Functional status and survival in patients ≥85 years of age who have keratinocyte carcinoma: A retrospective cohort study

J Am Acad Dermatol. 2020 Aug;83(2):463-468. doi: 10.1016/j.jaad.2020.04.042. Epub 2020 Apr 19.

Abstract

Background: Functional status assessment may help estimate which patients ≥85 years of age will benefit from surgical treatment for keratinocyte carcinoma (KC), but predictive value for short-term survival in this population has not been determined.

Objective: We sought to assess the predictive value of functional status for short-term survival in patients ≥85 years of age who have KC.

Methods: This was a retrospective cohort review of 238 patients ≥85 years of age who presented for the management of KC between 2010 and 2015. Functional status was assessed with the Karnofsky Performance Scale (KPS) and Katz Activities of Daily Living (ADL) index. Overall survival was determined.

Results: Lower functional status scores of KPS ≤40 and Katz ADL ≤4 were associated with 37% and 53% survival at 2 years, respectively.

Limitations: Retrospective design and single-center study.

Conclusion: In this study, KPS and Katz ADL predicted short-term survival. Patients with low functional status scores had significantly decreased survival at 2 years, with double the death rate of patients with high functional status. Functional status should be considered during shared decision-making for elderly individuals who are seeking treatment for KC.

Keywords: Karnofsky Performance Scale; Katz ADL; functional assessment; geriatrics; keratinocyte carcinoma; oncology.

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Carcinoma, Basal Cell / complications
  • Carcinoma, Basal Cell / diagnosis
  • Carcinoma, Basal Cell / mortality*
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Functional Status*
  • Humans
  • Kaplan-Meier Estimate
  • Karnofsky Performance Status / statistics & numerical data
  • Keratinocytes / pathology
  • Male
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment / methods
  • Skin Neoplasms / complications
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / pathology