Gaulin Charles, Sebaratnam Deshan F, Fernández-Peñas Pablo
University of Sydney, Sydney, New South Wales, Australia.
Australas J Dermatol. 2015 Feb;56(1):70-6. doi: 10.1111/ajd.12205. Epub 2014 Sep 8.
Basal cell carcinoma and squamous cell carcinoma are the most common malignancies and are classified under the umbrella of non-melanoma skin cancer (NMSC). NMSC exerts a small but appreciable decrement in quality of life (QOL). The impact posed may arise from the tumour itself or as a result of treatment, and through symptoms, functional limitations, cosmetic burden and auxiliary considerations such as cost and disturbance to the activities of daily living. Researchers have evaluated this burden using a variety of outcome measures including generic, dermatology-specific and disease-specific instruments. The skin cancer index represents a promising disease-specific patient-reported outcome measure in this setting. To overcome some of the constraints inherent to disease-specific instruments, and to allow comparisons with other diseases, utility weightings have been developed. Utility weightings represent a cardinal measure for a specific health status and are established through methods such as the standard gamble, willingness-to-pay and time trade-off, and have also been employed to generate utility weightings for NMSC. Utilities are becoming increasingly important as a means of comparing health states across medicine and are of particular importance from a health-care policy perspective as they are used for resource allocation. The small but definite impact on the individual's QOL posed by NMSC should be a clinical consideration for physicians and it should be recognised by researchers as a potential outcome measure.
基底细胞癌和鳞状细胞癌是最常见的恶性肿瘤，属于非黑色素瘤皮肤癌（NMSC）范畴。NMSC会对生活质量（QOL）产生虽小但明显的降低。所造成的影响可能源于肿瘤本身，也可能是治疗的结果，还会通过症状、功能限制、美容负担以及诸如成本和对日常生活活动的干扰等辅助因素体现出来。研究人员使用了包括通用型、皮肤病专科型和疾病特异性工具在内的多种结局指标来评估这种负担。在这种情况下，皮肤癌指数是一种很有前景的疾病特异性患者报告结局指标。为了克服疾病特异性工具固有的一些限制，并便于与其他疾病进行比较，已经开发了效用权重。效用权重是特定健康状态的主要衡量指标，通过标准博弈、支付意愿和时间权衡等方法确定，也已用于生成NMSC的效用权重。效用作为比较医学中不同健康状态的一种手段正变得越来越重要，从医疗保健政策角度来看尤其重要，因为它们用于资源分配。NMSC对个体QOL造成的虽小但确定的影响应成为医生的临床考量因素，研究人员也应将其视为一种潜在的结局指标。
