Associated Factors of Anxiety Symptoms in Patients with Keratinocyte Carcinoma: A Cross-Sectional Study
Article ID:
3833
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Abstract
Background: Keratinocyte carcinoma (KC) is a common malignancy characterized by a high recurrence rate and considerable psychological distress. The incidence of KC is increasing in China, raising concerns about its psychological consequences and adverse effects on quality of life. Demographic and clinical factors are thought to influence mental health outcomes in these patients. Nonetheless, data on the prevalence of anxiety in Chinese patients with KC and the factors associated with this anxiety are notably lacking. Therefore, a comprehensive investigation into the anxiety of patients with KC is imperative. Objective: This study aimed to investigate the prevalence of anxiety in patients with KC, a disease that can significantly affect a patient’s appearance and overall quality of life. Understanding the level of anxiety in this population is critical to developing targeted interventions, improving treatment outcomes, supporting mental health, and improving patient care practices. Methods: This cross-sectional study was conducted at China’s largest dermatology hospital from November 2017 to September 2022. A consecutive sampling method was used to recruit participants. Anxiety status was surveyed by the Self-rating Anxiety Scale (SAS). Explanatory variables were surveyed by demographic data questionnaires. Non-parametric test and Chi-square test analyses were used to compare the differences between groups. Multiple linear regression analysis was performed to identify factors associated with anxiety. Results: A total of 192 patients with KC were included. The median score of SAS was 35 (IQR 16.25). The prevalence of anxiety in patients with KC was 20.8%. Females (p = 0.008), under 60 years old (p = 0.011), living in rural (p = 0.010) or urban areas (p = 0.029), having fewer than three children (p = 0.016), with a history of skin diseases (p < 0.001), with a history of long-term oral medication (p = 0.001), and experiencing pain or itching (p = 0.001) had SAS scores that were significantly higher than their counterparts. Conclusion: This study showed that the prevalence of anxiety was very high among Chinese patients with KC, especially among women, young patients, rural residents, patients with fewer than three children, and individuals with a history of skin disease, long-term oral medications, or symptoms of pain or itching. Targeted psychological interventions for these specific populations should be implemented to effectively alleviate anxiety and improve quality of life in these at-risk groups.
References
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33.Sanchez N, Griggs J, Nanda S, Fayne R, Castillo D, De Bedout V, et al. The skin cancer index: quality-of-life outcomes of treatments for nonmelanoma skin cancer. J Dermatolog Treat. 2020;31(5):491–3. doi:10.1080/09546634.2019.1674772. [Google Scholar] [PubMed] [CrossRef]
34.Rhee JS, Matthews BA, Neuburg M, Logan BR, Burzynski M, Nattinger AB. Validation of a quality-of-life instrument for patients with nonmelanoma skin cancer. Arch Facial Plast Surg. 2006;8(5):314–8. doi:10.1001/archfaci.8.5.314. [Google Scholar] [PubMed] [CrossRef]
35.Lai SY, Weber RS. High-risk non-melanoma skin cancer of the head and neck. Curr Oncol Rep. 2005;7(2):154–8. doi:10.1007/s11912-005-0042-9. [Google Scholar] [PubMed] [CrossRef]
36.Raghupathi V, Raghupathi W. The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015. Arch Public Health. 2020;78:1–18. [Google Scholar]
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38.Peters L, Brederecke J, Franzke A, de Zwaan M, Zimmermann T. Psychological distress in a sample of inpatients with mixed cancer-a cross-sectional study of routine clinical data. Front Psychol. 2020;11:591771. doi:10.3389/fpsyg.2020.591771. [Google Scholar] [PubMed] [CrossRef]
