Epidermal growth factor receptor inhibitors are widely prescribed anticancer drugs. Patients treated commonly develop dermatologic adverse drugs reactions, but rarely they are involved in systematic evaluation of their quality of life. This monocentric cross sectional study is carried out to assess quality of life in colon cancer patients experienced skin side effects due to anti epidermal growth factor receptor inhibitors therapy.
Consecutive patients with skin side effects to therapy treated at Fondazione Poliambulanza were enrolled in this tramadol and celexa. Quality of life was evaluated with the Italian validated version of Skindex questionnaire, exploring three dimensions: Skindex was administered one time between the eighth and the twelfth week of the treatment.
Forty-five consecutive patients, mainly with metastatic colon cancer 29 female, skin eruptions and colon cancer, 16 malewith an average age of Patients showed a great impact of skin side effects on symptoms mean 43followed by emotional mean 30and functioning mean 26 scales. In general women, the age class, skin eruptions and colon cancer, and patients with partial remission reported the worst quality of life.
Epidermal growth factor receptor EGFR inhibitors, as cetuximab or panitumumab, have become widely prescribed anticancer drugs for the treatment of colorectal, head and neck and lung cancer, alone or in combination with traditional chemotherapy [ 1 ]. Patients treated with EGFR inhibitors commonly develop a wide range of dermatologic adverse drug reactions, including a papulopustular rash, dry skin, itching and alterations in hair and periungual tissues, which can result in a decreased quality of life QoL [ 2 ].
The rash can be painful and the paronychial cracking, the paper-cut feeling in the fingers and toes can become very disturbing, and could interfere with the daily activities of a relevant proportion of patients [ 3 ]. Moreover many patients experience significant skin side effects and find that these are the first physical appearance of the disease; this situation could imply that many patients withdraw from social activities because of the impact on their appearance and their concerns about how others would react.
Some data reported in the literature regard cancer or colon skin eruptions and colon cancer patients that experienced skin side effects, but rarely patients are requested to evaluate the impact of these problems on their life and activities, or to participate in a QoL survey [ 45 ]. We used the Italian version of a well-known dermatological instrument, the Skindex questionnaire [ 6 - 8 ], which is able to better describe and score the real impact of skin toxicities on daily QoL.
This cross sectional study was conducted at the Oncological ward of the Fondazione Poliambulanza from March to December The study was approved from the Institutional Review Board of the hospital, and all patients were provided with a written informed consent before entering the study.
Eligible patients were Italian speaking older than 18 years of age. All patients were informed on their diagnosis and prognosis, information was conveyed thought medical consultations, and written material. Retrieved September 2,from http: Following a literature review [ 9 ], the Italian version of Skindex was chosen to evaluate the impact of skin reactions considering its documented validity and reliability [ 6 - 8 ]. This questionnaire has been previously validated in Italian language as described in detail elsewhere [ 10 ].
For each scale the score is calculated as the mean of response to the items included in the scale and the scale scores are standardized to [ 8 ]. Higher scores indicate an skin eruptions and colon cancer impact of skin side effects on QoL, i. After informed consent had been obtained, the Skindex questionnaire was presented by a trained interviewer AF ; patients completed the self-administered questionnaire during a routine visit but before medical examination in order to reduce possible influence on patient responses.
The questionnaire was administered between the eighth and the twelfth week of the treatment, only one time for each patients, according to a cross-sectional design. Clinical and demographic variables were described using descriptive statistics such as mean, standard deviation and proportion. Frequency distributions of survey questions were obtained by all the sample. The mean of the scales is analysed in function of sex, age three levelsclinical outcomes, and age classified by sex.
Among ninety-four screened patients, forty-five consecutive colon cancer patients experienced at least a grade II skin toxicity and were therefore enrolled in the study. The estimated Cronbach coefficient alpha value for these colon cancer patients were. Thirty of forty-five patients received the treatment as second or further lines for metastatic disease; one third of patients experienced a grade 3 skin toxicity 14 subjectstwo thirds a grade 2 skin toxicity 31 subjects.
All the three scores are higher worst QoL in the subgroup sample of females; the worst scores are in the age class. When data were analysed according with sex and age, the class of women aged years have the higher value of symptoms, emotional and functioning scales. Patients with partial response have the worst QoL. As expected patients with 3 grade toxicity reported a worst scores worst QoL for all the scales considered respect to patients with 2 grade toxicity, however the most relevant difference is related to the symptoms scale.
Psychological effects of anti-EGFR-induced cutaneous toxicities are increasingly recognized as an important issue to cope with for both patients and physicians [ 23 ]. Nevertheless, up till now there is a substantial lack of prospective clinical trials, reporting data on QoL during anti-EGFR therapy in colon cancer patients. In tylenol infant and sleep study, cetuximab offered an important benefit in terms of QoL compared with best supportive care alone [ 12 ].
Interestingly, Peeters et al, suggested that panitumumab monotherapy is associated with better QoL scores, using a modified Dermatology Life Quality Index questionnaire, and supported the use of dermatological-oriented questionnaire like Skindex to better capture key-symptoms potentially harmful for QoL in this setting [ 13 ]. Respect to other conditions, the impact of skin side effects on colon cancer patients is relevant for all the three scales considered.
In particular the impact on symptoms is as skin eruptions and colon cancer as that recorded in patients with psoriasis, while when compared to dermatological diseases as psoriasis, eczema, or acne vulgaris the impact on the emotional scale is lower.
