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P73: A pilot study: determining frailty and cognitive impairment in patients with keratinocyte cancer

P73 A pilot study: determining frailty and cognitive impairment in patients with keratinocyte cancer Daniela Cino, Aoife Hollywood, Aoife Moloney, Orla Collins, Blaithin Moriarty and Aoife Lally UCD School of Medicine, University College Dublin, Dublin, Ireland; Department of Dermatology and Department of Medicine for the Elderly, St. Vincent’s University Hospital, Dublin, Ireland; and SVHG Strategic Skin Cancer Network, Dublin, Ireland The incidence of keratinocyte cancer is increasing as our population ages. Age-related variations in managing skin cancer pose the risk of both overand undertreatment (Garcovich S, Colloca G, Sollena P et al. Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis 2017; 8: 643– 61). Older patients may have comorbidities and frailty, which have been shown to predict quality of life, mortality and surgical outcomes (Valdatta L, Perletti G, Maggiulli F et al. FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non-melanoma skin cancer. Oncol Lett 2019; 17: 263–9). This study aimed to determine patient presentations in those with skin cancer aged ≤ 70 years vs. those aged > 70 years. Approval for this study was granted by the local ethics committee. Patients attending dermatology skin cancer clinics were recruited over 8 weeks in June–August 2021. Data, including comorbidities, Mini Mental State Exam (MMSE) and Rockwood Clinical Frailty Scale (RCFS), were recorded. Statistical methods included a v-test for binary characteristics. A total of 107 patients were interviewed: 46 patients aged ≤ 70 years and 61 aged > 70 years. Most patients in the younger cohort had no, one or two comorbidities (34.8%, 30.4% and 19.5%, respectively), whereas the older cohort had one or two (19.7% and 21.3%, respectively), with many having three, four, five and 6–10 comorbidities (13.1%, 11.4%, 13.1% and 4.9%, respectively). The younger cohort had a RCFS of very fit (81.8%), well (11.4%) and managing well (6.8%). In contrast, the older cohort patients were very fit (14.8%), well (21.3%), managing well (34.4%), vulnerable (14.8%), mildly frail (4.9%), moderately frail (3.2%) and severely frail (6.6%). The older cohort with confirmed skin cancer was significantly more frail (vulnerable and mild, moderate and severely frail category) than those in the same age cohort without skin cancer (P = 0.01). The younger cohort had no cognitive impairment as per the MMSE; however, the older cohort ranged from no cognitive impairment [25–30 (85.2%)], mild [21–24 (6.6%)], moderate [10–20 (4.9%)] and severe [0–9 (3.3%)]. The older cohort with confirmed skin cancer had significantly more cognitive impairment (moderate and severe category) than those in the same age cohort without skin cancer (P = 0.04). This study found that patients with a higher frailty score and cognitive impairment were more likely to have skin cancer than their age-matched counterparts without. Time constraints in skin cancer clinics may limit the ability to assess formally patient frailty and cognitive impairment, which this study highlights may be important factors in patients with skin cancer. This early work may support the development of clinical guidelines that include these two parameters to assist with selecting treatment for elderly patients with keratinocyte cancer.