Expert Recommendations on Facilitating Personalized Approaches to Long-term Management of Actinic Keratosis: The Personalizing Actinic Keratosis Treatment (PAKT) Project
DOI:
https://doi.org/10.2340/actadv.v103.6229Keywords:
actinic keratosis, consensus, Delphi study, squamous cell carcinoma, surveys and questionnaires, skin cancerAbstract
Actinic keratoses are pre-malignant skin lesions that require personalized care, a lack of which may result in poor treatment adherence and suboptimal outcomes. Current guidance on personalizing care is limited, notably in terms of tailoring treatment to individual patient priorities and goals and supporting shared decision-making between healthcare professionals and patients. The aim of the Personalizing Actinic Keratosis Treatment panel, comprised of 12 dermatologists, was to identify current unmet needs in care and, using a modified Delphi approach, develop recommendations to support personalized, long-term management of actinic keratoses lesions. Panellists generated recommendations by voting on consensus statements. Voting was blinded and consensus was defined as ≥ 75% voting ’agree’ or ’strongly agree’. Statements that reached consensus were used to develop a clinical tool, of which, the goal was to improve understanding of disease chronicity, and the need for long-term, repeated treatment cycles. The tool highlights key decision stages across the patient journey and captures the panellist’s ratings of treatment options for attributes prioritized by patients. The expert recommendations and the clinical tool can be used to facilitate patient-centric management of actinic keratoses in daily practice, encompassing patient priorities and goals to set realistic treatment expectations and improve care outcomes.
Downloads
References
Balcere A, Rone Kupfere M, Čēma I, Krūmiņa A. Prevalence, discontinuation rate, and risk factors for severe local site reactions with topical field treatment options for actinic keratosis of the face and scalp. Medicina 2019; 55: 92.
https://doi.org/10.3390/medicina55040092 DOI: https://doi.org/10.3390/medicina55040092
Cerio R. The importance of patient-centred care to overcome barriers in the management of actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31: 17-20.
https://doi.org/10.1111/jdv.14091 DOI: https://doi.org/10.1111/jdv.14091
Goldenberg G. Treatment considerations in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31: 12-16.
https://doi.org/10.1111/jdv.14152 DOI: https://doi.org/10.1111/jdv.14152
Siegel JA, Korgavkar K, Weinstock MA. Current perspective on actinic keratosis: a review. Br J Dermatol 2017; 177: 350-358.
https://doi.org/10.1111/bjd.14852 DOI: https://doi.org/10.1111/bjd.14852
Fernandez Figueras MT. From actinic keratosis to squamous cell carcinoma: pathophysiology revisited. J Eur Acad Dermatol Venereol 2017; 31: 5-7.
https://doi.org/10.1111/jdv.14151 DOI: https://doi.org/10.1111/jdv.14151
Cantisani C, De Gado F, Ulrich M, Bottoni U, Iacobellis F, Richetta AG, et al. Actinic keratosis: review of the literature and new patents. Recent Pat Inflamm Allergy Drug Discov 2013; 7: 168-175.
https://doi.org/10.2174/1872213X11307020008 DOI: https://doi.org/10.2174/1872213X11307020008
Filosa A, Filosa G. Actinic keratosis and squamous cell carcinoma: clinical and pathological features. G Ital Dermatol Venereol 2015; 150: 379-384.
Chetty P, Choi F, Mitchell T. Primary care review of actinic keratosis and its therapeutic options: a global perspective. Dermatol Ther 2015; 5: 19-35.
https://doi.org/10.1007/s13555-015-0070-9 DOI: https://doi.org/10.1007/s13555-015-0070-9
Tennvall GR, Norlin JM, Malmberg I, Erlendsson AM, Hædersdal M. Health related quality of life in patients with actinic keratosis-an observational study of patients treated in dermatology specialist care in Denmark. Health Qual Life Outcomes 2015; 13: 1-9.
https://doi.org/10.1186/s12955-015-0295-4 DOI: https://doi.org/10.1186/s12955-015-0295-4
Abbott P. Patient-centred health care for people with chronic skin conditions. Br J Dermatol 2017; 177: 329-330.
