Skin Cancer: Exploring needs and experiences (SCENE)

Project Duration

Unknown

Funder

The Burdett Trust for Nursing

Aims

To explore the quality of life, knowledge and experiences of patients undergoing treatment for non melanoma skin cancer (NMSC).

Methods

A prospective, longitudinal, mixed methodology study using postal questionnaires and semi-structured, one to one interviews. The study group comprised a consecutive series of patients with a new clinical diagnosis of NMSC. They were recruited over an eight month period at the Treatment Centre, Nottingham University Hospitals NHS Trust. 

Quantitative data were collected by postal questionnaire at four time points: baseline (just after clinical diagnosis), treatment, eight weeks post-treatment and 12 months after clinical diagnosis. Body image and psychological morbidity were assessed at each time point using the Derriford Appearance Scale 24, anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Knowledge of NMSC was assessed at baseline and eight weeks post-treatment. Participants’ concerns about how NMSC affected their quality of life were assessed using the Skin Cancer Index. 

Qualitative data were collected from a subset of participants (n=15) at the four time points using transcripts of one to one telephone interviews.

Outcomes and Findings

Seventy-seven patients consented to take part. The mean age was 70 years but age ranged from 35 to 89 years. A quarter reported having had a previous skin cancer. The most common diagnosis was basal cell carcinoma (80%), the majority of which were on the head or neck.

Mean anxiety and depression scores were in the normal range at all time points, there was however, a significant decrease in both anxiety and depression from baseline to one year after clinical diagnosis. This was not evident on analysis of data from treatment onwards. Participants had relatively high mean scores on the Skin Cancer Index, indicating a high quality of life at treatment, eight weeks later and at 12 months after diagnosis. There was however, a slight improvement in QOL from treatment to 8 weeks after treatment but this was of borderline significance. From treatment to one year after diagnosis there was a significant mean increase of 7 points. Body image mean scores were representative of a general non-clinical population and did not change from baseline.

Although anxiety and depression scores of the group were in the normal range and body image was high, equivalent to that of a non clinical population, these findings were not reflected in the qualitative analysis which showed that there was an emotional response to being diagnosed with a NMSC.

The study found that a lack of knowledge of the signs of NMSC had lead to delays in presentation which had impacted in terms of patients’ morbidity and increased health care costs due to treatment of larger and more complex lesions. There is a need to promote early detection and this might be done through education of health care personnel, hairdressers and beauticians who come into regular contact with skin.

Many NMSC participants had an increased awareness of NMSC and were determined to take action to avoid a reoccurrence. Many wanted reassurance that their skin cancer had not spread and that they had no new lesions. Regret over delay in presentation and therefore treatment contributed to such concerns. Most people reported that they were satisfied with the treatment and care they had received. They were happy that their NMSC had been completely removed, and that any scarring had healed.

One-year after receiving a clinical diagnosis of NMSC, many participants had an increased awareness of skin cancer. They accepted that they may get another NMSC and were more aware of the need to regularly check their skin although many were not sure what to look for. They were also aware of the need to adopt sun protection behaviour and to educate family and friends. 

A first paper of results at clinical diagnosis has been submitted and a paper documenting follow up results is in progress.