Validation of Photograph-Based Toxicity Score for Topical 5-Fluorouracil Cream Application

J Cutan Med Surg. 2016 Sep;20(5):458-66. doi: 10.1177/1203475416643952. Epub 2016 Apr 18.

Abstract

Background: An objective tool quantifying the toxicity of 5-fluorouracil (5-FU) from photographs was recently reported, and its reliability was confirmed.

Objective: The aim of this study was to validate the photograph-based toxicity score.

Methods: Photograph-based toxicity scores of participants assigned to the 5-FU arm of a randomized placebo-controlled trial were tested for correlations with their patient-reported symptom scores and baseline characteristics.

Results: Each pair of individual and overall scores of patient-reported symptoms and photograph-based toxicity was correlated at 2 and 4 weeks (correlation coefficient range, 0.34-0.95; P < .001 for all). Older age, more actinic keratoses, previous topical 5-FU use, and more keratinocyte carcinomas on the face and ears in the previous 5 years were correlated with increased 5-FU toxicity at 2 weeks (P < .05). An increase in the total number of 5-FU applications during the trial was correlated with less severe toxicity at 2 weeks (P < .001), but with increased toxicity at 4 weeks (P < .001).

Conclusion: This study provides evidence for construct validity of the photograph-based 5-FU toxicity score. The tool can be used to objectively measure 5-FU toxicity in clinical or research setting, and it can be a prototype for toxicity measurements of other topical medications.

Keywords: 5-fluorouracil; skin cancer; topical medication; validity study.

Publication types

  • Randomized Controlled Trial
  • Validation Study

MeSH terms

  • Administration, Cutaneous
  • Age Factors
  • Aged
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Carcinoma, Squamous Cell / diagnosis*
  • Drug Eruptions / etiology*
  • Ear Neoplasms / diagnosis*
  • Facial Neoplasms / diagnosis*
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects*
  • Humans
  • Keratosis, Actinic / drug therapy
  • Male
  • Photography*
  • Retreatment
  • Risk Factors
  • Severity of Illness Index*
  • Skin Cream / adverse effects

Substances

  • Antimetabolites, Antineoplastic
  • Fluorouracil