Personalized Care Improvements Identified for Older Patients with Skin Cancer

New data suggest care improvements can be made for patients with skin cancer who have frail skin through collaboration with geriatricians, the use of a geriatric assessment, and an onco-geriatric multidisciplinary team (OMDT).1

These results were the conclusion of a recently-published letter to the editor in the Journal of the European Academy of Dermatology and Venereology (JEADV). It was authored by such investigators as Esther Groll, from the University Medical Center Groningen Department of Dermatology.

Groll et al noted the prognostic value of evaluating frailty in a patient’s skin, though the condition is rarely addressed within patient guidelines. Such guidelines, they highlighted, most often prioritize the characteristics of skin cancer tumors instead.2

“The University Medical Center Groningen recently introduced a nurse-led frailty assessment to improve care for this population,” the investigators wrote.1 “We investigated how this screening affected treatment choices and time to treatment.”

Study Design and Findings

Although the Comprehensive Geriatric Assessment (CGA) is considered the reference standard for assessing older oncology patients, Groll and colleagues pointed to the substantial time and resources needed for the CGA’s use. Consequently, this nurse-led frailty screening program was evaluated in its aim to make improvements to older patient care, specifically among those living with skin cancer. They used a retrospective case–control study design, assessing the program’s effects on treatment decision-making and treatment timelines.

There were 290 patients aged 65 years or older involved in this study, all of whom were described as having head and neck skin malignancies.In specific, the study subjects had either cutaneous squamous cell carcinoma, lentigo maligna, or basal cell carcinoma. 145 of the study subjects were screened for frailty in the timeframe between 2022 - 2023. The study’s outcomes were compared with those of a matched historical control cohort of 145 individuals treated between 2018 - 2019 at the same institution.

Matching was done by Groll and coauthors based on sex, diagnosis, and age. The identification of the study’s control cohort was done via the Netherlands Cancer Registry. Individuals included in the control arm of the analysis were not provided with this frailty screening as part of their course of care. The frailty evaluation was conducted through the use of a shortened geriatric evaluation covering 4 domains:

• Social
• Psychocognitive
• Functional
• Somatic

If a participant was shown to have impairments in 2 or more domains, they would be described as frail. Reviews of treatment plans and decisions related to referrals for CGA by a geriatrician were done by an OMDT. This OMDT was made up of a specialized nurse, a dermatologist, a geriatrician, and a radiotherapist. Assessments in this analysis looked at estimated life expectancy, frailty status, and preferences among patients.

114 of the screened patients were labeled by Groll et al as frail (78.6%). The investigative team pointed to functional and psychocognitive impairments as the most commonly observed contributors to frailty. They found 53.8% were reviewed by the OMDT. Changes to treatment were made in 20.7% of these cases. In 1 notable finding, 83.3% of the treatment changes were described as having involved a shift toward less invasive therapeutic choices.

A strong association was identified between the use the OMDT and treatment modifications (OR 5.85, 95% CI 2.09–16.35, P < .001). Additionally, a strong link was identified with the selection of less invasive treatments (OR 0.16, 95% CI 0.05–0.52, P = .002). Overall, 17.2% of the subjects screened by Groll and colleagues were referred for a CGA. Among 44% of these individuals, Mohs micrographic surgery was replaced with a less invasive alternative.

In contrast, only 4.8% of those inclucded in the historical cohort were provided with treatment diverging from guideline-based recommendations. This was described by the team as a significant difference versus those involved in the screened cohort (P < .001).

Those who underwent this frailty screening attended more hospital visits on average (median 6 versus 4, P < .001), reported longer median interval to initiation of their treatment compared with those in the control arm (62 versus 41.5 days, P < .001), and presented with larger median tumor diameters (14 versus 9 mm, P < .001). Overall, frailty screening identified a high prevalence of patient frailty and, via the integration of geriatric expertise and patient-centered considerations, supported the implementation of treatment actions considered less aggressive.

“This aligns with prior research that stresses the importance of shared decision-making and incorporation of comorbidities, functional status and life expectancy to guide care and reduce treatment burden,” Groll and coauthors wrote.1

References

1. Groll E, Hetényi Z, Rácz E. Personalized care for older skin cancer patients: Impact of frailty screening on treatment decisions. J Eur Acad Dermatol Venereol. 2026 Jan 16. doi: 10.1111/jdv.70293. Epub ahead of print. PMID: 41542913.

2. van Winden MEC, Garcovich S, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol. 2021 Jan;35(1):95-104. doi: 10.1111/jdv.16607. Epub 2020 Jul 1. PMID: 32403174; PMCID: PMC7818261.