P52 Addressing the overtreatment of basal cell carcinoma and other skin cancer in the UK

Abstract

Abstract The incidence of keratinocyte cancers continues to increase in the UK, although survival is favourable compared with other cancers. This, coupled with a progressively ageing population, has resulted in an increasing number of clinical situations in which we question the benefit to the patient of treating their skin cancer. Currently, the main barrier to preventing overtreatment is the lack of a nationally accepted method for determining survival in patients with skin cancers. This study aims to identify trends in national datasets that support decision-making in basal cell carcinoma (BCC) intervention for frail patients. Frailty is multifactorial, but age is an independent predictor of physical frailty. National databases (Get Data Out—CancerData; national life tables from the UK Office for National Statistics) were accessed to identify the average life expectancy at a given age based on the mortality rates experienced between 2018 and 2022. Average life expectancy reduced in a linear fashion with increasing age. At 80 years of age, the average number of years a woman survived was 9.66 years vs. 3.6 years at 93 years of age. Crude rates for BCC in the whole population (total BCC) are lower than the crude rates in the older population (80+ years). Kaplan–Meier survival (i.e. how many patients are alive after 5 years) was 80% overall and dropped to approximately 55% for the population aged 80+ years. These data support the notion that with increasing age and subsequent frailty, life expectancy in the general population independent of comorbidities shortens. Having hard cutoffs for surgical intervention by age is a reductionist approach. Potential decision aids include frailty scores. Some frailty scores are specifically designed to estimate all-cause mortality. The OPERAM (Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People) trial compared several of these mortality scores. The Gagné Index performed most highly with a positive predictive value of 31% and a negative predictive value of 85% (Schneider C, Aubert CE, del Giovane C et al. Comparison of 6 mortality risk scores for prediction of 1-year mortality risk in older adults with multimorbidity. JAMA Netw Open 2022; 5:e2223911). The combination of national data and predictive scoring systems may be helpful in supporting decision-making when considering surgical intervention. Modification of this approach to achieve greater predictive value may be possible in order to achieve better outcomes.