39.Matud MP, Bethencourt JM, Ibáñez I. Gender differences in psychological distress in Spain. Int J Soc Psychiatry. 2015;61(6):560–8. doi:10.1177/0020764014564801. [Google Scholar] [PubMed] [CrossRef]
40.Bektas DK, Demir S. Anxiety, depression levels and quality of life in patients with gastrointestinal cancer in Turkey. Asian Pac J Cancer Prev. 2016;17(2):723–31. doi:10.7314/APJCP.2016.17.2.723. [Google Scholar] [PubMed] [CrossRef]
41.Buchhold B, Lutze S, Arnold A, Jülich A, Daeschlein G, Wendler M, et al. Psychosocial distress and desire for support among skin cancer patients-impact of treatment setting. J Dtsch Dermatol Ges. 2018;16(7):861–71. doi:10.1111/ddg.2018.16.issue-7. [Google Scholar] [CrossRef]
42.Kossintseva I, Zloty D. Determinants and timeline of perioperative anxiety in mohs surgery. Dermatol Surg. 2017;43(8):1029–35. doi:10.1097/DSS.0000000000001152. [Google Scholar] [PubMed] [CrossRef]
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44.Wang L, Luo J, Li Y, Zhou Y, Wang W. Social support, anxiety, and depression in patients with prostate cancer: complete mediation of self-efficacy. Support Care Cancer. 2022;30(8):6851–6. doi:10.1007/s00520-022-07065-8. [Google Scholar] [PubMed] [CrossRef]
2.Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069–80. doi:10.1111/bjd.2012.166.issue-5. [Google Scholar] [CrossRef]
3.Cives M, Mannavola F, Lospalluti L, Sergi MC, Cazzato G, Filoni E, et al. Non-melanoma skin cancers: biological and clinical features. Int J Mol Sci. 2020;21(15):5394. doi:10.3390/ijms21155394. [Google Scholar] [PubMed] [CrossRef]
4.Tu QF, Lv T, Lai YX, Zhang LL, Shi L, Li JJ, et al. Epidemiological study of elderly skin tumors in a community in Shanghai. Chin J Geriatr. 2013;19(3):142–5 (In Chinese). [Google Scholar]
5.Ciążyńska M, Kamińska-Winciorek G, Lange D, Lewandowski B, Reich A, Sławińska M, et al. The incidence and clinical analysis of non-melanoma skin cancer [published correction appears in Sci Rep. 2021 Jul 28;11(1):15705]. Sci Rep. 2021;11(1):4337. [Google Scholar] [PubMed]
6.Tiyawatanaroj A, Sudtikoonaseth P, Chayangsu O. Basal cell carcinoma trends in Thailand: a 10-year retrospective study of demographic, clinical and histopathological features. Dermatol Reports. 2021;14(1):9413. [Google Scholar] [PubMed]
7.Hu W, Fang L, Ni R, Zhang H, Pan G. Changing trends in the disease burden of non-melanoma skin cancer globally from 1990 to 2019 and its predicted level in 25 years. BMC Cancer. 2022;22(1):836. doi:10.1186/s12885-022-09940-3. [Google Scholar] [PubMed] [CrossRef]
8.Jia MX, Li DX, Liu YL. Clinical retrospective analysis of 340 inpatients with malignant skin tumors in western inner mongolia. Int J Dermatol Venereol. 2021;4(1):36–9. doi:10.1097/JD9.0000000000000123. [Google Scholar] [CrossRef]
9.Philipp-Dormston WG, Müller K, Novak B, Strömer K, Termeer C, Hammann U, et al. Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression. J Eur Acad Dermatol Venereol. 2018;32(7):1138–46. doi:10.1111/jdv.2018.32.issue-7. [Google Scholar] [CrossRef]
10.Liu Q, Sha M, Xue B, Shen L, Li G, Cheng X. Health-related quality of life and associated factors among non-melanoma skin cancer patients: a cross-sectional study. Ann Transl Med. 2023;11(3):150. doi:10.21037/atm. [Google Scholar] [CrossRef]
11.Gaulin C, Sebaratnam DF, Fernández-Peñas P. Quality of life in non-melanoma skin cancer. Australas J Dermatol. 2015;56(1):70–6. doi:10.1111/ajd.2015.56.issue-1. [Google Scholar] [CrossRef]
12.Barazzetti DO, Barazzetti PHO, Cavalheiro BT, Ely JB, Nunes DH, Stamm AMNF. Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel. An Bras Dermatol. 2019;94(3):304–12. doi:10.1590/abd1806-4841.20197842. [Google Scholar] [PubMed] [CrossRef]
