Blog | Thursday, May 2, 2013

QD: News Every Day--Nonmelanoma skin cancers treated even in patients with limited life expectancies

Most nonmelanoma skin cancers are treated surgically, regardless of the patient's life expectancy, reported a study that encouraged a change in the practice.

Researchers conducted a prospective cohort study of consecutive patients diagnosed with nonmelanoma skin cancers at a university-based private practice and a VA center in San Francisco. Patients were recruited in 1999 and 2000 and followed for a median of 9 years.

Limited life expectancy was defined as patients either 85 years or older at the time of diagnosis or patients with a Charlson Comorbidity Index of 3 or more. Patients were also offered a questionnaire about about how much their tumors bothered them. Treatment options included no treatment, destruction or surgery via either elliptical excision or Mohs surgery.

Results appeared online April 29 at Archives of Internal Medicine.

There were 1,360 patients with 1,739 tumors in the final analysis. Most nonmelanoma skin cancers (69%) were treated surgically, regardless of patient life expectancy.

Overall, 671 patients and 212 patients with limited life expectancy responded to the questionnaire; 22% reported they were frequently bothered by their tumor.

There were 203 unique patients (15% of the total cohort and 30% of 671 respondents to this item) who reported a complication after treatment for nonmelanoma skin cancer. There were 67 complications in patients with limited life expectancy (20% of the limited life expectancy subgroup and 32% of 212 respondents to this item), mostly poor wound healing and symptoms such as numbness or itching and pain. There were no significant differences between the types of complications reported by limited life expectancy compared with the overall cohort.

Five-year recurrence rates for the cancers were low in the entire cohort (3.7%; 95% confidence interval, 2.6% to 4.7%) and in the limited life expectancy subgroup (3.7%; 95% CI, 1.5% to 5.9%). Among 14 patients with limited life expectancy whose tumors recurred, nine died of other causes soon after their recurrence (median survival after recurrence, 21 months; IQR, 15 to 27 months).

Although serious complications were unusual, approximately 20% of patients with limited life expectancy reported complications of therapy, compared with 15% of other patients.

Researchers noted that Mohs surgery can be time consuming, often requiring several hours to complete while patients are awake, making it difficult for frail patients with limited life expectancy who are unable to tolerate extended procedures. And, wound care after surgery may be especially difficult for patients with limited life expectancy who often require assistance with activities of daily living, which might explain the higher rates of patient-reported complications.

Researchers said, "Given the very low tumor recurrence rates and high mortality rates in this patient population, we believe consideration of life expectancy should enter into treatment decisions."