BG11 The hidden cost of frailty: informal care in high-burden skin cancer management

Abstract

Keratinocyte cancer (KC) occurs more often in patients aged > 65 years, with increasing age and frailty being correlated. Given the clinic-based nature of skin cancer management, patients who lack independence in their activities of daily living depend on formal or informal supports to attend dermatology appointments. We assess frailty and formal social supports in patients attending tertiary skin cancer clinics. Patients were recruited from a tertiary hospital’s skin cancer clinics. Frailty was defined as Clinical Frailty Scale ≥ 5. Formal social support was defined as documented receipt of home help, nursing home residence or structured day services. Lifetime cumulative skin cancer counts were compared between fit and frail cohorts using the Mann–Whitney U-test, and associations between support and frailty were assessed using Fisher’s exact test. In total, 220 patients were recruited (mean age 76.2 years; 123 male); 25.0% (55 of 220) were frail (mean age 83.5 years, 35 male). A lifetime history of keratinocyte cancer was present in 91% (50 of 55) of frail patients compared with 60% (100 of 165) of the fit cohort. Analysis of cumulative lesion counts demonstrated that frail patients exhibited a significantly higher burden than the fit cohort (basal cell carcinoma: P = 0.002; squamous cell carcinoma: P < 0.001), while no significant differences were observed for melanoma (P = 0.28). A substantial unmet-support signal was observed: 60% of frail patients (33 of 55) had no documented formal care support. However, where support was received it was strongly associated with frailty (Fisher’s exact, odds ratio 36.0; P < 0.001). In a population with high skin cancer burden, frailty is associated with increased lifetime presentation of keratinocyte cancer, but not melanoma. The mismatch between high clinical burden and low formal support suggests a reliance on informal caregiving. The economic and societal impact of demographic shifts of an ageing population and a changing dependency ratio warrant further study into their implications on the future delivery of dermatological care.