9 studies had a serious risk of bias in at least one domain. The bias was observed mainly in the confounding and in the selection of participants for the study. For most elderly patients with breast cancer, the non-significant negative change in the QoL was transient. A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown. This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate, colon or cervical cancer population. CONCLUSIONS This review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours.
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Affiliation(s)
- Karis Kin-Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Ethel Yee-Ting Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Tran A, Fogarty G, Nowak A, Espinoza D, Rowbotham N, Stockler M, Morton R. A systematic review and meta-analysis of utility estimates in melanoma. Br J Dermatol 2018; 178:384-393. [DOI: 10.1111/bjd.16098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 12/19/2022]
Affiliation(s)
- A.D. Tran
- NHMRC Clinical Trials Centre; University of Sydney; 92-94 Parramatta Road Camperdown 2050 Australia
| | - G. Fogarty
- St Vincent's Department of Radiotherapy; St Vincent's Hospital; Darlinghurst 2010 Australia
| | - A.K. Nowak
- School of Medicine and Pharmacology; University of Western Australia; Crawley 6009 Australia
- Department of Medical Oncology; Sir Charles Gairdner Hospital; Nedlands 6009 Australia
| | - D. Espinoza
- NHMRC Clinical Trials Centre; University of Sydney; 92-94 Parramatta Road Camperdown 2050 Australia
| | - N. Rowbotham
- NHMRC Clinical Trials Centre; University of Sydney; 92-94 Parramatta Road Camperdown 2050 Australia
| | - M.R. Stockler
- NHMRC Clinical Trials Centre; University of Sydney; 92-94 Parramatta Road Camperdown 2050 Australia
| | - R.L. Morton
- NHMRC Clinical Trials Centre; University of Sydney; 92-94 Parramatta Road Camperdown 2050 Australia
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48
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Aberer E, Alexander A, Martin L, Michaela P, Sabina S, Regina FP, Nora W, Monika GG, Friedrich UH. The influence of religious/spiritual exercises on well-being and quality of life in dermatological patients: A quasi-experimental study. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1499593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Elisabeth Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Avian Alexander
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Lukanz Martin
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Pilch Michaela
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Scharf Sabina
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Fink-Puches Regina
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Wutte Nora
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | - Unterrainer Human Friedrich
- Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
- Department of Psychiatry, Medical University of Graz, Graz, Austria
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Lamprell K, Chin M, Braithwaite J. The plot thickens: Archetypal narrative structure in the melanoma patient journey. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1484053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Klay Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
| | - Melvin Chin
- Prince of Wales Clinical School, UNSW Medicine, NSW 2052, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW 2109, Australia
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50
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Kaufman HL, Hunger M, Hennessy M, Schlichting M, Bharmal M. Nonprogression with avelumab treatment associated with gains in quality of life in metastatic Merkel cell carcinoma. Future Oncol 2017; 14:255-266. [PMID: 29219612 DOI: 10.2217/fon-2017-0470] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the association between tumor response and health-related quality of life (HRQoL) in patients with metastatic Merkel cell carcinoma treated with the anti-PD-L1 avelumab. MATERIALS & METHODS Phase II single-arm trial (NCT02155647) data of 88 patients were analyzed. Correlations between percentage reduction in tumor size and change from baseline in Functional Assessment of Cancer Therapy - General (FACT-G), FACT - Melanoma (FACT-M) and EuroQol-5 Dimension scores were calculated. HRQoL and utility by tumor response (per the Response Evaluation Criteria In Solid Tumors version 1.1) was estimated. RESULTS Tumor shrinkage correlated positively with patients' change from baseline in the FACT-M total (0.364 [95% CI: 0.050-0.607]) and subscale scores. Differences in HRQoL and utility between nonprogressive disease and progressive disease were clinically relevant. CONCLUSION In patients with metastatic Merkel cell carcinoma, nonprogression during treatment with avelumab correlated with gains in HRQoL.
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