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

Author(s): Weinstock MA, Lee KC, Chren MM, Marcolivio K, VATTC Trial Group

Affiliation(s): Dermatoepidemiology Unit, VA Medical Center, 830 Chalkstone Ave, Medical Service-111D, Providence, RI 02908, USA. maw@brown.edu

Publication date & source: 2009-08, J Am Acad Dermatol., 61(2):207-15. Epub 2009 Apr 26.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.

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.