***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To identify predictors of skin-related quality of life ( QOL ) after treatment of nonmelanoma skin cancer ( NMSC ) . DESIGN Prospect i ve cohort study of consecutive patients with NMSC diagnosed in 1999 and 2000 . SETTING University-affiliated private practice and a Veterans Affairs clinic . PATIENTS A total of 633 patients who responded to a question naire before treatment .  MAIN OUTCOME MEASURE Skin-related QOL , measured with the 16-item version of  Skindex-16  , a vali date d measure . Skindex-16 scores vary from 0 ( best QOL ) to 100 ( worst QOL ) and are reported in 3 domains : symptoms , emotional effects , and effects on functioning . RESULTS Controlling for treatment group , the strongest independent predictor of skin-related QOL after treatment of NMSC was pretreatment skin-related QOL . Other patient characteristics that predicted better QOL included less comorbidity and better mental health status . No tumor or care characteristic ( including location of tumor , size of tumor , site of therapy , or training level of treating clinician [ attending physician , resident , or nurse practitioner ] ) was found to predict better skin-related QOL after treatment of NMSC . CONCLUSIONS Patients with better pretreatment  skin-related QOL , less comorbidity , and better mental health status had better skin-related QOL after treatment of NMSC . These findings may be useful for pretreatment assessment and counseling BACKGROUND Patient satisfaction is an important aspect of patient‐centered care but has not been systematic ally studied after treatment of nonmelanoma skin cancer ( NMSC ) , the most prevalent cancer . OBJECTIVE To compare patient satisfaction after treatment for NMSC and to determine factors associated with better satisfaction . METHODS We prospect ively measured patient , tumor , and care characteristics in 834 consecutive patients at two centers before and after destruction , excision , and Mohs surgery .  We evaluated factors associated with short‐term and long‐term satisfaction . RESULTS In all treatment groups , patients were more satisfied with the interpersonal manners of the staff , communication , and financial aspects of their care than with the technical quality , time with the clinician , and accessibility of their care ( p<.05 ) . Short‐term satisfaction did not differ across treatment groups . In multivariable regression models adjusting for patient , tumor , and care characteristics , higher long‐term satisfaction was independently associated with younger age , better pretreatment mental health and skin‐related quality of life , and treatment with Mohs surgery ( p<.05 ) . CONCLUSIONS Long‐term patient satisfaction after treatment of NMSC is related to pretreatment patient characteristics ( mental health , skin‐related quality of life ) and treatment type ( Mohs ) but not tumor characteristics . These results can guide informed decision‐making for treatment of NMSC . The authors have indicated no significant interest with commercial supporters BACKGROUND Quality of life ( QOL ) has been identified as an important outcome in cancer research , yet the most common malignancy among humans , nonmelanoma skin cancer ( NMSC ) , has been poorly studied in this regard . OBJECTIVE To determine whether change occurred in the QOL of NMSC patients after surgery using a general , vali date d dermatology QOL instrument : the Dermatology Life Quality Index ( DLQI ) . METHODS A prospect i ve study was conducted on 121 consecutive patients referred to a dermatologic Mohs surgery clinic with NMSC of the head and neck .  QOL assessment  was performed using the DLQI before ( n=121 ) and after surgical treatment at 4 months ( n=101 ) . RESULTS QOL scores demonstrated little h and icap at initial diagnosis . The total DLQI scores showed little change over time , but an item analysis revealed that 2 of the 10 items demonstrated statistically significant change over time , with QOL improving after treatment — decreased painfulness/itchiness/soreness and less necessity to use concealing clothing . CONCLUSIONS General dermatology QOL instruments demonstrated minimal h and icap at initial diagnosis and little change after treatment of NMSC . Although the associations were modest , improvement in some aspects of well-being after treatment of NMSC was demonstrated . A more disease-specific instrument may be necessary to study this disease process further Background An accurate , sensitive , but brief quality -of-life outcomes measure is needed for studies of dermatologic care . Objective To construct a single-page version of Skindex ( a dermatologic quality -of-life instrument ) that would have two new features compared with the current 29-item version : ( 1 ) fewer items to which a majority of patients choose the same response , and ( 2 ) measurement ofbother rather than frequency of patient experiences . Methods R and om sample s of patients waiting for dermatology appointments in clinics of Veterans Affairs hospitals and in private dermatology practice s completed question naires ; 692 patients responded to the parent instrument and 541 additional patients responded to the brief version .  