Utility of the Skin Cancer Quality of Life Impact Tool

Background: Skin cancer is the most rapidly increasing cancer type in fair-skinned populations worldwide. Although non-melanoma skin cancer (NMSC) are rarely life threatening, both disease and treatments can be associated with substantial morbidity and confer significant financial burden to the National Health Service (NHS). Consequently, the British Association of Dermatologists (BAD) commissioned the Patient-reported Outcomes Measurement Group, Oxford to review the evidence for PROMs for skin cancer. The authors concluded that cancer-specific quality of life (QOL) questionnaires appeared more sensitive than generic PROMs e.g. the Dermatology Life Quality Index (DLQI), in capturing relevant QOL issues. In the NMSC population, these issues include scarring, disfigurement, anxiety and fear of future skin cancers. One skin cancer-specific PROM that was evaluated was the Skin Cancer Quality of Life Impact Tool (SCQOLIT). The SCQOLIT is a ten-item instrument developed specifically for patients with non-metastatic skin cancer, which has demonstrated evidence in favour of reproducibility, validity, internal consistency but requires further evaluation. The decision to evaluate the SCQOLIT in this study, includes its similarity in overall format and brevity to that of the DLQI which is a PROM now widely used in routine medical dermatology clinical practice. The SCQOLIT takes less than five minutes for the patient to complete and has a similar score calculation to the DLQI. Acceptability and feasibility of this tool has never been rigorously assessed in Dermatology clinics. Studies evaluating PROMs in NMSC have been largely assessed in relation to surgical treatments yet basal cell carcinoma can be effectively treated using medical treatments e.g. topical immunomodulators and photodynamic therapy, and to date, PROMs have not been investigated in these sub-populations. Justification: This feasibility study is designed to evaluate the SCQOLIT questionnaire, and aims to establish its utility and impact in patients with NMSC. The investigators will assess both patient and clinician acceptability of the SCQOLIT questionnaire tool and hope to identify any unmet needs, which can potentially inform future clinical decisions and/or service planning. Study design: Participants: All patients referred to Dermatology Tumour outpatient clinics with a clinically suspected NMSC. There will be four categories of participants, Groups 1 - 3 are participants with a new diagnosis of NMSC (primary or recurrent) on any site of the body: Group 1 (Postal) - this will include those patients with a 'low risk' NMSC (namely basal cell carcinoma) Group 2 (Clinic-based) - this will include those patients with a 'moderate to high risk' NMSC (namely SCC or other rare NMSC) Group 3 (Interview) - these will be volunteers selected from Groups 1 and 2. Group 4 (Focus Group: Clinicians) - this will include any Dermatology staff member who is involved in consenting and collecting PROMS data and has a role for direct care of patients attending Dermatology outpatient clinics.