Learning Objectives Compare survival and toxicity outcomes of older patients with head and neck cancer with those of their younger cohorts. Describe the role played by comorbidity, quality of life, and supportive care in the treatment decision and treatment process of older patients with head and neck cancer.

PurposeAccurate assessment of toxicity allows for timely delivery of supportive measures during radiation therapy for head and neck cancer. The current paradigm requires weekly evaluation of patients by a provider. The purpose of this study is to evaluate the feasibility of monitoring patient reported symptoms via mobile devices.Methods and materialsWe developed a mobile application for patients to report symptoms in 5 domains using validated questions. Patients were asked to report symptoms using a mobile device once daily during treatment or more often as needed. Clinicians reviewed patient-reported symptoms during weekly symptom management visits and patients completed surveys regarding perceptions of the utility of the mobile application. The primary outcome measure was patient compliance with mobile device reporting. Compliance is defined as number of days with a symptom report divided by number of days on study.ResultsThere were 921 symptom reports collected from 22 patients during treatment. Median reporting compliance was 71% (interquartile range, 45%-80%). Median number of reports submitted per patient was 34 (interquartile range, 21-53). Median number of reports submitted by patients per week was similar throughout radiation therapy and there was significant reporting during nonclinic hours. Patients reported high satisfaction with the use of mobile devices to report symptoms.ConclusionsA substantial percentage of patients used mobile devices to continuously report symptoms throughout a course of radiation therapy for head and neck cancer. Future studies should evaluate the impact of mobile device symptom reporting on improving patient outcomes.

Background There is growing evidence in the literature that older patients may not benefit from more intensive therapy for Head and Neck Squamous Cell Carcinoma (HNSCC). A growing number of patients with Head and Neck Squamous Cell Carcinoma (HNSCC) are age 65 and older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decision. Methods Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992–2007), we identified non-metastatic HNSCC patients (n=10,867) and categorized them into treatment models: surgery vs. non-surgery, and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. Results Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93–0.94) but not surgery (OR 1.00; 95% CI 0.99–1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. Conclusion Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.

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The findings of this study indicate that GNPs are prescribing medications for complex medical conditions.