Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience

Publication date: Available online 5 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Junqian Zhang, Christopher J. Miller, Victoria O'Malley, Jeremy R. Etzkorn, Thuzar M. Shin, Joseph F. Sobanko
BackgroundChanges in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment.ObjectiveTo measure QOL before and after MMS and to identify risk factors associated with impaired QOL.MethodsProspective observational study of 727 skin cancer patients who self-reported QOL via the Skin Cancer Index immediately before and at 1-2 weeks and 3 months after MMS.ResultsQOL fluctuated after MMS. At 1-2 weeks after surgery, overall QOL remained unchanged compared to before MMS. Patients reported reduced anxiety about skin cancer, but had increased distress about social interactions and physical appearance. At three months after surgery, patients reported an overall improvement in QOL compared to before MMS, (p = 0.0007). Age under 65 years (p = 0.0001), female gender (p = 0.0001), and tobacco use (p = 0.03) were associated with lower QOL scores at all assessment points.LimitationsSingle-site observational study. Significant loss to follow-up at both time points after MMS.ConclusionSkin cancer patients had persistent concerns about social interactions and physical appearance 1-2 weeks after MMS, but all aspects of QOL improved by three months after surgery. MMS patients who were less than 65 years old, female, or smoked were at increased risk for longitudinally impaired QOL.

Teaser

Patient QOL is initially impaired from restricted social interactions and appearance concerns after Mohs micrographic surgery (MMS), but QOL improves from baseline by three months after MMS. Patients younger than 65, women, and smokers report worse QOL before and after MMS, Characterizing the evolution of and risk factors for impaired QOL may allow targeted management to improve the experience of MMS patients.