Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression

Abstract

Background: Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L.

Methods: The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data.

Results: A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011.

Conclusions: While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.

Figure 1

Quality of life differences (adjusted for age) between diagnoses. QL was measured by EQ Index and EQ VAS of the EQ‐5D‐5L. ANCOVA model 1 compares QL between patients with AK and NMSC diagnoses; Model 2 compares in detail QL differences between patients with AK and SCC to estimate whether disease progression results in higher QL impairment. All corrected ANCOVA models were significant: 1a F _(8/1134) = 18.322, P < 0.001, 1b F _(8/1148) = 14.402, P < 0.001, 1c F _(6/580) = 11.931, P < 0.001, and 1d F _(6/589) = 7.227, P < 0.001. Based on the estimated marginal means of QL (adjusted for age) of patients with AK, QL decrease (in percentage) for patients with NMSC diagnoses is presented along with significant levels: * P ≤ 0.050, ** P ≤ 0.010, *** P ≤ 0.001.