Quality of life issues in nonmetastatic skin cancer

Background Current knowledge of quality of life (QOL) issues affecting patients with nonmetastatic skin cancer is unsatisfactory, being based either on the use of QOL questionnaires derived from dermatology patients with predominantly benign lesions or inflammatory skin rashes, or on the use of general health QOL questionnaires. Objectives We sought to determine the impact of nonmetastatic skin cancer on patients' lives by asking such patients for their written opinions. Methods An open-ended 'Skin Cancer Quality of Life Question Sheet' was given to 100 consenting patients with nonmetastatic skin cancer [50 with malignant melanoma (MM) and 50 with nonmelanoma skin cancer (NMSC)]. Results In total, 82 'Skin Cancer Quality of Life Question Sheets' were returned complete (40 MM and 42 NMSC). There were 44 different patient concerns voiced overall in the responses. The concerns were grouped into 10 main themes. Patients with MM were significantly more likely than those with NMSC to mention 'a sense of relief/gratitude following treatment and/or a commitment to enjoy life here on' (P = 0.001), 'feelings of anxiety/depression/guilt/stress towards oneself or family/friends' (P < 0.001) and 'strengthening of emotional relationships with family and/or friends' (P = 0.02). Patients with NMSC were significantly more likely than those with MM to mention 'concern about the public's lack of understanding and recognition of skin cancer' (P = 0.02). The theme 'realization of one's mortality' was commoner among patients with MM than with NMSC, while the theme 'concern regarding possible scarring/disfigurement or the reaction of others' was commoner among patients with NMSC than with MM, although neither of these two differences was statistically significant (P = 0.07 and P = 0.11, respectively). Conclusions QOL issues expressed by patients with nonmetastatic skin cancer highlight concerns we must address during their care. A disease-specific QOL measure suitable for both nonmetastatic MM and nonmetastatic NMSC is needed. The psychosocial impact on patients with nonmetastatic MM must not be underestimated.