Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Theresa Steeb^{1

2

3}, Anja Wessely^{1

3}, Dagmar von Bubnoff⁴, Thomas Dirschka⁵, Konstantin Drexler⁶, Conrad Falkenberg⁵, Jessica C Hassel⁷, Kinan Hayani², Svea Hüning⁸, Katharina C Kähler⁹, Sigrid Karrer⁶, Christian Krammer², Ulrike Leiter¹⁰, Diana Lill², Enklajd Marsela², Andreas Meiwes¹⁰, Dorothée Nashan⁸, Suzan Nasifoglu², Lutz Schmitz¹¹, Judith Sirokay¹², Alexander Thiem¹³, Jochen Utikal¹⁴, Alexander Zink¹⁵, Carola Berking^{1

3}, Markus V Heppt^{1

3}

Affiliations

¹ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
² Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany.
³ Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany.
⁴ Department of Dermatology, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, Germany.
⁵ Centroderm Clinic, 42287 Wuppertal, Germany.
⁶ Department of Dermatology, University Hospital Regensburg, 93042 Regensburg, Germany.
⁷ Section of Dermatooncology, Department of Dermatology and National Center for Tumor Diseases, 69120 Heidelberg, Germany.
⁸ Department of Dermatology, Hospital of Dortmund, 44137 Dortmund, Germany.
⁹ Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany.
¹⁰ Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany.
¹¹ Department of Dermatology, Skin Cancer Center, Ruhr University Bochum, 44801 Bochum, Germany.
¹² Department of Dermatology and Allergy, University Hospital of Bonn, 53127 Bonn, Germany.
¹³ Clinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany.
¹⁴ Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany.
¹⁵ Department of Dermatology and Allergy, Technical University of Munich, 80802 Munich, Germany.

PMID: 32408601
PMCID: PMC7290787
DOI: 10.3390/jcm9051438

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Theresa Steeb et al. J Clin Med. 2020.

. 2020 May 12;9(5):1438.

doi: 10.3390/jcm9051438.

Authors

Affiliations

¹ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
² Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany.
³ Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany.
⁴ Department of Dermatology, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, Germany.
⁵ Centroderm Clinic, 42287 Wuppertal, Germany.
⁶ Department of Dermatology, University Hospital Regensburg, 93042 Regensburg, Germany.
⁷ Section of Dermatooncology, Department of Dermatology and National Center for Tumor Diseases, 69120 Heidelberg, Germany.
⁸ Department of Dermatology, Hospital of Dortmund, 44137 Dortmund, Germany.
⁹ Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany.
¹⁰ Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany.
¹¹ Department of Dermatology, Skin Cancer Center, Ruhr University Bochum, 44801 Bochum, Germany.
¹² Department of Dermatology and Allergy, University Hospital of Bonn, 53127 Bonn, Germany.
¹³ Clinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany.
¹⁴ Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany.
¹⁵ Department of Dermatology and Allergy, Technical University of Munich, 80802 Munich, Germany.

PMID: 32408601
PMCID: PMC7290787
DOI: 10.3390/jcm9051438

Abstract

Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1-10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items "avoid transition to invasive squamous cell carcinoma" (mean ± standard deviation; 8.98 ± 1.46), "AK are considered precancerous lesions" (8.72 ± 1.34) and "treating physician recommends treatment" (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items "effective lesion clearance" (8.36 ± 1.99), "safety" (8.20 ± 2.03) and "treatment-related costs are covered by health insurance" (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.

Keywords: actinic keratosis; cross-sectional study; patient education; patient-centered care; patient-reported outcomes; personalized medicine; skin cancer.

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Conflict of interest statement

C.B. has been a member of advisory boards for Almirall Hermal, Biofrontera, Galderma, ISDIN, and Leo Pharma, has received speaker’s honoraria by Almirall Hermal, Galderma, and Leo Pharma, and has received funding for clinical research by Leo Pharma. M.V.H. has been a member of advisory boards for Almirall Hermal and received speaker’s honoraria by Galderma and Biofrontera. K.C.K. has been a member of advisory boards for Almirall Hermal and has received speaker’s honoraria by Almirall Hermal. U.L. has been a member of advisory boards for Sanofi, Roche and Novartis and has received speaker’s honoraria by MSD, Novartis, Roche, Sanofi. L.S. has been a member of advisory boards for Almirall Hermal and received speaker’s honoraria by Almirall Hermal, Leo Pharma, Mylan, Galderma and Biofrontera. J.U. is on the advisory board or has received honoraria and travel support from Amgen, Bristol Myers Squibb, GSK, LeoPharma, Merck Sharp and Dohme, Novartis, Pierre Fabre, Roche, Sanofi outside the submitted work. S.K. has participated in previous clinical trials for Galderma and Leo Pharma. A.Z. has been a member of advisory boards for Beiersdorf Dermo Medical, Galderma, and has received speaker’s honoraria by Almirall Hermal, Beiersdorf Dermo Medical, Galderma and has received funding for clinical research by Beiersdorf Dermo Medical, Galderma. The remaining authors declare no conflicts of interests.

Figures

**Figure 1**
Boxplots showing all patients’ specific evaluation on (A) motivation for therapy of their actinic keratoses (AK) and (B) on expectations towards therapy of their AK.

**Figure 2**
Boxplots showing patients’ specific subgroup evaluation on (A) motivation for a therapy of their AK and (B) on expectations for the therapy of AK; p-values: * <0.05; ** <0.01; *** =0.001; **** =0.000.

**Figure 3**
Heat-map showing the correlations of patients’ motives and expectations towards AK management. The correlation coefficients were used to indicate the strength of the correlation. Four patient clusters were identified (black frames).

See this image and copyright information in PMC

References

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Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Affiliations

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources