Improving the applicability of guidelines on nonmelanoma skin cancer in frail older adults: a multidisciplinary expert consensus and systematic review of current guidelines

Summary Background Balancing treatment decisions in frail older adults with nonmelanoma skin cancer (NMSC) can be challenging. Clinical practice guidelines (CPGs) could provide assistance. Objectives To collect and prioritize items related to frail older adults with NMSC for integration into CPGs and to assess the current extent of this integration. Methods Items were collected and prioritized by a multidisciplinary working group (29 members) using a modified Delphi procedure and a five‐point Likert scale. To assess current integration of these items in CPGs, a systematic review was subsequently performed by two independent reviewers using five medical databases (PubMed, Embase, Cochrane Library, SUMsearch and Trip Database), websites of guideline developers/databases, and (inter)national dermatological societies. Results Prioritization of a final 13‐item list showed that ‘limited life expectancy’ (4·5 ± 0·9) and ‘treatment goals other than cure’ (4·4 ± 0·7) were most desired to be integrated into CPGs; both were included in six (46%) of the CPGs found (n = 13). Attention to ‘tumour characteristics’ and ‘comorbidities’ were included in CPGs most often (100% and 77%, respectively). Conclusions More attention to items related to frail older adults in NMSC CPGs is broadly desired, but CPG integration of these items is currently limited. More integration might stimulate more holistic, personalized and patient‐centred care in frail older adults. What's already known about this topic? Nonmelanoma skin cancer is common among the growing population of frail older adults worldwide. Treatment decisions in frail older adults with nonmelanoma skin cancer can be challenging. Clinical practice guidelines are intended to assist healthcare providers to optimize patient care in daily clinical practice, but balancing the extensiveness and specificity of clinical practice guidelines might be a challenge. What does this study add? More attention to several frailty‐related items in clinical practice guidelines on nonmelanoma skin cancer is broadly desired. Integration of these items into current clinical practice guidelines on nonmelanoma skin cancer is limited. More integration is expected to optimize current nonmelanoma skin cancer care and might stimulate more holistic, personalized and patient‐centred care in frail older adults. Plain language summary available online Video Commentary