Patients aged ≥85 years with biopsy-proven non-melanoma skin cancers (NMSCs) are less likely to receive treatment for their tumors, with impairment of activities in daily living (ADL) representing a significant predictor for lack of treatment in this population, study results in the Journal of the American Academy of Dermatology suggest.
The study was a retrospective review of biopsy-proven NMSCs in adults seen in a dermatology department at Beth Israel Deaconess Medical Center in Boston between 2017 and 2018. Treated and untreated patients were included in the analysis. Untreated patients were those for whom treatment was not initiated within 12 months of biopsy. A total of 927 patients met the inclusion criteria and were included in the final cohort.
Participants aged ≥85 years (ie, elderly) had higher rates of untreated skin cancer compared with nonelderly patients (13.0% vs 4.2%, respectively; X2 <.0001). The most common reasons for lack of treatment were loss to follow up (35%), negative biopsy margins (23%), refusal because of either age or comorbidities (21%), and management at an outside hospital (10%).
In elderly patients, female sex was associated with a greater likelihood to be untreated (odds ratio [OR], 7.43; P =.012). Patients were also more likely to not receive treatment if they had ≥4 comorbidities (OR, 3.91; P =.036), neurocognitive impairment (OR, 3.91; P =.036), impairment in ADL (OR, 10.0; P <.0001), and hemiplegia (P <.0001). A greater likelihood of treatment was observed in patients with a skin cancer history (OR, 0.10; P =.001). The multivariable analysis retained significance for impairment in ADL (OR, 48.6; P =.007) for a reduced likelihood of treatment and prior skin cancer (OR, 0.03; P =.003) for an increased likelihood of treatment.
The retrospective single center design, small sample size, and limited follow-up duration are limitations of the study.
The researchers added that “potential influences like insurance status and distance from hospital were also not considered” and could have influenced treatment decision making and therefore the study findings.
Basu P, Beckles A, Porter ML, Olbricht S. Non-melanoma skin cancers are more likely to be untreated in elderly patients [published online September 13, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.009