Aspects of Quality of Life in elderly with Actinic Keratosis.

Elling, R. (2014) Aspects of Quality of Life in elderly with Actinic Keratosis. thesis, Medicine.

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Abstract

Background: Actinic Keratosis (AK) is the most frequent premalignant condition in the elderly Caucasian population and it is estimated that incidence rates will increase even more in the future. This happens in addition to the fact that people are globally ageing which is generally accompanied by more comorbidity. Therefore quality of life (consisting of Health Related Quality of Life and well-being) and frailty become increasingly important concepts in care for the elderly and in making treatment decisions. Especially in conditions such as AK in which malignant conversion to squamous cell carcinoma (SCC) only occurs in a small fraction of the patients over the years. The objective of this study is to combine AK, quality of life and frailty and thereby identifying what the impact of treatment is on quality of life of (frail) older people. Objectives: To evaluate the impact of cryosurgery, 5-fluorouracil cream (5-FU) and photodynamic therapy (PDT) on Health Related Quality of Life (HRQoL) and well-being of elderly and possibly frail AK patients. Patients and Methods: Fifty-eight patients, aged 50 years or older, with AK were included into this prospective study. The questionnaires used for measuring disease-specific HRQoL were the Actinic Keratosis Quality of Life (AKQoL) and the Skindex-17. The questionnaires used for measuring general well-being were the Groningen Well Being Indicator (GWI) and the Scale of Positive and Negative Experience (SPANE). The Groningen Frailty Indicator (GFI) and the Intermed Self Assessment for the elderly (IM-E-SA) were used for making a classification in frailty between the patients. The AKQoL, Skindex-17, GWI and SPANE were assessed at baseline, shortly after treatment and 4 weeks after that. The IM-E-SA and the GFI were only assessed at baseline. Results: Ten patients had a GFI score of ≥ 4 and were classified as frail. The majority of these frail people were found in the age groups 70-79 and ≥ 80 years. The IM-E-SA showed a significant higher score (p<0.01) in the eldest age group (≥ 80 years) compared to the youngest age group (50-59 years), implying more complexity and healthcare needs of the eldest group at baseline. The AKQoL and Skindex-17 both showed significant impairment in HRQoL after treatment (respectively p<0.01 and p<0.01). Both scores normalized after 4 weeks. This trend was also observed for well-being in the GWI. With regard to the different treatment options we found a higher Skindex-17 score after treatment with 5-FU cream and PDT compared to cryosurgery, implying higher impact on HRQoL. The AKQoL and Skindex-17 showed no clear differences in HRQoL between frail and non-frail patients. This, in contrast to the GWI and SPANE on which frail patients scored lower after treatment than non-frail patients, implying more impact on well-being. Conclusion: HRQoL and well-being are significantly impaired by treatment especially with 5-FU cream and PDT. In frail patients the impact on QoL is more adequate assessed by the general well-being questionnaires not related to the disease (GWI and SPANE) than the disease-specific HRQoL questionnaires (AKQoL and Skindex-17).

Item Type:	Thesis (Thesis)
Supervisor name:	Houwing, RH and dermatologist Deventer Hospital and Slaets, Prof. JPJ and geriatrician University Medical Center Groningen
Supervisor name:	Waalboer-Spuij, R. resident dermatology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:48
Last Modified:	25 Jun 2020 10:48
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/937

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