Cancer Res Treat.  2018 Oct;50(4):1186-1193. 10.4143/crt.2017.435.

The Impact of Skin Problems on the Quality of Life in Patients Treated with Anticancer Agents: A Cross-Sectional Study

• Lee J
• Lim J
• Park JS
• Kim M
• Kim TY
• Kim TM
• Lee KH
• Keam B
• Han SW
• Mun JH
• Cho KH
• Jo SJ

• KMID: 2424791
• DOI: http://doi.org/10.4143/crt.2017.435

Abstract

PURPOSE
Patients treated with anticancer agents often experience a variety of treatment-related skin problems, which can impair their quality of life.
MATERIALS AND METHODS
In this cross-sectional study, Dermatology Life Quality Index (DLQI) and clinical information were evaluated in patients under active anticancer treatment using a questionnaire survey and their medical records review.
RESULTS
Of 375 evaluated subjects with anticancer therapy, 136 (36.27%) and 114 (30.40%) were treated for breast cancer and colorectal cancer, respectively. We found that women, breast cancer, targeted agent use, and longer duration of anticancer therapy were associated with higher dermatology-specific quality of life distraction. In addition, itching, dry skin, easy bruising, pigmentation, papulopustules on face, periungual inflammation, nail changes, and palmoplantar lesions were associated with significantly higher DLQI scores. Periungual inflammation and palmoplantar lesions scored the highest DLQI.
CONCLUSION
We believe our findings can be helpful to clinicians in counseling and managing the patients undergoing anticancer therapy.

Keyword

Adverse drug reaction; Antineoplastic agents; Quality of life; Dermatology Life Quality Index

MeSH Terms

Antineoplastic Agents*
Breast Neoplasms
Colorectal Neoplasms
Counseling
Cross-Sectional Studies*
Dermatology
Drug-Related Side Effects and Adverse Reactions
Female
Humans
Inflammation
Medical Records
Pigmentation
Pruritus
Quality of Life*
Skin*
Antineoplastic Agents

Figure

• 

  Fig. 1. Comparison of mean DLQI scores in patients between the type of cancer. Data are mean±stdandard error bars using the Independent T-test. Patients with breast cancer have more distraction in their life than those with any other type of cancer. a)Versus colorectal cancer; 5.16 vs. 3.35, p=0.038, b)Versus gastric cancer; 5.16 vs. 2.70, p=0.034, c)Versus others; 5.16 vs. 2.11, p=0.005.

• 

  Fig. 2. Differences in mean Dermatology Life Quality Index when the patients have a certain specific skin problems or not. *Statistically significant difference.

Reference

References

1. Byun HJ, Lee HJ, Yang JI, Kim KH, Park KO, Park SM, et al. Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients. Ann Oncol. 2012; 23:1992–8.

2. Boone SL, Rademaker A, Liu D, Pfeiffer C, Mauro DJ, Lacouture ME. Impact and management of skin toxicity associated with anti-epidermal growth factor receptor therapy: survey results. Oncology. 2007; 72:152–9.

3. Lacouture ME. The growing importance of skin toxicity in EGFR inhibitor therapy. Oncology (Williston Park). 2009; 23:194.

4. Huang V, Anadkat M. Dermatologic manifestations of cytotoxic therapy. Dermatol Ther. 2011; 24:401–10.

5. Jatoi A, Rowland K, Sloan JA, Gross HM, Fishkin PA, Kahanic SP, et al. Tetracycline to prevent epidermal growth factor receptor inhibitor-induced skin rashes: results of a placebo-controlled trial from the North Central Cancer Treatment Group (N03CB). Cancer. 2008; 113:847–53.

6. Garden BC, Wu S, Lacouture ME. The risk of nail changes with epidermal growth factor receptor inhibitors: a systematic review of the literature and meta-analysis. J Am Acad Dermatol. 2012; 67:400–8.

7. Balagula Y, Lacouture ME, Cotliar JA. Dermatologic toxicities of targeted anticancer therapies. J Support Oncol. 2010; 8:149–61.

8. Robert C, Soria JC, Spatz A, Le Cesne A, Malka D, Pautier P, et al. Cutaneous side-effects of kinase inhibitors and blocking antibodies. Lancet Oncol. 2005; 6:491–500.

9. Osio A, Mateus C, Soria JC, Massard C, Malka D, Boige V, et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. 2009; 161:515–21.

