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Impact of Dermatologic Adverse Events on Quality of Life in 283 Cancer Patients: A Questionnaire Study in a Dermatology Referral Clinic

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Abstract

Background

Anticancer therapies cause a wide range of dermatologic adverse events (AE). Although the frequency and severity of these events have been described, their effects on health-related quality of life (QoL) remain poorly understood, and the ones having a greater impact have not been ascertained.

Objective

To assess QoL in patients on conventional versus targeted anti-cancer therapies using a dermatology-specific questionnaire.

Methods

Patients (n = 283) completed the Skindex-16, a QoL questionnaire measuring the effects on three domains: symptoms, emotions, and function. Patients were grouped into two categories according to the types of oncology treatments received: (1) targeted therapies and (2) non-targeted therapies. Correlations of Skindex-16 scores with type of anti-cancer therapy, number of AEs, and specific dermatologic AEs were investigated.

Results

Significant differences between patients treated with targeted versus non-targeted therapy with regards to total Skindex-16 (p = 0.02) and emotion subdomain (p = 0.02) scores were observed. Additionally, patients on targeted therapies experienced a significantly greater number of AEs (p < 0.001) compared with patients on non-targeted therapies. Patients who exhibited epidermal growth factor receptor (EGFR) inhibitor-induced rash had higher Skindex-16 scores (p = 0.009) and higher scores in the symptom (p < 0.001), emotion (p = 0.01), and function (p = 0.001) subdomains than patients without this AE. Similar results were observed for pruritus. All p values were two sided.

Conclusions

Dermatologic AEs are associated with a diminished QoL. Targeted therapies are associated with a significantly increased number of AEs and worse total and emotion Skindex-16 scores in comparison with non-targeted therapies. EGFR inhibitor rash and pruritus produced the greatest negative impact.

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References

  1. Huang V, Anadkat M. Dermatologic manifestations of cytotoxic therapy. Dermatol therapy. 2011;24(4):401–10.

    Article  Google Scholar 

  2. Balagula Y, Lacouture ME, Cotliar JA. Dermatologic toxicities of targeted anticancer therapies. J Support Oncol. 2010;8(4):149–61.

    PubMed  CAS  Google Scholar 

  3. Robert C, Soria JC, Spatz A, Le Cesne A, Malka D, Pautier P, et al. Cutaneous side-effects of kinase inhibitors and blocking antibodies. Lancet Oncol. 2005;6(7):491–500.

    Article  PubMed  CAS  Google Scholar 

  4. Garden BC, Wu S, Lacouture ME. The risk of nail changes with epidermal growth factor receptor inhibitors: a systematic review of the literature and meta-analysis. J Am Acad Dermatol. 2012;67(3):400–8. doi:10.1016/j.jaad.2011.10.009

    Google Scholar 

  5. Lacouture ME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer. 2006;6(10):803–12.

    Article  PubMed  CAS  Google Scholar 

  6. Anderson R, Jatoi A, Robert C, Wood LS, Keating KN, Lacouture ME. Search for evidence-based approaches for the prevention and palliation of hand-foot skin reaction (HFSR) caused by the multikinase inhibitors (MKIs). Oncologist. 2009;14(3):291–302.

    Article  PubMed  CAS  Google Scholar 

  7. Swenson KK, Bell EM. Hand-foot syndrome related to liposomal doxorubicin. Oncology Nurs Forum. 2010;37(2):137–9.

    Article  Google Scholar 

  8. von Moos R, Thuerlimann BJ, Aapro M, Rayson D, Harrold K, Sehouli J, et al. Pegylated liposomal doxorubicin-associated hand-foot syndrome: recommendations of an international panel of experts. Eur J Cancer. 2008;44(6):781–90.

    Article  Google Scholar 

  9. Lacouture ME, Wu S, Robert C, Atkins MB, Kong HH, Guitart J, et al. Evolving strategies for the management of hand-foot skin reaction associated with the multitargeted kinase inhibitors sorafenib and sunitinib. Oncologist. 2008;13(9):1001–11.

    Article  PubMed  CAS  Google Scholar 

  10. Gressett SM, Stanford BL, Hardwicke F. Management of hand-foot syndrome induced by capecitabine. J Oncol Pharm Pract. 2006;12(3):131–41.

    Article  PubMed  CAS  Google Scholar 

  11. Boone SL, Rademaker A, Liu D, Pfeiffer C, Mauro DJ, Lacouture ME. Impact and management of skin toxicity associated with anti-epidermal growth factor receptor therapy: survey results. Oncology. 2007;72(3–4):152–9.

    Article  PubMed  CAS  Google Scholar 

  12. Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol. 2006;7(11):903–9.

    Article  PubMed  Google Scholar 

  13. Basch E. Beyond the FDA PRO guidance: steps toward integrating meaningful patient-reported outcomes into regulatory trials and US drug labels. Value Health. 2012;15(3):401–3.

    Article  PubMed  Google Scholar 

  14. Basch E, Abernethy AP. Commentary: encouraging clinicians to incorporate longitudinal patient-reported symptoms in routine clinical practice. J Oncol Pract. 2011;7(1):23–5.

