Quality of Life and Sun-Protective Behavior in Patients with Skin Cancer

Objectives: To determine whether change occurred in the general quality of life (QOL) of nonmelanoma skin cancer (NMSC) patients following surgery, to identify variables associated with patients' change in QOL, and to assess the impact of the disease and treatment on sun-protective behaviors and cigarette smoking. Design: Longitudinal prospective study of 121 consecutive patients referred to a dermatologic Mohs surgery clinic with NMSC of the head and neck. Interventions: Quality-of-life, smoking habit, and sun-protective behavior assessments were performed before treatment (N = 121) and after surgical treatment at 1 (n = 105) and 4 (n = 101) months. Quality-of-life measures included the Medical Outcomes Study 36-Item Short-Form Health Survey and the Functional Assessment of Cancer Therapy-General. Results: Overall, general QOL measures demonstrated little change over time. Only the mental (Medical Outcomes Study 36-Item Short-Form Health Survey) and emotional (Functional Assessment of Cancer Therapy-General) domains of QOL showed statistically significant change over time. A 2-way interaction showing effects for age and time on emotional well-being was modified by a 3-way interaction that depended on employment status. Emotional well-being scores for younger employed NMSC patients increased over time compared with scores among younger unemployed patients. In addition, many patients adopted greater use of sun-protective behaviors at 4 months following surgery. No change in cigarette smoking status was evidenced. Conclusions: Use of sun-protective behaviors increases after treatment. General QOL instruments demonstrate little change following treatment of NMSC. Although the associations are modest, improvements in emotional and mental health well-being following treatment of NMSC were demonstrated, especially for those younger than 65 years and employed. A disease-specific instrument may be necessary to further study this disease process.