https://doi.org/10.1111/bjd.15709 DOI: https://doi.org/10.1111/bjd.15709
Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease-strategies for optimizing treatment outcome. J Eur Acad Dermatol Venereol 2019; 33: 2253-2263.
https://doi.org/10.1111/jdv.15913 DOI: https://doi.org/10.1111/jdv.15913
Philipp-Dormston WG, Battistella M, Boussemart L, Di Stefani A, Broganelli P, Thoms KM. Patient-centered management of actinic keratosis. Results of a multi-center clinical consensus analyzing non-melanoma skin cancer patient profiles and field-treatment strategies. J Dermatol Treat 2020; 31: 576-582.
https://doi.org/10.1080/09546634.2019.1679335 DOI: https://doi.org/10.1080/09546634.2019.1679335
de Berker D, McGregor JM, Mohd Mustapa MF, Exton LS, Hughes BR. British Association of Dermatologists' guidelines for the care of patients with actinic keratosis 2017. Br J Dermatol 2017; 176: 20-43.
https://doi.org/10.1111/bjd.15107 DOI: https://doi.org/10.1111/bjd.15107
Richard MA, Amici JM, Basset-Seguin N, Claudel JP, Cribier B, Dréno B. Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians. J Eur Acad Dermatol Venereol 2018; 32: 339-346.
https://doi.org/10.1111/jdv.14753 DOI: https://doi.org/10.1111/jdv.14753
Heppt MV, Leiter U, Steeb T, Amaral T, Bauer A, Becker JC, et al. S3 guideline for actinic keratosis and cutaneous squamous cell carcinoma-short version, part 1: diagnosis, interventions for actinic keratoses, care structures and quality-of-care indicators. J Dtsch Dermatol Ges 2020; 18: 275-294.
https://doi.org/10.1111/ddg.14048 DOI: https://doi.org/10.1111/ddg.14048
Poulin Y, Lynde CW, Barber K, Vender R, Claveau J, Bourcier M, et al. Non-melanoma skin cancer in Canada chapter 3: management of actinic keratoses. J Cutan Med Surg 2015; 19: 227-238.
https://doi.org/10.1177/1203475415583414 DOI: https://doi.org/10.1177/1203475415583414
Shergill B, Zokaie S, Carr AJ. Non-adherence to topical treatments for actinic keratosis. Patient Prefer Adherence 2013; 8: 35-41.
https://doi.org/10.2147/PPA.S47126 DOI: https://doi.org/10.2147/PPA.S47126
Karrer S, Aschoff RAG, Dominicus R, Krähn-Senftleben G, Gauglitz GG, Zarzour A, et al. Methyl aminolevulinate daylight photodynamic therapy applied at home for non-hyperkeratotic actinic keratosis of the face or scalp: an open, interventional study conducted in Germany. J Eur Acad Dermatol Venereol 2019; 33: 661-666.
https://doi.org/10.1111/jdv.15422 DOI: https://doi.org/10.1111/jdv.15422
Norrlid H, Norlin JM, Holmstrup H, Malmberg I, Sartorius K, Thormann H, et al. Patient-reported outcomes in topical field treatment of actinic keratosis in Swedish and Danish patients. J Dermatol Treat 2018; 29: 68-73.
https://doi.org/10.1080/09546634.2017.1329514 DOI: https://doi.org/10.1080/09546634.2017.1329514
Vicentini C, Vignion-Dewalle AS, Thecua E, Lecomte F, Maire C, Deleporte P, et al. Photodynamic therapy for actinic keratosis of the forehead and scalp: a randomized, controlled, phase II clinical study evaluating the noninferiority of a new protocol involving irradiation with a light-emitting, fabric-based device (the Flexitheralight protocol) compared with the conventional protocol involving irradiation with the Aktilite CL 128 lamp. Br J Dermatol 2019; 180: 765-773.
