Behavior modification and risk perception in patients with nonmelanoma skin cancer

Nonmelanoma skin cancer (NMSC) is the most common cancer among humans, yet risk perceptions and preventive health behaviors in those who survive this cancer are relatively unknown.

To assess the impact of the disease and its treatment on sun-protective behaviors, general preventive health behaviors, and risk perception in NMSC patients, and to determine factors associated with behavioral change.

A prospective study was conducted of 211 consecutive NMSC patients presenting to a dermatologic surgery clinic at a tertiary care university medical center from February 2005 to March 2006. These patients were all adults, were fluent in English, and had NMSC of the head and neck. Of the 211 eligible patients, complete data was obtained for 183 (87%). The most common reasons for dropout were voluntary withdrawal and incompletely answered surveys.

Surveys that assessed disease-specific quality of life (QoL), preventive health behaviors, sun-protective behaviors, and risk perception were administered before and after surgical treatment of NMSC.

Sun-protective behaviors improved postsurgery even after controlling for seasons (P<0.001). Predictor factors associated with increased sun-protective behavior included poor skin tanning ability, summer season, no employment, less comorbid conditions, and previous NMSC treatment. Baseline QoL was not predictive of behavioral change. As for risk perception, respondents thought they were more likely than someone similar to themselves to develop future NMSCs but thought they had similar risks of developing melanoma or other non-skin cancers (P<0.001). NMSC patients demonstrated disease-specific behavior modifications by selectively improving their sun habits but showed no significant improvement in other preventive health behaviors. This finding is consistent with patients' specific perception of increased risk for future NMSCs, but surprisingly, not for melanoma. Increased patient education of associated cancer risks with NMSC is warranted.

NMSC patients demonstrated disease-specific behavior modifications by selectively improving their sun habits but showed no significant improvement in other preventive health behaviors. This finding is consistent with patients' specific perception of increased risk for future NMSCs, but surprisingly, not for melanoma. Increased patient education of associated cancer risks with NMSC is warranted.