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Quality of life in the actinic neoplasia syndrome: The VA Topical Tretinoin Chemoprevention (VATTC) Trial - 07/08/11

Doi : 10.1016/j.jaad.2009.02.022 
Martin A. Weinstock, MD, PhD a, b, c, , Kachiu C. Lee, BA a, d, Mary-Margaret Chren, MD e, Kimberly Marcolivio, MEd a

VATTC Trial Group

  See Appendix for key personnel of the VATTC Trial.

a Dermatoepidemiology Unit, VA Medical Center, Providence, Rhode Island 
b Departments of Dermatology, Rhode Island Hospital and Brown University, Providence, Rhode Island 
c Department of Community Health, Brown University, Providence, Rhode Island 
d Northwestern University Feinberg School of Medicine, Chicago, Illinois 
e Dermatology Service, San Francisco VA Medical Center, and the Department of Dermatology, University of California, San Francisco, California 

Reprint requests: Martin A. Weinstock, MD, PhD, Dermatoepidemiology Unit, VA Medical Center, 830 Chalkstone Ave, Medical Service-111D, Providence, RI 02908.

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.

Le texte complet de cet article est disponible en PDF.

Abbreviations used : AK, ANS, DLQI, FACT-G, 5-FU, KC, QoL, SCI, VATTC


Plan


 This trial was supported by the VA Cooperative Studies Program (CSP#402), Office of Research and Development, Department of Veterans Affairs. Additional support was received from the American Cancer Society. The study medication was donated by the OrthoNeutrogena division of Ortho-McNeil Pharmaceutical, Inc. Dr Weinstock is also supported by grants R01CA106592, R01CA106807, R25CA087972, and R01AR49342 from the National Institutes of Health. Dr Chren’s work is supported by a Midcareer Investigator Award (K24-AR052667) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.
 Conflicts of interest: None declared.
 Previous abstract publication: Weinstock MA, Chren M, Marcolivio K, VATTC Trial Group. Quality of life in the actinic neoplasia syndrome: the VATTC trial. J Invest Dermatol 2006;126(Suppl):49.


© 2009  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 61 - N° 2

P. 207-215 - août 2009 Retour au numéro
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