Treatment of the Elderly Head and Neck Cancer Patient

Horiot, Jean-Claude; Aapro, Matti

doi:10.1007/978-1-4419-9464-6_41

Cited by 1 publication

(3 citation statements)

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“…In addition, cumulative exposure to various risk factors and etiological agents is higher in older adults. Excessive use of tobacco and alcohol results in chronic obstructive pulmonary disease, susceptibility to recurrent infections, liver steatosis and cirrhosis, poor oral hygiene and dental condition, malnutrition, weight loss, frailty, low-performance status, Wernicke’s encephalopathy, and other neurological disorders ( 35 ). About 60% of SCCHN patients suffer from at least one coexisting illness, and this percentage is estimated to approach 75% in a population over 70 years old ( 36 , 37 ).…”

Section: Geriatric Evaluation In Oncologymentioning

confidence: 99%

“…Moreover, it may be further aggravated by local treatment such as surgery and radiotherapy. According to its severity, available interventions include dietetic counseling, oral nutritional supplements, or artificial nutrition usually by means of percutaneous endoscopic gastrostomy (PEG) ( 35 ). With respect to the latter, it needs to be mentioned that the role of prophylactic PEG tube placement still remains a point of controversy ( 42 ).…”

Section: Geriatric Evaluation In Oncologymentioning

confidence: 99%

“…With respect to the latter, it needs to be mentioned that the role of prophylactic PEG tube placement still remains a point of controversy ( 42 ). A related issue relevant to SCCHN patients is the evaluation of the dental and periodontal health status as it is directly linked to good nutritional intake ( 35 ).…”

Section: Geriatric Evaluation In Oncologymentioning

confidence: 99%

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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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Section: Geriatric Evaluation In Oncologymentioning

confidence: 99%

Section: Geriatric Evaluation In Oncologymentioning

confidence: 99%