Abstract
Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1–10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items “avoid transition to invasive squamous cell carcinoma” (mean ± standard deviation; 8.98 ± 1.46), “AK are considered precancerous lesions” (8.72 ± 1.34) and “treating physician recommends treatment” (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items “effective lesion clearance” (8.36 ± 1.99), “safety” (8.20 ± 2.03) and “treatment-related costs are covered by health insurance” (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.
Highlights
Long-term exposure to ultraviolet (UV) radiation can lead to the formation of actinic keratoses (AK) in light-skinned individuals [1,2]
AK lesions are considered precursors of invasive cutaneous squamous cell carcinoma, the conversion risk for an individual lesion to progress into cSCC is estimated low [4]
Patients presented predominantly with AK located in the face or scalp (65.6%; 261/398)
Summary
Long-term exposure to ultraviolet (UV) radiation can lead to the formation of actinic keratoses (AK) in light-skinned individuals [1,2]. The presence of multiple lesions, marked basal proliferation in histology, and additional signs of chronic UV damage on the adjacent skin increases the risk for progression considerably, and spontaneous regression is less likely to occur [5,6,7]. Numerous interventions with varying efficacy and safety profiles are licensed for the management of AK. These comprise lesion-directed therapies such as excision or cryosurgery as well as field-directed therapies including photodynamic therapy (PDT) or topical interventions, which target a whole area of skin bearing multiple AK and aim at clearing subclinical changes [10]
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