Effect of Patient Characteristics on Treatment Decisions Regarding Keratinocyte Carcinoma in Elderly Patients: A Review of the Current Literature

Abstract

This study collected data about the effect of patient characteristics (life expectancy, frailty and comorbidity) on treat ment decisions in elderly people with keratinocyte carcinoma, by searching PubMed database. Literature about how patient characteristics affect treatment decision is sparse and is mostly based on small retrospective studies. Therefore, it is difficult to give firm recommendations. A "one-size-fits-all" approach to this population is not sufficient: life expectancy, frailty and comorbidities must be taken into account in the decision-making about treatment, and registered using a validated scoring system, especially before major treatment modalities.There are straightforward guidelines for treatment of keratinocyte carcinoma (formerly known as non-melanoma skin cancer); however, there are no clear recommendations specifically for elderly patients. The aim of this review was to provide an overview of the current literature about the effect of patient characteristics, specifically life expectancy, frailty and comorbidity, on treatment decisions in elderly patients with keratinocyte carcinoma, by searching PubMed database. It was found that the literature is limited and based mostly on small retrospective studies. Therefore, it is difficult to give firm recommendations about how to treat elderly people who have keratinocyte carcinoma. A "one-sizefits-all" approach to this population is not sufficient: life expectancy and frailty need to be considered in the decision-making process regarding treatment for elderly people with keratinocyte carcinoma. Among the comorbidity scores, Adult-Comorbidity-Evaluation-27-index seems to have the best prognostic value. Prospective studies are needed to generate more individualized recommendations for this increasing and often vulnerable group.

Characteristics and management of skin cancers in very elderly patients: A real‐world challenge for clinicians

“…Therefore, when treating skin cancer in older patients, numerous key aspects should be taken into account, including comorbidities, performance status, the concepts of frailty, life expectancy and lag time to benefit. 26,27 The concept of frailty has been defined as a state of increased vulnerability to sudden health status changes and adverse outcomes when exposed to a stressor, such as cancer or surgery. 28 Even though it is an expression of population aging, chronological age itself does not define frailty, whose definition stems from a complex multidisciplinary evaluation.…”

“…Moreover, very elderly patients may not live long enough to benefit from treatment. Therefore, when treating skin cancer in older patients, numerous key aspects should be taken into account, including comorbidities, performance status, the concepts of frailty, life expectancy and lag time to benefit 26,27 …”

Radiologically Defined Sarcopenia as a Biomarker for Frailty and Malnutrition in Head and Neck Skin Cancer Patients

“…The lumbar SMI was then calculated using the formula published by Prado et al see Formula (2) [5] LumbarSMI cm 2 /m 2 = CMSAatL3/(height * height).…”

“…In general, surgical interventions for HNSC are relatively simple with local excision, but extensive surgery can be necessary for cases of advanced disease. Preoperative screening for this population is essential as older patients may have more comorbidities, functional impairments, psychological issues, and poorer social support, all of which can affect perioperative risk [5]. Hence, a multidisciplinary approach and personalized treatment are important for decision-making [6,7].…”