Patterns of Care in Elderly Head-and-Neck Cancer Radiation Oncology Patients: A Single-Center Cohort Study

• Published in: International journal of radiation oncology, biology, physics Vol. 79; no. 1; pp. 46 - 51
• Main Authors: Huang, Shao Hui, M.Sc., R.T. (T.), O'Sullivan, Brian, M.D, Waldron, John, M.D, Lockwood, Gina, M.Math, Bayley, Andrew, M.D, Kim, John, M.D, Cummings, Bernard, M.B, Dawson, Laura A., M.D, Hope, Andrew, M.D, Cho, John, M.D, Witterick, Ian, M.D, Chen, Eric X., M.D, Ringash, Jolie, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier
• Subjects: Adolescent; Adult; ADULTS; Age Distribution; Age Factors; AGE GROUPS; Aged; AGED ADULTS; Aged, 80 and over; Analysis of Variance; ANIMALS; Antineoplastic Agents - therapeutic use; Biological and medical sciences; BODY; Cisplatin - therapeutic use; Cohort Studies; DISEASES; elderly; ELDERLY PEOPLE; Female; Follow-Up Studies; HEAD; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; head-and-neck cancer; Hematology, Oncology and Palliative Medicine; HUMAN POPULATIONS; Humans; Male; MAMMALS; MAN; Medical sciences; MEDICINE; Middle Aged; MINORITY GROUPS; NECK; Neoplasm Staging; NEOPLASMS; NUCLEAR MEDICINE; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; outcome; Patterns of care; POPULATIONS; PRIMATES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy - mortality; Radiotherapy Dosage; Retrospective Studies; Survival Rate; THERAPY; Treatment Outcome; treatment tolerance; Tumors; VERTEBRATES; Young Adult; radiotherapy; head-and-neck cancer; treatment tolerance; elderly; outcome; Patterns of care; Human; Prognosis; Tolerance; Malignant tumor; Radiotherapy; Treatment; ENT disease; Head and neck cancer; Elderly; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.10.052

Purpose To compare the patterns of care for elderly head-and-neck cancer patients with those of younger patients. Methods and Materials A retrospective review was conducted of all new mucosal head-and-neck cancer referrals to radiation oncology between July 1, 2003 and December 31, 2007 at our institution. The clinical characteristics, treatment pattern, tolerance, and outcomes were compared between the elderly (aged ≥75 years) and younger (aged <75 years) cohorts. Results A total of 2,312 patients, including 452 (20%) elderly and 1,860 (80%) younger patients, were studied. The elderly patients were more likely to be women (36% vs. 27%, p <.01) and to have other malignancies (23% vs. 13%, p <.01), Stage I or II disease (38% vs. 32%, p <.01), and N0 status (56% vs. 42%, p <.01). Treatment was less often curative in intent (79% vs. 93%, p <.01). For the 1,487 patients who received definitive radiotherapy (RT), no differences were found between the elderly ( n = 238) and younger ( n = 1,249) patients in treatment interruption, completion, or treatment-related death. Within the subset of 760 patients who received intensified treatment (concurrent chemoradiotherapy or hyperfractionated accelerated RT), no difference was seen between the elderly ( n = 46) and younger ( n = 714) patients in treatment interruption, completion, or treatment-related death. After a median follow-up of 2.5 years, the 2-year cause-specific survival rate after definitive RT was 72% (range, 65–78%) for the elderly vs. 86% (range, 84–88%) for the younger patients ( p <.01). Conclusion Elderly head-and-neck cancer patients exhibited different clinical characteristics and experienced different patterns of care from younger patients. Although age itself was an adverse predictor of cause-specific survival, its effect was modest. Elderly patients selected for definitive RT or intensified RT showed no evidence of impaired treatment tolerance.