https://doi.org/10.1111/bjd.17350 DOI: https://doi.org/10.1111/bjd.17350
Stritt A, Merk HF, Braathen LR, Von Felbert V. Photodynamic therapy in the treatment of actinic keratosis. Photochem Photobiol 2008; 84: 388-398.
https://doi.org/10.1111/j.1751-1097.2007.00276.x DOI: https://doi.org/10.1111/j.1751-1097.2007.00276.x
Heron CE, Feldman SR. Ingenol mebutate and the treatment of actinic keratosis. J Drugs Dermatol 2021; 20: 102-104.
https://doi.org/10.36849/JDD.5328 DOI: https://doi.org/10.36849/JDD.5328
Perl M, Goldenberg G. Field therapy in the treatment of actinic keratosis. Cutis 2014; 93: 172-173.
Grada A, Feldman SR, Bragazzi NL, Damiani G. Patient-reported outcomes of topical therapies in actinic keratosis: a systematic review. Dermatol Ther 2021; 34: e14833.
https://doi.org/10.1111/dth.14833 DOI: https://doi.org/10.1111/dth.14833
Diepgen TL, Eicke C, Bastian M. Ingenol mebutate as topical treatment for actinic keratosis based on a prospective, non-interventional, multicentre study of real-life clinical practice in Germany: efficacy and quality of life. Eur J Dermatol 2019; 29: 401-408.
https://doi.org/10.1684/ejd.2019.3603 DOI: https://doi.org/10.1684/ejd.2019.3603
Regno LD, Catapano S, Stefani AD, Cappilli S, Peris K. Am J Clin Dermatol 2022; 23: 339-352.
https://doi.org/10.1007/s40257-022-00674-3 DOI: https://doi.org/10.1007/s40257-022-00674-3
Werner RN, Stockfleth E, Connolly SM, Correia O, Erdmann R, Foley P, et al. Evidence-and consensus-based (S3) guidelines for the treatment of actinic keratosis-International League of Dermatological Societies in cooperation with the European Dermatology Forum-short version. J Eur Acad Dermatol Venereol 2015; 29: 2069-2079.
https://doi.org/10.1111/jdv.13180 DOI: https://doi.org/10.1111/jdv.13180
Heppt MV, Steeb T, Niesert AC, Zacher M, Leiter U, Garbe C, et al. Local interventions for actinic keratosis in organ transplant recipients: a systematic review. Br J Dermatol 2019; 180: 43-50.
https://doi.org/10.1111/bjd.17148 DOI: https://doi.org/10.1111/bjd.17148
Neidecker MV, Davis-Ajami ML, Balkrishnan R, Feldman SR. Pharmacoeconomic considerations in treating actinic keratosis. Pharmacoeconomics 2009; 27: 451-464.
https://doi.org/10.2165/00019053-200927060-00002 DOI: https://doi.org/10.2165/00019053-200927060-00002
Basset-Seguin N, Baumann Conzett K, Gerritsen MJP, Gonzalez H, Haedersdal M, Hofbauer GFL, et al. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol 2013; 27: 57-66.
https://doi.org/10.1111/j.1468-3083.2011.04356.x DOI: https://doi.org/10.1111/j.1468-3083.2011.04356.x
Hofbauer G, Anliker M, Boehncke WH, Brand C, Braun R, Gaide O, et al. Swiss clinical practice guidelines on field cancerization of the skin. Swiss Med Wkly 2014; 144: w14026.
https://doi.org/10.4414/smw.2014.14026 DOI: https://doi.org/10.4414/smw.2014.14026
Noels EC, Lugtenberg M, van Egmond S, Droger SM, Buis PAJ, Nijsten T, et al. Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists. Br J Dermatol 2019; 181: 96-104.
https://doi.org/10.1111/bjd.17818 DOI: https://doi.org/10.1111/bjd.17818
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Colin Morton, Samira Baharlou, Nicole Basset-Seguin, Piergiacomo Calzavara-Pinton, Thomas Dirschka, Yolanda Gilaberte, Merete Haedersdal, Günther Hofbauer, Sheetal Sapra, Rick Waalboer-Spuij, Leona Yip, Rolf-Markus Szeimies
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.