A structured review of quality of life in advanced and high‐risk cutaneous squamous cell carcinoma shows the need for more studies and better measures

Abstract

Background: Cutaneous squamous cell carcinoma (cSCC) accounts for nearly a quarter of non-melanoma skin cancers. Studies reporting Quality of Life (QoL) in this group focus on early stage disease. A small proportion of cSCC patients have high-risk or advanced disease, with potentially significant QoL impacts, yet are largely overlooked. Aims: This structured review appraises measures and published QoL outcomes in this group. Materials & Methods: We conducted searches in MEDLINE, EMBASE, CINAHLplus and PsycInfo in June 2020 (updated in October) to identify publications specifically reporting QoL outcomes in this cohort. Returns were reviewed against a strict set of eligibility criteria. Results: We identified seven publications for inclusion; three relating to high-risk cSCC, three to metastatic disease and one to unresectable disease. Publications were appraised for quality using the Mixed Methods Appraisal Tool. Only one fulfilled more than two of the five quality criteria. Studies employed a range of patient reported outcome measures to assess QoL, both generic and disease specific. Discussion: All studies with multiple time-points reported stable or improving QoL, however extrapolation of these findings to the cSCC population is not warranted due to study limitations including mixed populations, incomplete data sets or single measurements. We set out to review the QoL literature for high-risk and advanced cSCC and found a small and disparate body of evidence. Studies varied significantly in terms of study population, design and quality. While the identified studies suggested stable or improving QoL, we question the choice of measures used and highlight the need for further work in this area. Conclusion:While there are some published reports about quality of life for patients with early stage cutaneous squamous cell carcinoma, these impacts for the high-risk or advanced cohort are largely unexplored. We conducted a structured review of published measures and outcomes used in this cohort and found a demonstrable need for further, targeted, exploration of patient needs in this area.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Maintenance of clinical response after short treatment with cemiplimab for advanced squamous cell carcinoma

“…Different studies showed a dramatic reduction in quality of life in patients with an advanced disease, underling the urgent need of resorting to systemic therapies. 2 In this regard, cemiplimab is a human IgG4 monoclonal antibody directed against the programmed death 1 (PD-1) receptor approved for the treatment of advanced cutaneous SCC (acSCC). Its efficacy has been investigated in an open label, phase 2 trial demonstrating an objective response in 34/78 patients (44%), and the best overall response was complete in ten (13%) and partial response in 24 (31%).…”

“…1 However, its immunemediated mechanism of action has been associated with a diverse spectrum of adverse events, including immune-related cutaneous adverse events (ir-cAE) that occur in up to 44% of patients on anti-PD1 drugs. 2 Eruptive keratoacanthomas (EKs) represent a rare ir-cAE among patients on anti-PD1+/-anti-CTLA-4 and have been associated with treatment discontinuation and represent a therapeutic challenge. 3 We present a retrospective case series of seven patients with immunotherapy-induced EK successfully treated with acitretin.…”

Health-Related Quality of Life with Pembrolizumab in Patients with Locally Advanced or Recurrent or Metastatic Cutaneous Squamous Cell Carcinoma: KEYNOTE-629

“…In most cases, surgical resection of cSCC is curative, but a small proportion of patients develop recurrent/metastatic (R/M) or locally advanced (LA) cSCC, which generally requires systemic treatment and has a poor prognosis [5,6]. Because of the high tumor mutational burden associated with UV-mediated carcinogenesis, cSCC is an immunogenic cancer that is amenable to immunotherapy [7,8].…”

“…The symptoms and treatment outcomes of patients with advanced cSCC can have a marked effect on their health-related quality of life (HRQoL) [6]. Patients may experience scarring and disfigurement and impairment in functions such as speech and swallowing [6,13]. Pain is also a significant and common feature of cSCC [14].…”

Immunotherapy and Hypofractionated Radiotherapy in Older Patients with Locally Advanced Cutaneous Squamous-Cell Carcinoma of the Head and Neck: A Proposed Paradigm by the International Geriatric Radiotherapy Group

“…However, older cancer patients may not be candidates for surgery due to multiple comorbidities and frailty [7]. In addition, surgical resection may lead to a higher risk of postoperative complications, impaired functional and cosmesis outcomes, and a reduced quality of life (QOL) in frail patients [8,9]. In patients who are inoperable, radiotherapy alone or combined with systemic therapy are offered as alternatives [10][11][12].…”