Treatment of Older Patients With Head and Neck Cancer: A Review

VanderWalde, Noam A.; Fleming, Mary; Weiss, Jared; Chera, Bhishamjit S.

doi:10.1634/theoncologist.2012-0427

Cited by 115 publications

(141 citation statements)

References 94 publications

(77 reference statements)

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“…7,56 Taken together, these findings underscore the fact that older adults with cancer comprise an extraordinarily heterogeneous group of patients, made of a range of very fit to very frail individuals with disparate performance status, functional status, and comorbidity burden. In fact, a recent study from the National Cancer Data Base including patients diagnosed between 1998 and 2011 demonstrated that for patients aged 71 and older, there was improved survival with concomitant CRT in those aged 71 to 80 with low comorbidity scores, but not in those with multiple comorbidities or over the age of 80.…”

Section: Methodsmentioning

confidence: 82%

“…7 Moreover, given that the epidemiology of HNSCC in older patients has dramatically changed over the past decade, with rapid increases in oropharyngeal cancers, likely due to HPV-related malignancies, and concomitant decreased incidence of tobacco- and alcohol-related cancers arising from the oral cavity, larynx, and hypopharynx, 8 the limited data available may be less applicable to older patients seen in current practice. This evidence vacuum, combined with projected increases in absolute number of older patients with HNSCC, 9 creates a situation in which it is imperative to develop high level evidence to drive treatment paradigms for older patients.…”

Section: Introductionmentioning

confidence: 99%

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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: 82%

Section: Introductionmentioning

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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“…We examined associations between multiple sociodemographic, clinical, symptom distress, and mood variables and neurocognitive performance, and few significant associations were noted. Although reflective of the changing demographic of HNC patients, the sample is relatively young and may not be representative of the classic HNC population which is older [44]. Neurocognitive function in older and younger HNC patients may differ.…”

Section: Limitationsmentioning

confidence: 99%

Neurocognitive function in patients with head and neck cancer undergoing primary or adjuvant chemoradiation treatment

Bond

Dietrich

Gilbert

et al. 2016

Support Care Cancer

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Purpose Cancer and cancer therapy-related neurocognitive changes negatively affect quality of life, yet few studies have examined neurocognitive changes in patients with head and neck cancer. The purpose of this study was to evaluate neurocognitive performance in patients with head and neck cancer at baseline before starting treatment and 3 months after treatment completion to assess treatment-associated changes in performance. Methods Patients with head and neck cancer who were to receive primary or adjuvant chemoradiation (N = 55) underwent neuropsychological testing before and 3 months posttreatment. Changes in neurocognitive performance were assessed using a practice effect adjusted Reliable Change Index.Results At baseline, 38 % of patients exhibited global neurocognitive impairment. Posttreatment, 21.8 % demonstrated declines in neurocognitive performance in at least one domain. Declines in domain-specific performance ranged from 1.8 to 12.7 % with the greatest decline in language, specifically verb retrieval. Domain-specific improvements ranged from 0 to 7.3 %. Conclusions Patients had a high prevalence of baseline neurocognitive impairment. While neurocognitive performance posttreatment remained unchanged in the majority, almost 13 % suffered declines in language. Small percentages of patients exhibited improvements in their performance. Long-term effects and risk factors for neurocognitive decline in this population should be studied on a larger scale.

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“…Curative treatment for locally advanced HNC often involves a combination of modalities, including surgery, radiation, and/or chemotherapy. 10 The optimal selection of patients for intensive treatment is not standardized and remains controversial. 7,8 Indeed, in clinical practice, many patients, especially older patients and those with significant comorbidities, may be treated with less intensive treatments such as cetuximab with radiation 9 and radiation therapy alone or even no treatment.…”

Section: Introductionmentioning

confidence: 99%

Undertreatment of women with locoregionally advanced head and neck cancer

Park

Alabaster

Shen

et al. 2019

Cancer

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BACKGROUND: It is difficult to predict whether a patient with head and neck cancer (HNC) is more likely to die of the cancer or another comorbidity. Competing event models can help to identify individual patients or groups of patients who may be undertreated or overtreated in clinical practice. METHODS: Patients with HNC (n = 884), aged 18 to 85 years and diagnosed from 2000 to 2015 with stage II to IVB disease according to the seventh edition of the American Joint Committee on Cancer system, were identified. With a generalized competing event (GCE) model that controlled for age, sex, tumor site, surgical treatment, and Charlson Comorbidity Index (CCI), the association between these factors and the relative hazard for cancer mortality was determined. Logistic regression models were used to estimate the odds of receiving platinum-based chemoradiotherapy or a less intensive therapy, with adjustments made for age, sex, tumor site, CCI, stage, smoking, and alcohol abuse history. RESULTS: Compared with men, women had an increased relative hazard ratio for death from HNC versus other causes, which was reported as an adjusted ω + ratio comparing women with men (ω + ratio, 1.95; 95% CI, 1.09-3.49), even though they were less likely to receive intensive chemoradiotherapy than men (adjusted odds ratio, 0.69; 95% CI, 0.48-0.99). CONCLUSIONS: These findings indicate that women in this cohort may be undertreated in clinical practice and potentially miss the opportunity for their HNC to be aggressively treated. This study supports the use of GCE models to identify patients who are potentially undertreated and may also help to guide future research in health disparities. Cancer 2019;125:3033-3039.

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Treatment of Older Patients With Head and Neck Cancer: A Review

Cited by 115 publications

References 94 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

Neurocognitive function in patients with head and neck cancer undergoing primary or adjuvant chemoradiation treatment

Undertreatment of women with locoregionally advanced head and neck cancer

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