Does Life Expectancy Change Skin Cancer Treatment?
Nonmelanoma skin cancer, or keratinocyte carcinoma (KC), is the most common malignancy and the fifth most costly cancer to Medicare. There are a range of treatment choices available that vary in cost and invasiveness. Treatments include topical chemotherapy creams, tumor destruction with electrodesiccation and curettage (ED&C), and surgery. Surgery could be a simple excision or Mohs micrographic surgery (MMS). MMS aims to remove as much of the cancer as possible and prevent tumor recurrence, which for these typically slow-growing tumors occurs several years later. However, MMS costs approximately twice as much as excision, which is about twice as expensive as ED&C. Therefore, a recent study sought to determine whether a patient’s age and life expectancy affected the treatment options offered. The study was focused on participants aged 65 and older who were eligible for Medicare. Life expectancy was linked to variables that included advanced age (≥85), which is associated with a life expectancy of 6 years, comorbid disease burden, and Charlson comorbidity score which is an index of disease burden closely linked to survival. The results showed that for this population neither individual prognostic characteristics nor life expectancy influenced KC treatment choice, including rates of MMS. These findings suggest that skin cancer treatment choice is not currently customized to life expectancy and functional status. The authors conclude that a more-individualized approach to skin cancer treatment may be preferred and provide better care for frail elderly adults. They caution that while advanced age alone should not dictate or restrict treatment options because life expectancy varies tremendously in those of similar age, it is possible that some individuals would choose less-invasive treatment. The authors suggest that providers might make different recommendations if they had more guidance (including decision tools or evidence-based guidelines) on this topic.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: October 31, 2016
Adapted from the original article.
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