Patient-reported health not associated with keratinocyte carcinoma treatment choice in a Medicare cohort of older adults.
Patient-reported health not associated with keratinocyte carcinoma treatment choice in a Medicare cohort of older adults.
复制标题
在老年医疗保险队列中，患者报告的健康状况与角化细胞癌的治疗选择无关。
DOI：
10.1111/bjd.18543
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Margolis,DJ
中科院分区：
文献类型：
--
作者：
Wehner,MR;Kwong,PL;Kurichi,JE;Xie,D;Hennessy,S;Margolis,DJ
DEAR EDITOR, Keratinocyte carcinomas [KCs; basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)], are common in older adults, with 241 million yearly in US Medicare patients. 1 Common treatments include destruction (typically electrodessication and curettage), surgical excision and Mohs micrographic surgery (MMS), all of which can offer cure rates> 90% 2, 3 (highest for MMS, followed by excision, then destruction). These treatments differ: longer procedure times and more follow-up for MMS and excision, although healing times can be shorter and cosmesis better. In the USA, MMS is approximately 70% more expensive than excision, which is approximately 160% more expensive than destruction. 4 Two recent studies report KC treatment does not differ by age or life expectancy. 5, 6 However, these studies focused on MMS, indicated for higher-risk KCs, for which excisions or destructions might not be appropriate. Additionally, prior studies did not assess patients’ own health perceptions, which might be important. We hypothesized that patients who perceive their health to be worse might be more likely to choose a faster treatment with slightly lower cure rate and fewer postoperative visits (destruction rather than excision).We used the US Medicare Current Beneficiary Survey, a nationally representative sample of Medicare patients with insurance claims data and survey data from in-person interviews. 7 Medicare is federal insurance for people 65 years of age and older, and some younger patients with chronic conditions. We included participants age≥ 65 years from 2001 to 2009 with at least one KC treatment. We excluded participants with HIV, organ transplant or non-Medicare insurance coverage. We collected information including functional status [activities of daily living (ADLs), in stages, from 0 (no difficulty in any ADL) to IV (difficulty in all ADLs)]. Participants also rated their health as excellent, very good, good, fair or poor. Finally, we calculated a Lee Mortality Index value, 8 a validated prognostic index which uses age, comorbidities and function,
