Quality of life in the actinic neoplasia syndrome: The VA Topical Tretinoin Chemoprevention (VATTC) Trial

Abstract

Background: Keratinocyte carcinomas (KCs) are the most common malignancies of the skin. As lesions have a low mortality rate, understanding quality-of-life (QoL) factors is necessary in their management.

Objective: To assess QoL and associated patient characteristics in those with a history of keratinocyte carcinomas.

Methods: We conducted a cross-sectional study of veterans with a history of KCs enrolled in a randomized controlled trial for chemoprevention of keratinocyte carcinomas. Study dermatologists counted actinic keratoses (AKs) and assessed for skin photodamage. QoL was assessed using Skindex-29 and KC-specific questions. Demographics were self-reported.

Results: Participants (n = 931) enrolled at 5 clinical sites had worse QoL on all subscales (emotions, functioning, and symptoms) compared to a reference group of patients without skin disease. Univariate analysis demonstrated worse QoL associated with higher AK count, past 5-fluorouracil (5-FU) use, and greater sun sensitivity. Multivariate analysis demonstrated that higher AK count and past 5-FU use were independently related to diminished QoL. Higher comorbidities showed modest associations on the symptoms and functioning subscales. Number of previous KCs was not independently associated with any QoL differences.

Limitations: Study population may not be generalizable to the general population. Counting of AKs is of limited reliability. Previous 5-FU use is self reported.

Conclusions: A history of ever use of 5-FU and present AKs was strongly associated with worse QoL. We find it more useful to consider these patients as having the chronic condition "actinic neoplasia syndrome," whose burden may be best measured by factors other than their history of KCs.

Fig 1

Baseline QoL in VATTC trial participants and a reference population. Skindex-29 scores of patients with the actinic neoplasia syndrome (ANS) compared to a historical reference group without skin disease. ANS is a chronic syndrome consisting of a history of KCs with persistent AKs. *, Chren MM, Lasek RJ, Flocke SA, Zyzanski SJ. Improved discriminative and evaluative capability of a refined version of Skindex, a QoL instrument for patients with skin diseases. Arch Dermatol 1997;11:1433–40. **, VA Topical TretinoinChemoprevention Trial. ***, Lasek RJ, Chren MM. Acne vulgaris and the QoL of adult dermatology patients. Arch Dermatol 1998:134:454–8.

Fig 2

Baseline QoL means for each item of the Skindex-29 with standard errors shown. These figures depict means for each item, as well as KC-specific questions. Dashed vertical line represents the mean of each specific subscale. A, B, C, and D show the emotions, functioning, and symptoms subscales, and KC-specific items, respectively.