Results of a survey on elderly head and neck cancer patients on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

Belgioia, Liliana; Felice, Francesca De; Bacigalupo, Almalina; Alterio, Daniela; Argenone, Angela; D’Angelo, Elisa; Desideri, Isacco; Franco, P.; Merlotti, Anna; Musio, Daniela; Orlandi, Ester; Ursino, Stefano; Paiar, Fabiola

doi:10.14639/0392-100x-n0618

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…An online survey asking radiation oncologists with expertise in HNSCC identified a gap in the management of older adult HNSCC patients. Only 10% of the radiation oncologists interviewed performed a CGA in older adult patients and approximately 7% of multidisciplinary tumor boards included a geriatrician [ 27 ]. This is problematic as another study found that for approximately 60% of cancer cases discussed with a multidisciplinary team, the diagnosis and management of the patient changed [ 28 ].…”

Section: Geriatric Assessmentsmentioning

confidence: 99%

Management of Older Adults with Locally Advanced Head and Neck Cancer

Dickstein

Lehrer²,

Hsieh³

et al. 2022

Cancers

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Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity on optimal management. Older adults are a complex patient population, often requiring increased support due to issues relating to functional and performance status, medical comorbidities, and medication management. Furthermore, in older adults with HNSCC, many of these conditions are independently associated with increased toxicity and worse outcomes. Toxicity in the older adult remains difficult to predict and to understand, and as treatment decisions are based on treatment tolerability, it is essential to understand the toxicities and how to minimize them. Novel predictive scores are being developed specifically for older adults with HNSCC to understand toxicity and to assist in personalized treatment decisions. There are clinical trials presently underway that are investigating shortened radiation courses and novel, less toxic systemic treatments in this population. In the forthcoming sections, we provide a detailed overview of the clinical data, treatment paradigms, and considerations in this population. This review provides a comprehensive overview of existing clinical data and clinical considerations in the older adult head and neck cancer population. Additionally, we provide a detailed overview of pertinent current and ongoing clinical trials, as well as future areas for investigation.

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Section: Geriatric Assessmentsmentioning

confidence: 99%

Management of Older Adults with Locally Advanced Head and Neck Cancer

Dickstein

Lehrer²,

Hsieh³

et al. 2022

Cancers

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“…Previous studies have reported that 16.7-38.7% of patients underwent a change in treatment following the geriatric assessment. [41][42][43][44][45][46] An Italian survey by AIRO on elderly HNSCC patients showed that while the majority of cases were discussed in a multidisciplinary setting, a geriatrician was rarely part of the clinic, and comprehensive geriatric assessment was performed in only 10% of radiotherapy-oncology departments, thus risking under or overtreatment due to inaccurate frailty assessments 47 . There is still the need for larger, more HNSCC-focused study that may be used in the future as the basis for risk strati cation and decision making, as there is now available only limited evidence to support default geriatric assessment.…”

Section: Discussionmentioning

confidence: 99%

Vulnerability Assessment and Decision-Making in Older Patients with Head and Neck Cancers Planned for Chemoradiation: Experience from a Tertiary Care Cancer Centre in India

Noronha,

Sarkar,

Pillai

et al. 2024

Preprint

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Objectives We aimed to evaluate clinical characteristics and outcomes of patients with head and neck squamous cell cancers (HNSCC) planned for chemoradiation enrolled in our geriatric clinic and the role of geriatric assessment (GA) in treatment decision-making. Methods Patients aged over 60 years with locally advanced HNSCC planned for chemoradiation referred to the geriatric clinic from 2018 to 2023 were identified from the clinic database. Results Of 164 patients identified, 36/148 (24.3%) patients were vulnerable in the domain of function and falls, 41/84 (48.8%) in comorbidities, 88/148 (55.4%) in nutrition, 35.148 (23.6%) in psychological, 6/87 (6.9%) in cognition, 25 (11.8%) in polypharmacy and 8 (5.4%) in social domains. 76 (51.4%) were frail, with 2 or more vulnerabilities. 35 (21.3%) patients were planned for radiotherapy alone, and 117 (71.3%) patients ultimately received chemoradiation. Decision on chemotherapy regimen was made awaiting GA in 99 (84.6%) patients. Among them, tentative chemotherapy regimen was changed after GA in 13 (13.1%) patients. 24-month OS was 64.7% (95% CI: 52.2%-80.3%). Factors significantly associated with poorer overall status (OS) were Eastern Cooperative Oncology Group performance status (PS) >=2 (hazard ratio (HR) 5.38, CI 2.39-12.1), vulnerability in nutrition (HR 2.52, CI 1.17-5.39), higher CARG score (HR 9.92, CI 3.91-25.16) and frailty (HR 10.51, CI 2.89-38.22). Factors impacting grade 3/4 toxicity included vulnerability in nutrition, higher CARG score and PS >=2. Conclusion 71.3% patients planned for chemoradiation went on to receive concurrent chemotherapy after GA, with vulnerabilities in nutrition, frailty, performance status and CARG score being predictive for OS.

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“…In a survey study published in 2020, only 10% of the HNSCC radiation oncologists in Italy stated that they performed a CGA in older adult patients. 60 …”

Section: Work-upmentioning

confidence: 99%

“…In a survey study published in 2020, only 10% of the HNSCC radiation oncologists in Italy stated that they performed a CGA in older adult patients. 60 In addition to geriatric assessments, there are several predictive models to calculate probabilities of cancer-related events. The Generalized Competing Event (GCE) model is a way of risk-stratifying patients by weighing the relative hazard of cancer-and non-cancer-related events.…”

Section: Geriatric Assessmentsmentioning

confidence: 99%

Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

Dickstein¹,

Powers²,

Vujović³

et al. 2023

CIA

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Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.

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Results of a survey on elderly head and neck cancer patients on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

Abstract: A, et al. Results of a survey on elderly head and neck cancer patients on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO).

Cited by 5 publications

References 17 publications

Management of Older Adults with Locally Advanced Head and Neck Cancer

Management of Older Adults with Locally Advanced Head and Neck Cancer

Vulnerability Assessment and Decision-Making in Older Patients with Head and Neck Cancers Planned for Chemoradiation: Experience from a Tertiary Care Cancer Centre in India

Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

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