Risk of complications may outweigh benefits for frail elderly who do not have melanoma, study suggests
TUESDAY, April 30, 2013 (HealthDay News) -- Surgery may not be the best option for treating non-melanoma skin cancer in frail, elderly patients, a new study reports.
These patients face an increased risk of complications and may not live long enough to benefit from surgery, according to the researchers from the University of California, San Francisco.
The investigators followed more than 1,300 patients with non-melanoma skin cancers for about a decade. About one-quarter of the patients were believed to have a short life expectancy because they were at least 85 years old and had multiple serious health conditions.
Most of the patients in the study underwent surgery for their skin cancer, and one in five patients reported complications from the surgery. Nearly half of the patients with a short life expectancy died within five years and none of those deaths was from skin cancer.
Instead, most of the deaths were due to heart disease, cerebrovascular disease (such as stroke), lung cancer, pneumonia, chronic respiratory disease, prostate cancer and Alzheimer's disease, according to the study published online April 29 in the journal JAMA Internal Medicine.
The findings suggest that doctors should consider the benefits, risks and preferences of patients when deciding on an appropriate treatment for non-melanoma skin cancers, the researchers said.
"It can be very challenging to decide whether and how to treat patients with non-melanoma skin cancer who have limited life expectancy, especially when the tumors are asymptomatic [or symptomless]," study lead author Dr. Eleni Linos, an assistant professor of dermatology, said in a UCSF news release.
"One challenge is that it is hard to precisely predict an individual's life expectancy. Another challenge is that elderly patients are very diverse. For example, some 90-year-olds are active, healthy and would like to choose the most aggressive treatments for skin cancer, while others are very frail and unable to care for themselves, and may prefer less invasive management for a skin cancer that doesn't bother them," Linos explained.
"Bothersome or medically dangerous skin tumors should always be treated, regardless of age or life expectancy. But treatment of asymptomatic tumors might not be the best option for all patients," she concluded.
The U.S. National Cancer Institute outlines treatment options for non-melanoma skin cancer (http://www.cancer.gov/cancertopics/pdq/treatment/skin/Patient/page4 ).
SOURCE: University of California, San Francisco, news release, April 29, 2013