Abstract
There is limited data on non-adherence for surgical treatment in non-melanoma skin cancer (NMSC) patients. The objective of this single-center, retrospective cohort study is to compare rates of non-adherence of surgical treatment options, determine factors associated with non-adherence, and identify barriers for non-adherence. All adult patients with NMSC (> 18 years) seen between 2015 and 2017 recommended surgical treatment (surgical excision and electrodessication and curettage (ED&C) or Mohs surgery) were eligible. Non-adherence was defined as not completing recommended treatment and reasons for non-adherence were collected. Out of 427 patients that met inclusion criteria, patients recommended surgical excision and ED&C had a lower non-adherence rate of 3.4% compared to those recommended Mohs (11.4%) (p = 0.006). Factors associated with non-adherence included self-pay patients (19.07% adherent vs. 43.24% non-adherent, p = 0.004). Multivariate logistic regression analysis confirmed that Mohs patients were more likely to be non-adherent (odds ratio (OR) = 3.839, 95% confidence interval (CI) (1.435–10.270), p = 0.007) compared to surgical excision and ED&C patients. Males were more likely to be non-adherent (OR = 2.474, 95% CI (1.105–5.542), p = 0.028) to females, and self-pay patients were more likely to be non-adherent than those with other payers (OR = 3.050, 95% CI (1.437–6.475), p = 0.004). Of the 37 patients who were non-adherent, the most common reasons were loss to follow-up (46%), social reasons (41%), medical reasons (38%), and financial reasons (22%). There was a significant difference in non-adherence rates between surgical treatments for NMSCs in our cohort. Our study suggests the need for future interventional studies that implement strategies and patient education to decrease non-adherence rates.
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Abbreviations
- NMSC:
-
Non-melanoma skin cancer
- ED&C:
-
Electrodessication and curettage
References
Aziz H, Hatah E, Makmor Bakry M et al (2016) How payment scheme affects patients’ adherence to medications? A systematic review. Patient Prefer Adherence 10:837–850. https://doi.org/10.2147/PPA.S103057
Davis JL, Buchanan KL, Katz RV et al (2012) Gender differences in cancer screening beliefs, behaviors, and willingness to participate: implications for health promotion. Am J Mens Health 6:211–217. https://doi.org/10.1177/1557988311425853
Guy GP, Ekwueme DU (2011) Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer: a systematic review of the literature. Pharmacoeconomics 29:863–874. https://doi.org/10.2165/11589300-000000000-00000
Guy GP Jr, Machlin SR, Ekwueme DU et al (2015) Prevalence and costs of skin cancer treatment in the U.S., 2002–2006 and 2007–2011. Am J Prev Med 48:183–187. https://doi.org/10.1016/j.amepre.2014.08.036
Iuga AO, McGuire MJ (2014) Adherence and health care costs. Risk Manag Healthc Policy 7:35–44. https://doi.org/10.2147/RMHP.S19801
Janda M, Youl PH, Lowe JB et al (2004) Attitudes and intentions in relation to skin checks for early signs of skin cancer. Prev Med 39:11–18. https://doi.org/10.1016/j.ypmed.2004.02.019
Kalimullah FA, Brown CW (2014) Compliance with follow-up among patients with melanoma and non-melanoma skin cancers. Dermatol Online J 20:doj_21537
Kaplan-Lewis E, Percac-Lima S (2013) No-show to primary care appointments: why patients do not come. J Prim Care Community Health 4:251–255. https://doi.org/10.1177/2150131913498513
Kaul S, Avila JC, Mehta HB et al (2017) Cost-related medication nonadherence among adolescent and young adult cancer survivors. Cancer 123:2726–2734. https://doi.org/10.1002/cncr.30648
Khera R, Valero-Elizondo J, Das SR et al (2019) Cost-related medication nonadherence in adults with atherosclerotic cardiovascular disease in the United States, 2013 to 2017. Circulation 140:2067–2075. https://doi.org/10.1161/CIRCULATIONAHA.119.041974
Kleinsinger F (2018) The unmet challenge of medication nonadherence. Perm J 22:18–033. https://doi.org/10.7812/TPP/18-033
Kripalani S, Henderson LE, Jacobson TA et al (2008) Medication use among inner-city patients after hospital discharge: patient-reported barriers and solutions. Mayo Clin Proc 83:529–535. https://doi.org/10.4065/83.5.529
Sach TH, Whynes DK (2009) Men and women: beliefs about cancer and about screening. BMC Public Health 9:431. https://doi.org/10.1186/1471-2458-9-431
Ullah S, Rajan S, Liu T et al (2018) Why do patients miss their appointments at primary care clinics? J Family Med Dis Prevent. https://doi.org/10.23937/2469-5793/1510090
Acknowledgements
The authors would like to thank Mohsin Ahmad for providing data from the electronic medical records for this project.
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This study was supported in part by Parkland Health and Hospital System. The content is solely the responsibility of the authors and does not necessarily represent the official views of Parkland Health and Hospital System.
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All authors contributed to the study conception and design. Data collection and analysis were performed by SKC, ML, and LSB. The first draft of the manuscript was written by SKC, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Dr. Chong is an investigator for Daavlin Corporation and Biogen Incorporated, Pfizer Incorporated, and Amgen Incorporated. He is a consultant for Celgene Corporation, Viela Bio, Bristol Meyers Squibb, and Principia Biopharma. The other authors have no other financial disclosures.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board at the University of Texas Southwestern Medical Center approved this study.
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Cho, S.K., Lee, M., Brown, L.S. et al. Non-adherence of surgical treatment in patients with non-melanoma skin cancer: a retrospective cohort pilot study. Arch Dermatol Res 315, 101–105 (2023). https://doi.org/10.1007/s00403-021-02296-x
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DOI: https://doi.org/10.1007/s00403-021-02296-x