If you or a family member are elderly and have a non-melanoma skin cancer (basal cell or squamous cell) aggressive treatment is often not indicated. A recent article by E. Linos reports a study on this topic.
As usual, this article is not available to the public at large, but Paula Spann has written an excellent synopsis in the NY Times: Low-Risk Skin Cancers Often Treated Too Aggressively in Elderly, Study Finds.
The synopsis can be quite simple. It is often more important to treat the patient with the tumor, than the tumor the patient has. If an individual has a limited life expectancy, many non-melanoma skin cancers can be monitored periodically rather than being treated. This presupposes that the physician who is following the patient has expertise in the management of skin cancers.
There are certain tumors in the elderly that should be treated, however. These are the ones that are likely to cause pain or become management problems. Sadly, doing something is more lucrative for physicians than simple observation. If fee-for-service medicine was replaced by a salaried model, the end-point might be different. This is not likely to occur.
Doing nothing is more difficult for physicians, because this can be perceived as neglect. It is important to have open-ended discussions with the patient and, where appropriate, his/her family, so all parties are on the same page.
“Treat the patient, not the tumor” is an important mantra for all care givers.
References:
Treatment of Nonfatal Conditions at the End of
Life: Nonmelanoma Skin Cancer (Abstract only available)
Paula Spann's NY Times article in The New Old Age section of the NY Times.