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CLINICAL REPORT ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Development and Validation of the Basal and Squamous Cell Carcinoma Quality of Life( BaSQoL) Questionnaire
Rick WAALBOER-SPUIJ 1, 2, Loes M. HOLLESTEIN 1, 3, Reiner TIMMAN 4, Lonneke V. VAN DE POLL-FRANSE 3, 5, 6 and Tamar E. C. NIJSTEN 1; on behalf of the BaSQoL Group
1
Department of Dermatology, 4 Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC University Medical Centre, Rotterdam, 2 Department of Dermatology, Elisabeth – TweeSteden Hospital, Tilburg, 3 Netherlands Comprehensive Cancer Organization( IKNL), Netherlands Cancer Registry, Eindhoven, 5 CoRPS – Centre of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, and 6 Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
Health-related quality of life( HRQoL) is important in the management of basal cell carcinoma( BCC) and squamous cell carcinoma( SCC). Disease-specific questionnaires exist, but with important shortcomings. The aim of this study was to develop and validate a questionnaire suitable for use in all patients with BCC and those with SCC. In a 4-phase trajectory, a preliminary questionnaire was created and population-based testing( 1,173 patients) carried out. The questionnaire was reduced using exploratory factor analysis and item response theory. Individual item performance was assessed using classical test theory. A total of 721 patients completed the questionnaire. The number of items was reduced to 16, covering 5 scales. Confirmatory factor analysis showed a good fit. Cronbach’ s αs( range 0.67 – 0.82) were reasonable to high with good internal consistency. In conclusion, the Basal and Squamous Cell Carcinoma Quality of Life questionnaire has good face, content and construct validity. It is useful in the wide range of BCC and SCC patients and captures HRQoL impact over different time-frames.
Key words: basal cell carcinoma; squamous cell carcinoma; health-related quality of life; questionnaire.
Accepted Sep 27, 2017; Epub ahead of print Sep 27, 2017 Acta Derm Venereol 2018; 98: 234 – 239.
Corr: Rick Waalboer-Spuij, Department of Dermatology, Erasmus MC University Medical Centre, Postbus 2040, NL-3000 CA, Rotterdam, The Netherlands. E-mail: r. waalboer @ erasmusmc. nl
The use of patient-reported outcome measures
( PROMs) and, more specifically, health-related quality of life( HRQoL) in dermatology patients has increased dramatically over the past decades. It is now an essential outcome for clinical studies and in daily practice, especially in chronic inflammatory skin diseases( 1, 2). In skin cancer, the use of PROMs and HRQoL has only been used over the past 2 decades and most of the focus has been on melanoma( 3). Since the incidences of basal cell carcinoma( BCC) and squamous cell carcinoma( SCC) are increasing rapidly( 4 – 6), the need for PROMs assessment including HRQoL is warranted to evaluate individual and global disease burden. Generic, cancer- or even melanoma-specific HRQoL instruments are neither content-specific nor sensitive enough to detect the impact of the, rarely life-threatening, BCCs and SCCs, which are most often treated by conventional excision. Specific issues for keratinocytic cancers is that patients are likely to develop multiple carcinomas and actinic keratosis( AK)( so-called actinic neoplasia syndrome) and that they can check their skin constantly( 7).
Measurement of HRQoL in patients with BCC has been performed in several studies, using generic, cancerrelated and dermatology-specific questionnaires, all reporting little to no impact( 7 – 13).
A few disease-specific questionnaires have been developed, but these have several important shortcomings. The Skin Cancer Index( SCI) was developed and tested only in a tertiary care Mohs surgery clinic and therefore is only suitable for use in a selected population( 14, 15). The Skin Cancer Quality of Life Impact Tool( SCQO- LIT) has been developed as a tool for patients with nonmetastatic skin cancer( 16). A limitation of the SCQOLIT is that it addresses 5 psychological issues regarding 2 different aspects in one item. In contrast to the SCI and the SCQOLIT, the Skin Cancer Quality of Life Questionnaire( SCQoL) was developed and validated using modern test theory, namely Rasch analysis( 17). This instrument was, however, derived from the previously developed Actinic Keratosis Quality of Life questionnaire( AKQoL) and pre-tested in a small sample( 18 AK patients, 14 skin cancer patients) with the objective of distinguishing between patients with AK and those with skin cancer( 18). From a content validity perspective, the above-mentioned questionnaires do not capture the psychological issues due to the behavioural changes often required to reduce sun exposure( 19).
The objective of this study was to create and validate a HRQoL questionnaire suitable for use with patients with BCC and those with SCC, addressing relevant issues for patients and healthcare providers using different methodological approaches.
METHODS Study design
The BCC- and SCC-specific HRQoL questionnaire was prepared and developed following the guidelines of the European Organisation for Research and Treatment of Cancer Quality of Life doi: 10.2340 / 00015555-2806 Acta Derm Venereol 2018; 98: 234 – 239
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica.