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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3078 — Patient-Reported Outcome of Treatments for Nonmelanoma Skin Cancer in a VA Clinic Compared with a Private Practice

Author List:
Chren MM (SF VAMC)
Sahay AP (Palo Alto VAMC)
Bertenthal D (SF VAMC)
Sen S (SF VAMC)

Objectives:
Quality of life is an important outcome of treatments for non-fatal cancers such as nonmelanoma skin cancer (NMSC), which is the most common cancer and the fifth most costly malignancy to Medicare. To assess the quality of care at a VA clinic and a private practice, we compared quality-of-life outcomes of NMSC treatments, controlling for potential confounders, including sociodemographic characteristics, severity of tumors, and pre-treatment quality of life.

Methods:
We performed a prospective cohort study of consecutive patients with nonmelanoma skin cancer diagnosed in 1999 and 2000 at a VA dermatology clinic and a university-affiliated private practice. All patients with newly-diagnosed NMSC were enrolled at the time of biopsy of cancer (before therapy), and followed for two years after therapy. Treatments were tumor destruction in 151 patients (20%), excision in 298 (40%), and histologically-guided serial excision (Mohs surgery) in 289 (39%). Tumor-related quality of life was measured with the 16-item version of Skindex, a validated measure. Skindex scores vary from 0 to 100 (worst quality of life), and are reported in three domains: Symptoms, Emotional effects, and effects on Functioning.

Results:
Overall, 589 patients (80%) responded between one and two years after therapy. In all treatment groups, patients at the VA were older, poorer, and generally had worse pre-treatment tumor-related quality of life. At both sites, patients treated with tumor destruction improved only minimally in quality of life after treatment, and patients treated with excision and Mohs surgery improved in all three quality-of-life domains, particularly in Symptoms and Emotional effects. In multivariable linear regression models adjusting for pre-treatment patient and tumor characteristics, however, there was no difference between the two sites (P>0.05) in the improvement in quality of life in any treatment group. For example, in the Mohs group, at the VA and private sites, respectively, mean adjusted change scores (+ SE) for Symptoms were -7.3 (+ 3.5) and -10.0 (+ 1.3); for Emotions were -19.9 (+ 4.5) and -21.3 (+ 1.7); and for Functioning were -3.8 (+ 3.2) and -5.4 (+ 1.2).

Implications:
VA patients with NMSC were older, poorer, and had worse pre-treatment quality-of-life than patients treated in a private site. Nevertheless, there was no difference in quality of life outcomes between VA and private patients.

Impacts:
These data suggest that the quality of care for NSMC is similar at VA and private sites.


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