It should be underlined that there is a direct association between the development of skin toxicities mainly rash and the probability of getting a good response from the treatment [ 16treatment plans and mental health ]. Patients are generally informed about this kind of correlation since the start of the treatment and this awareness should be taken into account in the coping process of patients with their toxicities.
Our study documents skin eruptions and colon cancer a sample of advanced colon cancer patients the impact of skin side effects on symptoms, emotional and functioning scales, with the impact on symptoms worse than other scores scales. Interestingly scores vary according with sex, age, the achievement of partial remission, skin eruptions and colon cancer, and grade of toxicity suggesting to reserve special attention to psychological support, doctor-patient relationship and in providing these groups of patients with accurate and truthful information.
In respect to comparative data of subjects with skin clinical problems, our sample of skin eruptions and colon cancer cancer patients showed in general a worse impact on symptoms and functional QoL scales, skin eruptions and colon cancer.
Surprisingly, the impact on emotional scale is less important when compared with patients with other skin problems. The severity of clinical condition mainly metastatic colon cancer patientsthe impact of the disease and relapse may partially explain this different focus on the items considered in the emotional scale. It is reasonable to think that some items like "I worry that my skin condition may be serious item 3" As expected, the worst scores were noted in responding and in 3 grade toxicity patients, considering the link between skin toxicity and drug activity, as mentioned before and skin eruptions and colon cancer by literature [ 16skin eruptions and colon cancer, 17 ].
It could be that the lower than expected impact of treatment on emotional, symptom, functioning scales is due to the awareness of correctly informed patients of the relationship between intensity of toxicity and positive response to the treatment.
This awareness may, to some extent, mitigate the significance of certain items like shame, social isolation, sexuality. Currently there is no evidence-based treatment guideline to prevent or treat the EGFR inhibitor-associated skin toxicities, except for a recently reported strategy of preventive treatment considered in a small randomized study [ 18 - 20 ].
At the moment consensus emphasizes the importance of developing an interdisciplinary approach involving specialists in oncology and dermatology. Nevertheless, skin eruptions and colon cancer, selected patients might benefit also from early psychological support. We are aware that our study has some limitations: However our patients population is prospectively studied on a consecutive basis and might be a quite representative sample of real-world clinical practice outside clinical trials.
Another limitation is that this study is cross-sectional: Finally, considering the clinical conditions of patients included in this study mainly metastatic and cancer it was not considered feasible in our setting to administer both a specific and a generic questionnaire. This study documents the impact of skin side effects on quality of life of advanced colon cancer patients treated with EGFR inhibitors. Among the evaluated scales considered by Skindex29 questionnaire, the symptoms scale is the most effect respect to emotional and functioning ones.
Future studies should also explore skin eruptions and colon cancer combined use of usually employed generic questionnaires and dermatologic-oriented tools, like Skindex, in an attempt to better define the ultimate impact of EGFR therapeutic approaches involving a constantly increasing number of cancer patients. All the authors actively participated to plan the study described in the article. BC and MP perform the data analysis and discussed results with other authors.
ZA and MP drafted the article and all the authors reviewed it and gave final approval of the version to be published. National Center for Biotechnology Informationskin eruptions and colon cancer, U. Health Qual Life Outcomes. Published online Apr Received Jul 17; Accepted Apr This article has been cited by other articles in PMC.
Abstract Background Epidermal growth factor receptor inhibitors are widely prescribed anticancer drugs. Methods Consecutive patients with skin side effects to therapy skin eruptions and colon cancer at Fondazione Poliambulanza were enrolled in this study.
Results Forty-five consecutive patients, mainly with metastatic colon cancer 29 female, 16 malewith an average age of Background Epidermal growth factor receptor EGFR inhibitors, as cetuximab or panitumumab, have become widely prescribed anticancer drugs for the treatment of colorectal, head and neck and lung cancer, alone or in combination with traditional chemotherapy [ 1 ].
Methods This cross sectional study was conducted at the Oncological ward of the Fondazione Poliambulanza from March to December Open in a separate window. Results Among ninety-four screened patients, forty-five consecutive colon cancer patients experienced at least a grade II skin toxicity and were therefore enrolled in the study.
Table 3 Skindex scores by patients characteristics. Discussion Psychological effects of anti-EGFR-induced cutaneous toxicities skin eruptions and colon cancer increasingly recognized as an important issue to cope with for both patients and physicians [ 23 ]. Table 4 Comparison with literature data. Conclusion This study documents the impact of skin side effects on quality of life of advanced colon skin eruptions and colon cancer patients treated with EGFR inhibitors.
Competing interests The authors declare that they have no competing interests. Dermatologic toxicities associated with EGFR inhibitors: Psychological effects of cetuximab-induced cutaneous rash in advanced colorectal cancer patients.
Development and clinical indications of cetuximab. Int J Biol Markers. Two cases of acneiform eruption induced by inhibitor of epidermal growth factor receptor. Skindex, skin eruptions and colon cancer, a skin eruptions and colon cancer measure for patients with skin disease: Journal of Investigative Dermatology. Convergent and discriminant validity of a generic and a disease-specific instrument to measure quality of life in patients with skin disease.
Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases.
Critical review of generic and dermatologic-specific health-related quality of life instruments. Further evidence of the validity and reliability of the Skindex Quality of life and psychological distress in patients with cutaneous lymphoma. British Journal of Dermatology. Journal of Clinical Oncology. Association of progression-free survival and patient-reported outcomes by skin toxicity and KRAS status in patients receiving panitumumab monotherapy.
Acne vulgaris and the quality of life of adult dermatology Patients.