10. Nardone B, Hensley JR, Kulik L, West DP, Mulcahy M, Rademaker A, et al. The effect of hand-foot skin reaction associated with the multikinase inhibitors sorafenib and sunitinib on health-related quality of life. J Drugs Dermatol. 2012; 11:e61–5.

11. Sibaud V, Dalenc F, Chevreau C, Roche H, Delord JP, Mourey L, et al. HFS-14, a specific quality of life scale developed for patients suffering from hand-foot syndrome. Oncologist. 2011; 16:1469–78.

12. Unger K, Niehammer U, Hahn A, Goerdt S, Schumann M, Thum S, et al. Treatment of metastatic colorectal cancer with cetuximab: influence on the quality of life. Z Gastroenterol. 2013; 51:733–9.

13. Chan A, Cameron MC, Garden B, Boers-Doets CB, Schindler K, Epstein JB, et al. A systematic review of patient-reported outcome instruments of dermatologic adverse events associated with targeted cancer therapies. Support Care Cancer. 2015; 23:2231–44.

14. Rosen AC, Case EC, Dusza SW, Balagula Y, Gordon J, West DP, et al. Impact of dermatologic adverse events on quality of life in 283 cancer patients: a questionnaire study in a dermatology referral clinic. Am J Clin Dermatol. 2013; 14:327–33.

15. Charles C, Bungener C, Razavi D, Mateus C, Routier E, Lanoy E, et al. Impact of dermatologic adverse events induced by targeted therapies on quality of life. Crit Rev Oncol Hematol. 2016; 101:158–68.

16. Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol. 2006; 7:903–9.

17. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19:210–6.

18. Lewis V, Finlay AY. 10 years experience of the Dermatology Life Quality Index (DLQI). J Investig Dermatol Symp Proc. 2004; 9:169–80.

19. Finlay AY, Basra MK, Piguet V, Salek MS. Dermatology life quality index (DLQI): a paradigm shift to patient-centered outcomes. J Invest Dermatol. 2012; 132:2464–5.

20. Basra MK, Salek MS, Camilleri L, Sturkey R, Finlay AY. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology. 2015; 230:27–33.

21. Sampogna F, Chren MM, Melchi CF, Pasquini P, Tabolli S, Abeni D, et al. Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis. Br J Dermatol. 2006; 154:325–31.

22. Shah M, Coates M. An assessment of the quality of life in older patients with skin disease. Br J Dermatol. 2006; 154:150–3.

23. Nakao M, Fricchione G, Zuttermeister PC, Myers P, Barsky AJ, Benson H. Effects of gender and marital status on somatic symptoms of patients attending a mind/body medicine clinic. Behav Med. 2001; 26:159–68.

24. Macintyre S, Ford G, Hunt K. Do women 'over-report' morbidity? Men's and women's responses to structured prompting on a standard question on long standing illness. Soc Sci Med. 1999; 48:89–98.

25. Holm EA, Esmann S, Jemec GB. Does visible atopic dermatitis affect quality of life more in women than in men? Gend Med. 2004; 1:125–30.

26. Gilbar P, Hain A, Peereboom VM. Nail toxicity induced by cancer chemotherapy. J Oncol Pharm Pract. 2009; 15:143–55.

27. Minisini AM, Tosti A, Sobrero AF, Mansutti M, Piraccini BM, Sacco C, et al. Taxane-induced nail changes: incidence, clinical presentation and outcome. Ann Oncol. 2003; 14:333–7.

28. Joshi SS, Ortiz S, Witherspoon JN, Rademaker A, West DP, Anderson R, et al. Effects of epidermal growth factor receptor inhibitor-induced dermatologic toxicities on quality of life. Cancer. 2010; 116:3916–23.

29. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998; 139:846–50.

30. Cash TF. The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol. 1992; 26:926–31.

31. Cash TF. The psychology of hair loss and its implications for patient care. Clin Dermatol. 2001; 19:161–6.

32. Ljosaa TM, Mork C, Stubhaug A, Moum T, Wahl AK. Skin pain and skin discomfort is associated with quality of life in patients with psoriasis. J Eur Acad Dermatol Venereol. 2012; 26:29–35.

33. Mendez-Flores S, Orozco-Topete R, Bermudez-Bermejo P, Hernandez-Molina G. Pain and pruritus in cutaneous lupus: their association with dermatologic quality of life and disease activity. Clin Exp Rheumatol. 2013; 31:940–2.