Predictors of surgical treatment burden, outcomes, and overall survival in older adults with basal cell carcinoma: Results from the prospective, multicenter BATOA cohort - 29/06/21

Doi : 10.1016/j.jaad.2021.05.041

Marieke E.C. van Winden, MD, MSc ^a,^⁎ , Ewald M. Bronkhorst, PhD ^b, M. Birgitte Visch, PhD ^c, Gertruud A.M. Krekels, PhD ^d, Simone van der Geer, PhD ^e, Godelieve W.J. A. Damen, PhD ^f, Avital Amir, PhD ^g, Katja K.H. Aben, PhD ^h, Marie-Jeanne J.P. Gerritsen, PhD ^a, Peter C.M. van de Kerkhof, PhD ^a, Elke M.G. J. de Jong, PhD ^a, Satish F.K. Lubeek, PhD ^a
^a Department of Dermatology, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
^b Department of Biostatistics, Radboud University Medical Center, Nijmegen, the Netherlands
^c Department of Dermatology, Rijnstate Hospital, Arnhem, the Netherlands
^d Department of Dermatology, MohsA Clinic, Eindhoven, the Netherlands
^e Department of Dermatology, MohsA Clinic, Venray, the Netherlands
^f Department of Otorhinolaryngology/Facial Plastic Surgery, Nijmegen, the Netherlands
^g Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
^h Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands

^∗Correspondence and reprint requests to: Marieke E. C. van Winden, MD, MSc, Department of Dermatology, Radboud University Medical Center, Post Office Box 9101, Nijmegen 6500 HB, the Netherlands.Department of DermatologyRadboud University Medical CenterPost Office Box 9101, Nijmegen 6500 HBthe Netherlands

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 29 June 2021
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Incorporating patient-related factors associated with treatment outcomes could improve personalized care in older patients with basal cell carcinoma (BCC).

Objective

To evaluate and identify predictors of treatment burden, treatment outcomes, and overall survival in patients aged ≥70 years, surgically treated for BCC in the head and neck area.

Methods

The data from the prospective, multicenter Basal Cell Carcinoma Treatment in Older Adults (BATOA) cohort study were extracted to evaluate the experienced treatment burden (visual analog scale, 0-10 cm; lower scores indicating higher treatment burden), treatment outcomes, and mortality.

Results

A total of 539 patients were included (median age, 78 years). The patients experienced a low overall treatment burden (median, 8.6) and good cosmetic results. The predictors of higher treatment burden were instrumental activities of daily living (iADL) dependency, female sex, complications, larger tumor diameter, and polypharmacy. Thirty-five patients (6.5%) died (none of the deaths were due to BCC) within the follow-up period; the predictors of mortality were increasing comorbidity index and iADL dependency. No difference in these outcomes was seen between Mohs micrographic surgery and conventional excision after correction for covariates. Age was not significantly associated with any outcome.

Limitations

A selection bias may exist owing to the observational design.

Conclusion

BCC management decisions based on chronological age alone should be avoided, whereas more attention is recommended for patient-related factors. Based on these data, early BCC intervention is beneficial for robust and fit patients or those experiencing symptoms.

Le texte complet de cet article est disponible en PDF.

Key words : aged, basal cell carcinoma, basal cell carcinoma recurrences, complications, conventional excision, cosmetic result, elderly, facial surgery, frailty, keratinocyte carcinoma, Mohs micrographic surgery, mortality, older adults, skin cancer, surgery, survival, traditional excision, treatment burden, treatment outcomes

Abbreviations used : ADL, BATOA, BCC, CCI, CE, CI, HR, iADL, IQR, MMS, OR, VAS

Plan

Introduction

Methods

Study design and participants

	Funding sources: None.
	Preliminary data in this study were presented as a poster at the 28th European Academy of Dermatology and Venereology Congress, Madrid, Spain, 9-13 October, 2019.
	IRB approval status: Research Ethics Committee of Radboud University Medical Centre, Institutional review board has approved this study.