Skin Cancer Index and Quality of Life

The Skin Cancer Index can be used in a number of different ways, Dr. Neuburg said. It can demonstrate whether a given intervention affects quality of life. And it can be used to compare modalities that have similar cure rates. Perhaps one has a better quality of life measure than the other. When looking at skin cancer prevention, the index can be used to measure improvement, or lack thereof, in quality of life.

Development of the Index

The Medical College of Wisconsin research team began the development of the Skin Cancer Index in 2001 with a survey of 20 NMSC patients and six health care providers specializing in their care. With 52 additional survey participants, the index questions were rated in terms of their importance to quality of life. Data analysts evaluated the tool in terms of data quality, item variability, internal consistency, and range and skewness of scale scores on aggregation and floor and ceiling effects.

The first questionnaire, reported in Laryngoscope in July 2005, included 36 distinct items, representing six domains: emotional, appearance, work/financial, lifestyle/recreation, social/family, and physical/functioning.

In that paper, the authors noted that information in regard to differing illness perceptions will help clinicians to target at-risk groups in terms of perioperative counseling.

A little more than a year later, the index described in the September/October 2006 issue of Archives of Facial Plastic Surgery had been refined following its testing with 211 patients. The Skin Cancer Index now included 15 items in three domains-emotional, social, and appearance. The authors noted that the appearance subscale appears to capture the issues of disfigurement, scarring and self-imaging perceptions, whereas the emotional subscale appears to focus more on issues related to the clinical course of the cancer.

Among the items rated by patients were worries about the cancer spreading, concern about scarring, frustration with recovery time, and embarrassment about skin cancer.

Scores reflected the clinical burden of disease, the perception of illness, and a way to objectify the impact on the patient, Dr. Rhee said.

With the recent paper in Laryngoscope and a presentation to the Triological Society, Dr. Rhee and his colleagues discussed some of the demographic and clinical factors that predicted lower QOL scores. These included female gender and skin cancer on the lips. Noting that these make intuitive sense, Dr. Rhee said the purpose of the paper was to validate these.