Reproducibility , internal consistency reliability , validity , and responsiveness of the brief version of Skindex were determined . Results For 16 items of the current 29-item version ( 55 % ) , more than 50 % of patients responded “ Never . ” After an explicit process of item analysis and elimination , a single-page 16-item version was composed that asks patients about bother from their experiences ; responses are reported as three scales , Symptoms , Emotions , and Functioning . For 6 items of the 16-item version ( 38 % ) , more than 50 % of patients responded “ Never . ” Scale scores were reproducible after 72 hours ( r = 0.88 - 0.90 ) and were internally reliable ( Cronbach ’s α = 0.86 - 0.93 ) . The instrument demonstrated both content and construct validity : Most patients ’ responses to an open-ended question about their skin disease was addressed by the items ; patients with inflammatory dermatoses had higher scores than those with isolated lesions ; and in an exploratory principal axes factor analysis with an oblique rotation , 74 % of the common variance was explained by three factors that correlated with thea priori scales . Mean scale scores stayed the same or changed in the expected direction in patients who reported that their skin was the same or had improved . Conclusion This brief single-page version of Skindex accurately and sensitively measures how much patients are bothered by their skin conditions . SommaireAntécédentsLa mesure des résultats relatifs à la qualité de vie lors d’études sur les soins dermatologiques doit être précise , sensible mais concise . ObjectifÉlaborer une version en une seule page du Skindex ( instrument de mesure de la qualité de vie sur le plan dermatologique ) qui comporterait deux nouvelles caractéristiques par rapport à la version actuelle de 29 questions : ( 1 ) moins de questions pour lesquelles la majorité des patients choisissent la même réponse , et ( 2 ) la mesure des ennuis causés par la maladie plutôt que celle de la fréquence des épisodes . MéthodesDes échantillonnages r and omisés de patients en attente de rendezvous à la clinique de dermatologie des hôpitaux des Anciens Combattants et en cabinets privés ont rempli les question naires ; 692 patients ont répondu à l’instrument de mesure principal et 541 à la version simplifiée . La reproductibilité , la cohérence interne , la fiabilité , la validité et la réactivité de la version simplifée du Skindex ont été évaluées . RésultatsPlus de 50 % des patients ont répondu « jamais » à 16 des 29 questions de la version actuelle ( 55 % ) . Après un travail en profondeur d’analyse et d’élimination des questions , on a rédigé une version d’une page comportant 16 questions sur les ennuis causés par la maladie , les réponses étant rapportées selon trois échelles : symptômes , émotions et fonctionnement . Plus de 50 % des patients ont répondu « jamais » à 6 des 16 questions ( 38 % ) . Les résultats de l’échelle étaient reproductibles après 72 heures ( r = 0 , 88 - 0,90 ) et fiables sur le plan interne ( Cronbach ’s α = 0,86 - 0,93 ) . L’instrument de mesure a permis de démontrer la validité du contenu et de la conception : la plupart des réponses des patients à une question ouverte sur leur affection cutanée étaient abordées dans la question ; les patients atteints de dermatoses inflammatoires avaient des résultats plus élevés que ceux présentant des lésions isolées ; et dans une analyse factorielle exploratoire des principaux axes , la variance commune s’expliquait à 74 % par trois facteurs qui étaient en corrélation avec les échelles établies a priori . Les résultats moyens sont demeurés les mêmes ou ont changé dans le sens attendu chez les patients qui avaient rapporté que l’état de leur peau était le même ou qu’il s’était amélioré . Conclusion Cette version simplifiée d’une page du Skindex mesure de façon précise et sensible l ’ importance des ennuis que causent les affections cutanées aux patients OBJECTIVE To establish the clinical responsiveness of the Skin Cancer Index ( SCI ) , a new disease-specific quality of life ( QOL ) instrument , and to assess demographic and clinical factors which impact QOL in patients with nonmelanoma skin cancer ( NMSC ) . STUDY DESIGN Prospect i ve study of 183 patients with NMSC of the face and neck referred to a tertiary care Mohs surgery clinic . METHODS The SCI is a 15 item , vali