13.Ulrich C, Salavastru C, Agner T, Bauer A, Brans R, Crepy MN, et al. The European Status Quo in legal recognition and patient-care services of occupational skin cancer. J Eur Acad Dermatol Venereol. 2016;30(Suppl 3):46–51. [Google Scholar] [PubMed]
14.Black N. Patient-reported outcome measures in skin cancer. Br J Dermatol. 2013;168(6):1151. doi:10.1111/bjd.2013.168.issue-6. [Google Scholar] [CrossRef]
15.Siegel JA, Chren MM, Weinstock MA. Department of Veterans affairs keratinocyte carcinoma chemoprevention trial group. Correlates of skin-related quality of life (QoL) in those with multiple keratinocyte carcinomas (KCsa cross-sectional study. J Am Acad Dermatol. 2016;75(3):639–42. doi:10.1016/j.jaad.2016.05.008. [Google Scholar] [PubMed] [CrossRef]
16.Radiotis G, Roberts N, Czajkowska Z, Khanna M, Körner A. Nonmelanoma skin cancer: disease-specific quality-of-life concerns and distress. Oncol Nurs Forum. 2014;41(1):57–65. doi:10.1188/14.ONF.57-65. [Google Scholar] [PubMed] [CrossRef]
17.El Abbadi S, Susok L, Stockfleth E, Bechara FG, Gambichler T, Herbrandt S, et al. Comparison of the skin cancer quality of life impact tool and the skin cancer index questionnaire in measurement of health-related quality of life and the effect of patient education brochures in patients with actinic keratosis, non-melanoma skin cancer, and cutaneous melanoma [published correction appears in Dermatol Ther. 2021 May 6]. Dermatol Ther. 2021;11(3):929–40. [Google Scholar]
18.Sobanko JF, Zhang J, Margolis DJ, Etzkorn JR, Shin TM, Sarwer DB, et al. Patient-reported quality of life and psychosocial health prior to skin cancer treatment–A cross-sectional study. J Am Acad Dermatol. 2016;75(1):217–8.e2. doi:10.1016/j.jaad.2016.01.033. [Google Scholar] [PubMed] [CrossRef]
19.Sampogna F, Paradisi A, Iemboli ML, Fania L, Ricci F, Napolitano M, et al. Sex differences in health-related quality of life in patients with keratinocyte carcinomas. Acta Derm Venereol. 2021;101(4):adv00439. doi:10.2340/00015555-3736. [Google Scholar] [PubMed] [CrossRef]
20.Aggarwal P, Knabel P, Fleischer Jr AB. United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol. 2021;85(2):388–95. doi:10.1016/j.jaad.2021.03.109. [Google Scholar] [PubMed] [CrossRef]
21.Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998–2012. JAMA Dermatol. 2015;151(9):976–81. doi:10.1001/jamadermatol.2015.1188. [Google Scholar] [PubMed] [CrossRef]
22.Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, et al. Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis. 2017;8(5):643–61. doi:10.14336/AD.2017.0503. [Google Scholar] [PubMed] [CrossRef]
23.Meng YH, Zhang Q, Zhang YB, Zhang CL. Retrospective analysis of 4695 cases of single skin tumor. Chin J Peking Univ (Health Sci). 2016;48(2):195–7 (In Chinese). [Google Scholar]
24.Guo HX, Liu G, Liu F, Xiao Y, Li PY. A retrospective analysis of 1293 cases of cutaneous malignant tumors. Chin J Dermatovenereol Integr Tradit West Med. 2019;18(2):107–10 (In Chinese). [Google Scholar]
25.Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371–9. doi:10.1016/S0033-3182(71)71479-0. [Google Scholar] [PubMed] [CrossRef]
26.Zung WW. The measurement of affects: depression and anxiety. Mod Probl Pharmacopsychiat. 1974;7:170–88. doi:10.1159/issn.0077-0094. [Google Scholar] [CrossRef]
27.Lindsay WR, Michie AM. Adaptation of the Zung self-rating anxiety scale for people with a mental handicap. J Ment Defic Res. 1988;32(6):485–90. [Google Scholar] [PubMed]
28.Ramirez SZ, Lukenbill J. Psychometric properties of the Zung self-rating anxiety scale for adults with intellectual disabilities (SAS-ID). J Dev Phys Disabil. 2008;20:573–80. doi:10.1007/s10882-008-9120-x. [Google Scholar] [CrossRef]
29.Mehnert A, Brähler E, Faller H, Härter M, Keller M, Schulz H, et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J Clin Oncol. 2014;32(31):3540–6. doi:10.1200/JCO.2014.56.0086. [Google Scholar] [PubMed] [CrossRef]
