Original articleComorbidity scores associated with limited life expectancy in the very elderly with nonmelanoma skin cancer
Section snippets
Patient selection
This was a single-center retrospective study of prospectively collected patients age 85 years or older who underwent Mohs micrographic surgery (MMS) for NMSC with 3 surgeons in a dermatologic surgery service between July 1999 and December 2014. A retrospective search using an institutional database was performed to identify patients who presented to the service with NMSC and did not undergo MMS during that time period. Patient demographics, tumor characteristics, and surgical details were
Patient and lesion characteristics
In all, 488 patients age 85 years or older were included in the study. Of these, 371 of 10,103 total patients who presented for MMS were age 85 years or older. An additional 117 patients age 85 years or older were seen for MMS consultation but did not pursue MMS. Characteristics of the study participants and the presenting skin cancer are presented in Table I.17, 18 The mean age was 88.1 years and the majority were female (52.5%). The majority of lesions were located on the head and neck (the
Discussion
Life expectancy is estimated to increase from 6 to 7 years in men and from 7.1 to 8.5 years in women age 85 years between 2012 and 2050.5 With life expectancy and the proportion of the population of very elderly individuals projected to increase in the United States, the management of non–life-threatening illnesses such as skin cancer will increasingly be relevant. In this study, patients presenting to a tertiary cancer center for MMS had a mean age of death of 93.5 years and longer than the
Conclusions
Patients 85 years and older presenting to a dermatologic surgery service surpassed expected survival. Higher comorbidity scores were associated with decreased survival, and both the ACE-27 and ACCI were predictive of LLE at scores of 3 and 7+, respectively. Patients who underwent MMS survived longer despite similarities in comorbidity profiles between groups, implying that additional factors selected for by patients and their physicians may significantly contribute to survival in this cohort.
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2022, Journal of the American Academy of DermatologyCitation Excerpt :These findings could aid clinicians in advising patients who may need extra measures to reduce the burden of therapy, for instance, extra postoperative care, home visits, or help from medical caretakers, general practitioners, or relatives. In line with reports in several articles,3,13,29,31 comorbidities (increasing CCI) and iADL dependency were significantly associated with an increased overall (non-BCC-related) short-term mortality, although the study by Linos et al12 indicated that CCI was less accurate at estimating 5-year survival in a majority of the included patients. Therefore, it remains difficult to estimate life expectancy, and more research is highly needed to provide consensus in this field.
Funding sources: Supported by the National Cancer Institute of the National Institutes of Health (NIH) under award No. R25CA020449 and in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest: None disclosed.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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