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.