Overbehandeling van patiënten met basaalcelcarcinoom

Basal cell carcinoma (BCC) is the most common cancer type in the Netherlands and frequently diagnosed in older adults. Unlike other common forms of skin cancer (squamous cell carcinoma and melanoma), BCC generally grows slowly and the risk of metastasis and/or death is extremely small. In the first years after presentation, BCC often causes no or only minor complaints. Nevertheless, the vast majority of patients with BCC are treated immediately after diagnosis, usually with surgical excision. We think that overtreatment of patients with BCC is common and active surveillance may be an excellent alternative for patients with a limited life expectancy and should therefore be considered more often

Overtreatment of patients with basal cell carcinoma:active surveillance should be considered more often

Basal cell carcinoma (BCC) is the most common cancer type in the Netherlands and frequently diagnosed in older adults. Unlike other common forms of skin cancer (squamous cell carcinoma and melanoma), BCC generally grows slowly and the risk of metastasis and/or death is extremely small. In the first years after presentation, BCC often causes no or only minor complaints. Nevertheless, the vast majority of patients with BCC are treated immediately after diagnosis, usually with surgical excision. We think that overtreatment of patients with BCC is common and active surveillance may be an excellent alternative for patients with a limited life expectancy and should therefore be considered more often.</p

Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy – a mixed-method pilot study

Background Evidence-based guidance in older adults (≥65 years) with psoriasis is sparse and undertreatment might be present. Objectives To assess prescribing patterns, comfort levels, barriers and needs of dermatologists when treating older adults with systemic antipsoriatic therapy. Methods A mixed-methods design was used including a survey among all Dutch dermatologists and residents, followed by semi-structured interviews. Results Most of the survey respondents applied systemic treatment to the same extent in older versus younger patients (n = 49; 67.1%) and weren’t reluctant prescribing systemic therapy (n = 50; 68.5%) in older adults. However, 26% (n = 19) of the respondents treated older adults less often with systemic therapy compared to younger patients and 68.1% (n = 49) performed additional actions in older adults, e.g. intensified monitoring or dose reduction. Based on the survey and interviews (n = 10), the main reasons for these age-based treatment differences were comorbidity, comedication, and fear of adverse events. More evidence-based guidance, education, and time to assess older adults were identified as most important needs, especially regarding frailty screening. Conclusions Age-based treatment differences in and reluctance to treating older adults with systemic antipsoriatic therapy were common. There is a need for more evidence-based guidance, education, and consultation time, to improve treatment in this growing population