date d , disease-specific QOL instrument with 3 distinct subscales , Emotion , Social , and Appearance . Higher scores reflect better QOL . The  SCI  and the  Dermatology Life Quality Index ( DLQI ) , a general dermatology instrument , was administered at initial consultation and 4 months after surgical treatment . Multivariate analysis was conducted to assess demographic and clinical factors predictive of QOL for both instruments . RESULTS The SCI total score and all three subscale scores increased with treatment , demonstrating strong evidence of responsiveness over time ( P < .001 ) in contrast with the DLQI ( P = .46 ) . Predictors of poorer QOL for the SCI included female sex and cancers located on the lip . Patients who demonstrated greatest improvement in QOL with treatment included those who were younger ( < 50 yr ) and had lower reported household income . Also , first time NMSC patients and those patients who underwent less extensive reconstructions demonstrated greater improvements in QOL . CONCLUSION The SCI is a sensitive and responsive QOL instrument for patients with NMSC . Distinct demographic and clinical variables that impact QOL have been demonstrated using this multidimensional , disease-specific instrument CONTEXT Nonmelanoma skin cancer ( NMSC ) is the most common cancer among humans , yet risk perceptions and preventive health behaviors in those who survive this cancer are relatively unknown . OBJECTIVES To assess the impact of the disease and its treatment on sun-protective behaviors , general preventive health behaviors , and risk perception in NMSC patients , and to determine factors associated with behavioral change . DESIGN AND SETTING A prospect i ve study was conducted of 211 consecutive NMSC patients presenting to a dermatologic surgery clinic at a tertiary care university medical center from February 2005 to March 2006 . These patients were all adults , were fluent in English , and had NMSC of the head and neck . Of the 211 eligible patients , complete data was obtained for 183 ( 87 % ) . The most common reasons for dropout were voluntary withdrawal and incompletely answered surveys . INTERVENTION AND OUTCOME MEASURES Surveys that assessed disease-specific quality of life ( QoL ) , preventive health behaviors , sun-protective behaviors , and risk perception were administered before and after surgical treatment of NMSC . RESULTS Sun-protective behaviors improved postsurgery even after controlling for seasons ( P<0.001 ) . Predictor factors associated with increased sun-protective behavior included poor skin tanning ability , summer season , no employment , less comorbid conditions , and previous NMSC treatment . Baseline QoL was not predictive of behavioral change . As for risk perception , respondents thought they were more likely than someone similar to themselves to develop future NMSCs but thought they had similar risks of developing melanoma or other non-skin cancers ( P<0.001 ) . NMSC patients demonstrated disease-specific behavior modifications by selectively improving their sun habits but showed no significant improvement in other preventive health behaviors . This finding is consistent with patients ' specific perception of increased risk for future NMSCs , but surprisingly , not for melanoma . Increased patient education of associated cancer risks with NMSC is warranted . CONCLUSIONS NMSC patients demonstrated disease-specific behavior modifications by selectively improving their sun habits but showed no significant improvement in other preventive health behaviors . This finding is consistent with patients ' specific perception of increased risk for future NMSCs , but surprisingly , not for melanoma . Increased patient education of associated cancer risks with NMSC is warranted BACKGROUND Keratinocyte carcinomas ( KCs ) are the most common malignancies of the skin . As lesions have a low mortality rate , underst and ing quality -of-life ( QoL ) factors is necessary in their management . OBJECTIVE To assess QoL and associated patient characteristics in those with a history of keratinocyte carcinomas . METHODS We conducted a cross-sectional study of veterans with a history of KCs enrolled in a r and omized controlled trial for chemoprevention of keratinocyte carcinomas . Study dermatologists counted actinic keratoses ( AKs ) and assessed for skin photodamage . QoL was assessed using Skindex-29 and KC-specific questions . Demographics were self-reported . RESULTS Participants ( n = 931 ) enrolled at 5 clinical sites had worse QoL on all subscales ( 
    Output:
    
The Skin Cancer Index demonstrates the most evidence of its usefulness in patients with BCC/SCC .
The Patient Outcomes of Surgery-Head/Neck may be beneficial to assess perceptions in appearance before and after surgical intervention