Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR)

Brugel, L.; Laurent, Marie; Caillet, Philippe; Radenne, Anne; Durand‐Zaleski, Isabelle; Martin, Michel; Baron, Melany; Kermadec, H. De; Bastuji‐Garin, Sylvie; Canouï‐Poitrine, Florence; Paillaud, Éléna

doi:10.1186/1471-2407-14-427

Cited by 59 publications

(31 citation statements)

References 34 publications

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“…The EGESOR trial (NCT02025062) is obtaining baseline GA prior to any HNSCC treatment for adults age ≥65 years. 33 This is one of the largest studies to date evaluating baseline GA and how it may be associated with IADL impairments and other geriatric-oriented outcomes over time following HNSCC treatment. The same GA is serving as the baseline for the three ELAN trials: FIT (NCT01864772); UNFIT (NCT01884623); and RT (NCT01864850).…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…In oral cavity and pharynx cancers, the SEER database from 2006 to 2012 revealed 5-year overall survival of 69 and 56% for patients younger and older than 65 years, respectively (4). Other factors that may have contributed to such difference in outcomes include serious age-related comorbidities and individual decisions to avoid receiving full-dose regimens (29). This is in accordance with the results of a long-term prospective observational study of 266 subjects showing that chronological age has no independent prognostic value as opposed to comorbidities and non-standard treatment (30).…”

Section: How To Approach An Elderly Patient With Head and Neck Cancermentioning

confidence: 99%

Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

Szturz

Vermorken

2016

Front. Oncol.

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The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people, and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants. The situation is even more challenging in the recurrent and/or metastatic setting, where usually only palliative measures are employed. Nevertheless, it is becoming clear that, if treated irrespective of chronological age, fit elderly patients in a good general condition and with a low burden of comorbidities may derive a similar survival advantage as their younger counterparts. Despite that, undertreatment represents a widespread phenomenon and, together with competing non-cancer mortality, is suggested to be an important cause of the worse treatment outcomes observed in this population. Due to physiological changes in drug metabolism occurring with advancing age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70 years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomized trial conducted in lung cancer showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who needs such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We, therefore, conclude that also in SCCHN, the application of elderly specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted.

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“…Although several publications have reported experiences with CGA in cancer patients, there has been only a single prospective study reported on surgically treated head and neck cancer patients [23]. A recent review of this topic mainly includes CGA studies performed for sites other than head and neck [14].…”

mentioning

confidence: 99%

On the need for comprehensive assessment of impact of comorbidity in elderly patients with head and neck cancer

Teymoortash

Halmos

Silver

et al. 2014

Eur Arch Otorhinolaryngol

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Although a generally accepted definition of ''elderly'' still does not exist, in a medical context, persons over the age of 65 are often considered to be elderly. As life expectancy rates have increased within the last decades and continuously increase every year by approximately 3 months [1], this segment of the population has increased, particularly in Western countries. Because cancer is a disease of aging, the risk of developing malignant disease including head and neck cancer is highest in this patient population. It also follows that malignancy-related mortality is highest among the elderly.Younger patients with head and neck cancers have a much better overall prognosis. A comparative survival analysis revealed that patients with head and neck cancer who are aged 40 years or younger at the time of diagnosis show significantly improved 5-year survival when compared to older patients [2]. For all age groups the 5-year survival rate of patients with a newly diagnosed head and neck cancer is approximately 60 % at diagnosis. However, prognosis is a dynamic process that improves after the initial critical years of recurrence-free survival. Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age [3]. Conditional survival rates can better analyze and reflect actual life expectancy. After 3 years of survival, the conditional survival rate improves from 60 % up to 80 %. However, long-term survival rates stagnate at 80 %. Patients cured of and neck cancer face an excess mortality of about 20 % in long-term follow-up [4]. The critical reason for this is attributed to the comorbid burden of head and neck cancer patients, connected with unhealthy habits and general lifestyle choices.Comorbidities in cancer patients are defined as one or more unrelated diseases present at the time of cancer diagnosis. Particularly in elderly patients, these predominantly consist of reduced organ and cognitive functions, malnutrition, polypharmacy, and socio-economic factors. Most studies show that approximately 60 % of head and neck cancer patients have concurrent illnesses [5]. For better evaluation of comorbidities, weighted assessment systems like Adult Comorbidity Evaluation-27 (ACE-27), and Charlson Comorbidity Index (CCI) include the occurrence of comorbidities as well as their degrees. Comorbidities exist in 46 % of head and neck cancer

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Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR)

Cited by 59 publications

References 34 publications

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck

On the need for comprehensive assessment of impact of comorbidity in elderly patients with head and neck cancer

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