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More patients than docs report skin surgery problems

By Genevra Pittman

NEW YORK (Reuters Health) - More than one quarter of people being treated for non-melanoma skin cancer in their doctor's office reported some type of complication after surgery, in a new study.

About half of those complications were medical problems related to the cancer-removing procedure, including pain, infections and slow wound healing.

But just 3 percent of doctors noted a complication in the same patients' medical records, researchers reported this week in JAMA Internal Medicine.

"It's important, in order to improve care and improve quality of care, to be aware of what our weaknesses are as physicians," said Dr. Eleni Linos, who led the new study at the University of California, San Francisco.

"If a quarter of Toyota customers were unhappy after service, they would take that very seriously," she said - the same as if a quarter of Apple product buyers didn't like their purchases.

The researchers followed 866 people - mostly older men - being treated for non-melanoma skin cancer, which includes basal and squamous cell cancers.

About 2.2 million people are diagnosed with those cancers every year in the U.S., but only 2,000 or so die, according to the American Cancer Society.

One recent report, also from Linos and her colleagues, found most people with non-melanoma skin cancer undergo surgery to treat it - even though for some elderly or ill patients, benefits are unlikely (see Reuters Health story of April 29, 2013 here: http://reut.rs/11RhiQn).

This time, the researchers sent questionnaires to patients who had undergone some type of in-office skin cancer procedure for up to five years after their surgery.

Thirteen percent of them reported a non-medical problem, such as issues with their scar or appearance or difficulty getting to appointments. Another 14 percent said they had a medical complication - most commonly pain, numbness or itching, problems with wound healing or infections.

One in ten people reported a moderate or severe complication on a post-surgery questionnaire.

In contrast, Linos and her colleagues found doctors noted a complication in the medical charts of just 22 of those patients, or 3 percent.

She said the proportion of patients who reported a complication was "sky high" compared to what the researchers were expecting.

WHAT'S A COMPLICATION?

Patients might have a broader view of what counts as a complication, she said, such as disliking bandages or scars. Or, doctors may simply not ask patients about their post-surgery problems often enough - and may miss chances to address treatable issues.

Complications can be subjective for patients, and even scarring can be "life-altering" for certain people, according to Anthony Simon Bates, who has studied how patients are asked about complications of skin cancer surgery at the UK's University of Bristol.

"There's a real need to manage patient expectations and for doctors to provide adequate pre-operative advice and information to patients," Bates, a medical student who wasn't involved in the new research, told Reuters Health.

According to Linos, the same patterns have been suggested for hospital care, as well as medication side effects: what patients experience can be very different from what doctors expect.

"The bottom line is, it's worth asking patients what they're experiencing directly," she said. "We're all on the same team, but often we may not be as aware as the patient is about their own experience."

SOURCE: http://bit.ly/14xz8Ji JAMA Internal Medicine, online May 20, 2013.

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