Common skin cancer interventions lack rigorous evaluation in randomized controlled trials
September 17, 2018 | Download Release
TORONTO, September 17, 2018 – Despite the high occurrence of basal cell carcinoma (BCC) across Canada, most commonly-used treatment interventions have not been rigorously studied, according to new research led by Women’s College Research Institute scientist, Dr. Aaron Drucker. Approximately 50,000 to 60,000 Canadians are diagnosed with BCC each year and will work with their healthcare providers to make complex decisions when choosing among the many treatment options available.
The study, published online today and in the October 2 issue of Annals of Internal Medicine, was the first analysis to compare multiple BCC interventions simultaneously to evaluate their effectiveness and safety. The results confirmed recent guidelines from the American Academy of Dermatology which called out the scarcity of evidence and randomized controlled trials conducted on these treatments.
“Despite the fact that basal cell carcinoma is the most common of all cancers in Canada, there’s still substantial uncertainty about how various treatment options perform relative to each other,” says Dr. Drucker, a dermatologist at Women’s College Hospital. “Fortunately, most cases of basal cell carcinoma are not aggressive. However, tumours and treatments can negatively impact patients’ quality of life, which is why other factors including cosmetic outcomes should be considered as well.”
The study reviewed 40 randomized controlled trials and five nonrandomized comparative studies to evaluate a variety of outcomes including tumour recurrence, cosmetic appearance, quality of life, mortality and costs. The results supported the known effectiveness of commonly-used treatment options including surgery, external beam radiation, and topical creams, but found a lack of evidence to support choices between these interventions.
“Surgical treatments are the most commonly used treatments in clinical practice due to low recurrence rates. Yet specialty care such as Mohs surgery, a microscopically controlled surgery where tumours are removed in layers, is not available in all communities,” says Dr. Drucker. “By evaluating treatment options against each other, future findings will help patients and their healthcare providers choose the management strategy that best fits their individual needs.”
Within the trials that were analyzed, the majority of the adult participants were men in their 60s. The researchers add that additional research on more aggressive BCC subtypes and patient populations with more complex conditions is needed.
These findings suggest that future studies will need to investigate the comparative effectiveness of these BCC treatments through randomized controlled trials. In addition, future research should address the cost of treating BCC on our health system. Currently, a large amount of money is spent treating BCC without concrete knowledge about the value of choosing one treatment over another. Patients and providers should also have further discussions about which treatment option best fits the needs of the patient including convenience and cosmetic outcomes.
Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading, academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system as a whole.
Women’s College Research Institute (WCRI) is tackling some of the greatest health challenges of our time. Its scientists are conducting global research that advances the health of women and improves healthcare options for all, and are then translating those discoveries to provide much-needed improvements in healthcare worldwide.