|
BACKGROUND/RATIONALE:
Nonmelanoma skin cancer is the most frequent malignancy in veterans, with an incidence exceeding that of all noncutaneous malignancies combined. The conventional goal of therapy is destruction of the primary cancer and prevention of its recurrence, a long-term outcome that cannot be assessed adequately before five years after therapy. For most tumors, many therapies can prevent recurrence, and although therapies vary in cost, existing data about effectiveness in preventing recurrence are insufficient to permit evidence-based choices among therapies.
OBJECTIVE(S):
Our immediate objective is to determine the effectiveness of different therapies for nonmelanoma skin cancer in preventing tumor recurrence.
METHODS:
This application proposes a prospective longitudinal study of a cohort of patients assembled at the time of diagnosis of nonmelanoma skin cancer (NMSC). The Nonmelanoma Skin Cancer Cohort consists of all 1545 patients with new primary NMSC diagnosed in 1999-2000 at the San Francisco VAMC and the private practice of the dermatology department of the University of California at San Francisco. In this project we will review medical records to compare tumor recurrence at at least five years after the three most common therapies, electrodessication & curettage, excision, and Mohs surgery. These treatments were used in 1213 patients with 1552 cancers. Based on our preliminary data, we hypothesize that tumor recurrence will be highest after electrodessication & curettage, and similar after excision and Mohs surgery. Mixed effects generalized linear models will be used to model the effect of procedure on outcomes, adjusting for patient, tumor, and clinician factors that might likely have affected tumor recurrence at five years after therapy. Multivariate Cox proportional hazards models will also be used to explore the distribution of time to detection of first tumor recurrence.
FINDINGS/RESULTS:
Because of the VA-mandated REAP research stand-down earlier in 2007, we requested and were approved to modify this project by returning the majority of FY2007 funds and applying them to FY2009. This modification extends the project for an additional year. Meanwhile, work on the project is progressing in several areas. First, we have composed and pilot-tested a complex dataform for the medical record review to determine recurrence of the tumor diagnosed in 1999 or 2000. Based on this pilot-testing and the complexity of this form, we determined that training non-clinical research staff to review medical records was not possible (or optimal) for the study. We have recruited two experienced dermatologic nurse practitioners (NPs) for record review, and are now determining inter-rater reliability of the dataform by having the same records reviewed by the PI and both NPs, to assure that responses are the same. Once we have a valid and reliable dataform and trained nurse chart abstractors, we anticipate that the study will progress as approved. Finally, we continue to analyze and report the results of multiple research questions that have been addressed with the data collected so far: Chren MM, Sahay AP, Bertenthal D, Sen S, Landefeld CS. Quality-of-life outcomes of treatments for cutaneous basal cell carcinoma and squamous cell carcinoma. J Invest Dermatol 2007; 127:1351-57. Chen T, Bertenthal D, Sahay A, Sen S, Chren MM. Predictors of skin-related quality of life after treatment of cutaneous basal cell carcinoma and squamous cell carcinoma. Arch Dermatol 2007; 143:1386-1392. Clark FL, Sahay AP, Bertenthal D, Maddock L, Lindquist K, Grekin R, Chren MM. Variation in care for recurrent nonmelanoma skin cancer in a university-based practice and a Veterans Affairs clinic. Arch Dermatol 2007 (in press). Asgari M, Bertenthal D, Sen S, Sahay A, Chren MM. Patient satisfaction with treatments of nonmelanoma skin cancer. Society for Investigative Dermatology Annual Meeting, Los Angeles, CA, May 2007. J Invest Dermatol 2007; 127 Suppl 1:S63.
IMPACT:
Given the high prevalence of NMSC in older veterans, effectiveness of therapies is important, but poorly understood. This project will evaluate effectiveness of therapies in preventing tumor recurrence in a valuable consecutive cohort on whom high-fidelity baseline clinical and patient-reported data are available. Results will inform clinicians by permitting therapeutic choices that are more directly based on evidence. The results will also provide a basis for planning controlled trials of different treatments of NMSC, to guide decisions about the use of health care resources for this common tumor.
Journal Articles
1 . Chren MM, Sahay AP, Bertenthal DS, Sen S, Landefeld CS. Quality-of-life outcomes of treatments for cutaneous basal cell carcinoma and squamous cell carcinoma. The Journal of Investigative Dermatology. 2007; 127(6): 1351-7.
Conference Presentations
2 . Chren MM. Patient satisfaction with treatments of nonmelanoma skin cancer. 68th Annual Meeting of the Society of Investigative Dermatology. Los Angeles, CA 2007.
3 . Chren MM. Quality-of-Care Research in Dermatology: the Example of Nonmelanoma Skin Cancer. Visiting Professor, Department of Dermatology, University of Alabama,. Birmingham, AL 2007.
Journal Other
4 . Chren MM. Determining the value of surgical therapies for basal cell carcinoma. Archives of Dermatology. 2006; 142(2): 231-2.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases
DRE:
Quality of Care, Prevention
Keywords:
Cancer, Patient outcomes, Quality of life
MeSH Terms:
none
|
