Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?

TitleSkin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?
Publication TypeJournal Article
Year of Publication2016
AuthorsLinos, E, Chren, M-M, Cenzer, I, Covinsky, KE
JournalJ Am Geriatr Soc
Date Published2016 08
ISSN Number1532-5415
KeywordsActivities of Daily Living, Aged, Aged, 80 and over, Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Comorbidity, Cost-Benefit Analysis, Cross-Sectional Studies, Curettage, Decision Support Techniques, Disability Evaluation, Electrosurgery, Female, Humans, Keratinocytes, Life Expectancy, Male, Mohs Surgery, Prognosis, Skin Neoplasms

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

User Guide Notes

Alternate JournalJ Am Geriatr Soc
Citation Key8503
PubMed ID27303932
PubMed Central IDPMC5459407
Grant ListK24 AR052667 / AR / NIAMS NIH HHS / United States
KL2 RR024130 / RR / NCRR NIH HHS / United States
R01 NR013347 / NR / NINR NIH HHS / United States
K24 AG029812 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States
R01 AR054983 / AR / NIAMS NIH HHS / United States