Patient-centered management of actinic keratosis. Results of a multi-center clinical consensus analyzing non-melanoma skin cancer patient profiles and field-treatment strategies

Abstract

Patient-centered management of actinic keratosis. Results of a multi-center clinical consensus analyzing non-melanoma skin cancer patient profiles and field-treatment strategies Abstract Introduction: Actinic keratosis (AK) is a chronic skin condition that can be a precursor to cutaneous squamous cell carcinoma. AK can recur and patients are likely to undergo multiple treatments. It is important that AK lesions are managed appropriately, and that patients are involved in treatment decisions. Materials and methods: The Supporting Professional Expertise in AK (SPEAK) program aims to facilitate this patient-centered care by identifying patient needs and aiding healthcare practitioners (HCPs) in selecting optimal treatment and communication strategies for different types of patients. Twenty-two dermatooncologists with established expertise in the treatment of AK collaborated to describe commonly encountered psychosocial patient profiles, and to develop respective communication and treatment strategies. Results and conclusion: Six patient profiles were defined based on different psychosocial characteristics and were used to develop appropriate management approaches. We provide a systematic way of identifying these patient profiles in clinical practice and we outline communication strategies tailored to the primary needs of each type of patient. In addition, we provide recommendations for potential fieldtreatments that may be best suited for each profile. The recommendations provided here may help improve the communication and relationship between patients and HCPs, resulting in higher treatment adherence and improved patient outcomes.

Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial

“…A previous study defined six profiles based on the experience of an expert panel. However, patients themselves or patient representatives were not involved when the profiles were derived [19]. In analogy to other dermatologic conditions, we believe that it is indispensable to use patient-derived data as a primary source to outline specific profiles and to guide patient-centered treatment [20,21].…”

Update aktinische Keratosen – Neuigkeiten und Relevanz für den Alltag

“…Daher ist bei diesen Patienten eine rein läsionale Therapie nicht zu empfehlen. Nach Meinung des Expertengremiums sind feldkanzerisierte Patienten eher weniger motiviert, therapeutische Optionen anzunehmen [17], und könnten auch die Patienten sein, die hinterfragen, weshalb aktinische Keratosen überhaupt therapiert werden sollten [18].…”

“…Das Areal mit dem höchsten kosmetischen Anspruch stellt das Gesicht dar. Dies ist insbesondere für die Patienten relevant, für die das Aussehen unter der Therapie oder nach der Therapie ein wichtiges Entscheidungskriterium ausmacht [17] (▶ Abb. 3 a-c).…”

“…3 a-c). Für diese Patientengruppen ist am ehesten eine photodynamische Therapie oder alternativ, wenn der Lokalbefund dies erlaubt, eine topische Therapie mit Diclofenac zu empfehlen [17]. Da das Auftreten lokaler Nebenwirkungen zeitlich nur schwer vorhergesagt werden kann, sind Imiquimod und 5-FU (5-Fluoruracil) aufgrund des Potenzials von Narbenbildung bei entzündlichen Reaktionen mit Blasenbildung in dieser Situation eher weniger empfehlenswert [17].…”

Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

“…Other therapies with less efficacy include ingenol mebutate, topical diclofenac gel, and piroxicam. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs, and cosmetic results [5,8,9] (Fig. 2).…”