30.Meggiolaro E, Berardi MA, Andritsch E, Nanni MG, Sirgo A, Samorì E, et al. Cancer patients’ emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Palliat Support Care. 2016;14(3):204–11. doi:10.1017/S1478951515000760. [Google Scholar] [PubMed] [CrossRef]
31.Aymonier M, Taieb C, Corgibet F, Joly P, Sei JF, Chaussade V, et al. Patient perception of the diagnosis announcement and its impact on quality of life of patients with primary melanoma or basal cell carcinoma. Acta Derm Venereol. 2022;102:adv00717. doi:10.2340/actadv.v102.2217. [Google Scholar] [PubMed] [CrossRef]
32.Sampogna F, Paradisi A, Iemboli ML, Ricci F, Sonego G, Abeni D. Comparison of quality of life between melanoma and non-melanoma skin cancer patients. Eur J Dermatol. 2019;29(2):185–91. doi:10.1684/ejd.2019.3523. [Google Scholar] [PubMed] [CrossRef]
33.Sanchez N, Griggs J, Nanda S, Fayne R, Castillo D, De Bedout V, et al. The skin cancer index: quality-of-life outcomes of treatments for nonmelanoma skin cancer. J Dermatolog Treat. 2020;31(5):491–3. doi:10.1080/09546634.2019.1674772. [Google Scholar] [PubMed] [CrossRef]
34.Rhee JS, Matthews BA, Neuburg M, Logan BR, Burzynski M, Nattinger AB. Validation of a quality-of-life instrument for patients with nonmelanoma skin cancer. Arch Facial Plast Surg. 2006;8(5):314–8. doi:10.1001/archfaci.8.5.314. [Google Scholar] [PubMed] [CrossRef]
35.Lai SY, Weber RS. High-risk non-melanoma skin cancer of the head and neck. Curr Oncol Rep. 2005;7(2):154–8. doi:10.1007/s11912-005-0042-9. [Google Scholar] [PubMed] [CrossRef]
36.Raghupathi V, Raghupathi W. The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015. Arch Public Health. 2020;78:1–18. [Google Scholar]
37.Vaidya TS, Mori S, Dusza SW, Rossi AM, Nehal KS, Lee EH. Appearance-related psychosocial distress following facial skin cancer surgery using the FACE-Q Skin Cancer. Arch Dermatol Res. 2019;311(9):691–6. doi:10.1007/s00403-019-01957-2. [Google Scholar] [PubMed] [CrossRef]
38.Peters L, Brederecke J, Franzke A, de Zwaan M, Zimmermann T. Psychological distress in a sample of inpatients with mixed cancer-a cross-sectional study of routine clinical data. Front Psychol. 2020;11:591771. doi:10.3389/fpsyg.2020.591771. [Google Scholar] [PubMed] [CrossRef]
39.Matud MP, Bethencourt JM, Ibáñez I. Gender differences in psychological distress in Spain. Int J Soc Psychiatry. 2015;61(6):560–8. doi:10.1177/0020764014564801. [Google Scholar] [PubMed] [CrossRef]
40.Bektas DK, Demir S. Anxiety, depression levels and quality of life in patients with gastrointestinal cancer in Turkey. Asian Pac J Cancer Prev. 2016;17(2):723–31. doi:10.7314/APJCP.2016.17.2.723. [Google Scholar] [PubMed] [CrossRef]
41.Buchhold B, Lutze S, Arnold A, Jülich A, Daeschlein G, Wendler M, et al. Psychosocial distress and desire for support among skin cancer patients-impact of treatment setting. J Dtsch Dermatol Ges. 2018;16(7):861–71. doi:10.1111/ddg.2018.16.issue-7. [Google Scholar] [CrossRef]
42.Kossintseva I, Zloty D. Determinants and timeline of perioperative anxiety in mohs surgery. Dermatol Surg. 2017;43(8):1029–35. doi:10.1097/DSS.0000000000001152. [Google Scholar] [PubMed] [CrossRef]
43.Mor V, Allen S, Malin M. The psychosocial impact of cancer on older versus younger patients and their families. Cancer. 1994;74(7 Suppl):2118–27. doi:10.1002/(ISSN)1097-0142. [Google Scholar] [CrossRef]
44.Wang L, Luo J, Li Y, Zhou Y, Wang W. Social support, anxiety, and depression in patients with prostate cancer: complete mediation of self-efficacy. Support Care Cancer. 2022;30(8):6851–6. doi:10.1007/s00520-022-07065-8. [Google Scholar] [PubMed] [CrossRef]
Published
2024-09-12
How to Cite
Liu, Q., Zhang, H., Gao, J., Sha, M., Shen, L., Cheng, X., & Chen, H. (2024). Associated Factors of Anxiety Symptoms in Patients with Keratinocyte Carcinoma: A Cross-Sectional Study. Psycho-Oncologie, 18(3). Retrieved from https://ojs.piscomed.com/index.php/PO/article/view/3833
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