Life expectancy tool may help facilitate care for veterans with basal cell carcinoma

Key takeaways:

• The Care Assessment Need score predicts a veteran’s risk for hospitalization and death.
• When used for basal cell carcinoma, the tool may help facilitate treatment conversations and reduce surgical procedures.

The Veterans Health Administration’s Care Assessment Need tool may be able to predict the life expectancy of veterans, helping facilitate conversation about treatment for basal cell carcinoma, according to a study.

As the incidence of basal cell carcinoma (BCC) rises with age, patients with a limited life expectancy may wonder if undergoing treatment is worth it.

“Care for older adults with cancer is complex, and counseling requires consideration of life expectancy, likelihood of benefit, harm and patient values,” Matthew P. Dizon, MD, of the center for innovation to implementation and dermatology services at Veterans Affairs Palo Alto Health Care System and the department of health policy at Stanford University School of Medicine, and colleagues wrote. “The decision to pursue surgery deserves particular attention, as frailty is associated with adverse outcomes after even low-stress ambulatory procedures.”

Determining if a patient has a low or high life expectancy can be difficult as collecting their demographic characteristics, history of comorbid conditions and functional status is time-consuming, according to the study.

However, the Veterans Health Administration has a tool called the Care Assessment Need (CAN) score that can predict a veteran’s risk for hospitalization and death using their entire medical history. According to the study, this tool could hypothetically help inform dermatologists if a patient has a limited life expectancy, thus steering the conversation between patient and practitioner.

Using the national Veterans Health Administration electronic medical record data, Dizon and colleagues conducted a retrospective study to evaluate the CAN score’s performance in predicting 1-, 3- and 5-year mortality in veterans with BCC.

The data set included 54,744 veterans that received BCC treatment between 2013 and 2018. Higher CAN scores represent higher risks, with scores expressed as percentiles in 5-unit increments from 0 to 95, changing to 1-unit increments from 96 to 99.

Results showed that the CAN score predicted mortality well. The negative predictive value for patients with a CAN score of 90 was 98.3% for 1-year mortality, 87.8% for 3-year mortality and 67.5% for 5-year mortality.

The positive predictive value for CAN 90 was 11.7% for 1-year mortality, 55% for 3-year mortality and 87.2% for 5-year mortality.

In addition to predicting mortality, the CAN score was also used as a screening tool for frailty with patients that had CAN scores greater than 95 receiving a positive predictive value of 63.4% for frailty.

Ultimately, Dizon and colleagues determined that the CAN score is a promising tool that can improve the quality-of-care veterans receive.

“The CAN score can facilitate conversations that reduce the number of surgical procedures performed in cases where the expected risk may outweigh the benefit,” the researchers wrote.