Skin Cancer in US Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?
Skin Cancer in US Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?
复制标题
DOI：
10.1111/jgs.14202
复制
发表时间：
2016-08-01
影响因子：
6.3
通讯作者：
Covinsky, Kenneth E.
中科院分区：
文献类型：
--
作者：
Linos, Eleni;Chren, Mary-Margaret;Covinsky, Kenneth E.
目的检验预期寿命是否影响非黑色素瘤皮肤癌或角质形成细胞癌(KC)的治疗模式。KC是最常见的恶性肿瘤，也是医疗费用第五高的癌症。设计具有全国代表性的横断面研究。设置与医疗保险索赔相关的具有全国代表性的健康和退休研究。参与者包括1992至2012年间因基底或鳞状细胞癌(N=2,702)而接受治疗的65岁及以上个人(N=9,653)的治疗情况。衡量标准是根据85岁及以上、医疗合并症、Charlson共病指数评分3或更高、日常生活困难(ADL)至少一项以及Lee指数13或更高来定义的有限预期寿命。根据程序代码，治疗类型(Mohs显微外科手术(MMS)(强度最大，费用最高)、切除或电干刮除(ED&C)(强度最小，费用最低))。在预期寿命有限的参与者和预期寿命正常的参与者中，MMS(19%)、切除(42%)和ED&C(39%)的发生率没有差异。例如，有ADLS困难或依赖的参与者中有19%，Charlson共病评分大于3的参与者中有20%，在他们生命的最后一年的参与者中有15%患有MMS；在诊断后1年内死亡的参与者接受与寿命更长的参与者相同的治疗。结论一种一刀切的方法，即年龄、健康状况、功能状况和预后与治疗的强度无关，似乎指导了KC的治疗。KC通常是一种非致命性疾病。尽管当皮肤癌引起症状时，可以选择强化治疗，而不考虑预期寿命，但预期寿命有限的人应该被给予选择，以确保治疗符合他们的目标和偏好。
ObjectivesTo examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.DesignNationally representative cross-sectional study.SettingNationally representative Health and Retirement Study linked to Medicare claims.ParticipantsTreatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.MeasurementsLimited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.ResultsMost KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.ConclusionA one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.