gms | German Medical Science

Background: By causing slight symptoms in the early stages persons suffering from some forms of skin cancer often run into high stages of illness. Delayed medical attention in higher stages demand a more invasive and cost-intensive therapy. Also patients undergo losses in their quality of life from symptoms and invasive therapy. Despite continually increasing incidences in skin cancer entities like malignant melanoma (MM), basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) most people are still misunderstanding the hazards for skin cancer. Preventing strategies in each stage, primary, secondary, and tertiary are in high demand. But interventions like skin cancer screening are still missing the evidence for effectiveness and therefore are criticised. A prerequisite should be the critical dealing of utilised parameter that are defined as measures for effectiveness. Characterized as complex interventions prevention strategies have to be handled with approaches that include more study designs besides RCTs and similar controlled designs. Furthermore, the context of prevention strategies and its causalities has to be evaluated not only quantitatively but also qualitatively to extract caused effects and further point out consecutive endpoints for the prove of effectiveness and cost-effectiveness.

Research question: This review seeks to outline existing and practised interventions in prevention and their experienced effects and furthermore display possibility for inferred effectiveness within following research questions:

• What effects can display effectiveness considering time horizon, perspective and organizational level?
• What are essential and sufficient conditions to prove effectiveness and cost-effectiveness in skin cancer prevention strategies?

Method: A systematic review is performed to spot studies from any design and assess the data quantitatively and qualitatively. Included studies from each key question will be summarized by characteristics like population, intervention, comparison, outcomes, study design, endpoints, effect estimator, etc. Beside statistical relevancies for a systematic review the qualitative method of qualitative comparative analysis (QCA) will be performed. This approach is employed to combine quantitative to qualitative research methods and therefore to aid a new perspective in HSR. The review protocol is registered in PROSPERO with the registration number CRD42017053859.

Outcomes: The review is ongoing and outcomes will be available and presented in October 2017.

Studies in the systematic review will be filed by prevention level: primary, secondary, tertiary. The estimated outcomes from this review and QCA are the accomplishment and absence of effects that are appropriate for application in effectiveness assessments and further cost-effectiveness assessment. Estimated effects are for example reduced UV-exposure, reduced numbers of sunburns and reduced use of tanning beds induced by knowledge enhancement from enlightenment campaigns and education, and municipally provided sun screen facilities in primary prevention. In secondary prevention e.g. increased numbers of detected skin cancers, stage shifts to early stages, metal burden from screening tests, or false positive or negative screenings are expected. In tertiary prevention milder disease processes, less invasive therapeutic strategies (e.g. less prescribed chemotherapies), a smaller impairment of quality of life in patients, and decreased numbers of recurrences are estimated to show up. Further the conditions for the accomplishment and absence of effects and thus effectiveness and cost-effectiveness are expected to become apparent.

Discussion and practical implications: The expected outcomes from the systematic review and related QCA offer an appropriate method to reveal experienced interventions, their context, and effects. This is performed not only quantitatively for the purpose of evidence-based medicine but also qualitatively with regard to underlying conditions for the attainability of effects or their absence. This is an indispensable groundwork in order to frame also suitable endpoints for effectiveness measures and furthermore cost-effectiveness.