    Article  PubMed  Google Scholar 

  15. Lacouture ME, Mitchell EP, Piperdi B, Pillai MV, Shearer H, Iannotti N, et al. Skin toxicity evaluation protocol with panitumumab (STEPP), a phase II, open-label, randomized trial evaluating the impact of a pre-emptive skin treatment regimen on skin toxicities and quality of life in patients with metastatic colorectal cancer. J Clin Oncol. 2010;28(8):1351–7.

    Article  PubMed  CAS  Google Scholar 

  16. Lacouture ME, Basti S, Patel J, Benson A 3rd. The SERIES clinic: an interdisciplinary approach to the management of toxicities of EGFR inhibitors. J Support Oncol. 2006;4(5):236–8.

    PubMed  Google Scholar 

  17. Chren MM, Lasek RJ, Sahay AP, Sands LP. Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases. J Cutan Med Surg. 2001;5(2):105–10.

    Article  PubMed  CAS  Google Scholar 

  18. Li T, Perez-Soler R. Skin toxicities associated with epidermal growth factor receptor inhibitors. Target Oncol. 2009;4(2):107–19.

    Article  PubMed  Google Scholar 

  19. Joshi SS, Ortiz S, Witherspoon JN, Rademaker A, West DP, Anderson R, et al. Effects of epidermal growth factor receptor inhibitor-induced dermatologic toxicities on quality of life. Cancer. 2010;116(16):3916–23.

    Article  PubMed  Google Scholar 

  20. Bowe WP, Doyle AK, Crerand CE, Margolis DJ, Shalita AR. Body image disturbance in patients with acne vulgaris. J Clin Aesthet Dermatol. 2011;4(7):35–41.

    PubMed  Google Scholar 

  21. Pruthi GK, Babu N. Physical and psychosocial impact of acne in adult females. Indian J Dermatol. 2012;57(1):26–9.

    Article  PubMed  Google Scholar 

  22. Murota H, Kitaba S, Tani M, Wataya-Kaneda M, Azukizawa H, Tanemura A, et al. Impact of sedative and non-sedative antihistamines on the impaired productivity and quality of life in patients with pruritic skin diseases. Allergol Int. 2010;59(4):345–54.

    Article  PubMed  Google Scholar 

  23. Gandhi M, Oishi K, Zubal B, Lacouture M. Unanticipated toxicities from anticancer therapies: survivors’ perspectives. Support Care Cancer. 2010;18(11):1461–8.

    Article  PubMed  Google Scholar 

  24. Frith H, Harcourt D, Fussell A. Anticipating an altered appearance: women undergoing chemotherapy treatment for breast cancer. Eur J Oncol Nurs. 2007;11(5):385–91.

    Article  PubMed  Google Scholar 

  25. Thompson SC, Sobolew-Shubin A, Galbraith ME, Schwankovsky L, Cruzen D. Maintaining perceptions of control: finding perceived control in low-control circumstances. J Pers Social Psychol. 1993;64(2):293–304.

    Article  CAS  Google Scholar 

  26. Velikova G, Keding A, Harley C, Cocks K, Booth L, Smith AB, et al. Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: secondary outcomes of a randomised controlled trial. Eur J Cancer. 2010;46(13):2381–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

SKINDEX-16 contact information and permission to use: MAPI Research Trust, Lyon, France. E-mail: PROinformation@mapi-trust.org—Internet: www.mapi-trust.org.

M.E.L is supported by a Dermatology Foundation Career Development Award. He has a consultant or advisory role with Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Genzyme, GlaxoSmithKline, Hana, Imclone, Lilly, Onyx, OSI, Pfizer, Roche, and Wyeth. He is also receiving research funding from Hana Biosciences and Onyx Pharmaceuticals.

Conflict of interest

A.C.R, E.C.C., S.W.D., Y.B., J.G., and D.P.W. have no conflicts of interest to declare.

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Authors and Affiliations

  1. Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Rockefeller Outpatient Pavilion Suite 228, 160 East 53rd St, New York, NY, 10022, USA

    Alyx C. Rosen, Emily C. Case, Stephen W. Dusza, Yevgeniy Balagula & Mario E. Lacouture

  2. Department of Dermatology, Northwestern University, Chicago, IL, USA

    Jennifer Gordon

  3. Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Dennis P. West

Authors
  1. Alyx C. Rosen
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  2. Emily C. Case
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  3. Stephen W. Dusza
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  4. Yevgeniy Balagula
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  5. Jennifer Gordon
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  6. Dennis P. West
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  7. Mario E. Lacouture
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Corresponding author

Correspondence to Mario E. Lacouture.

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Rosen, A.C., Case, E.C., Dusza, S.W. et al. Impact of Dermatologic Adverse Events on Quality of Life in 283 Cancer Patients: A Questionnaire Study in a Dermatology Referral Clinic. Am J Clin Dermatol 14, 327–333 (2013). https://doi.org/10.1007/s40257-013-0021-0

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  • DOI: https://doi.org/10.1007/s40257-013-0021-0

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