Head and Neck Cancer and the Elderly Patient

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Key points

  • Surgery, radiation, and chemotherapy have equivalent oncologic efficacy in elderly patients.

  • Elderly patients are more likely to suffer from multiple comorbid conditions and decreased functional status.

  • Comorbid conditions and decreased functional status increase the risk of treatment-induced morbidity.

  • Using screening tools to evaluate comorbid conditions and functional status can help stratify patients, predict treatment toxicity, and guide treatment decisions.

  • Elderly patients should be closely

Surgery

Surgery is a common treatment modality for head and neck cancer and is a major determinant of locoregional control and treatment-associated morbidity. Multiple studies have shown that oncologic outcomes after primary surgery are independent of age (Table 1).12, 13, 14 Four small retrospective single-institution series have compared survival outcomes for head and neck cancer patients treated with primary surgery between age groups. Three of these showed no difference in the 5-year survival rates

Radiation therapy

Radiation therapy is effective in the treatment of head and neck cancer and is used both in the definitive setting and in the adjuvant setting after surgery. Radiation can have many side effects, including mucositis with associated severe pain, xerostomia, skin reaction, fatigue, loss of taste and hypothyroidism. Chronic side effects include osteoradionecrosis, muscle fibrosis, trismus and secondary malignancy. In patients with limited functional status at baseline, these side effects can be

Chemotherapy

The National Comprehensive Cancer Network (NCCN) recommends the addition of chemotherapy to radiotherapy when used as definitive nonsurgical therapy for advanced stage tumors or postoperatively when there is histologic evidence of positive margins or extracapsular extension. There is some evidence, however, that the anticipated survival benefit of chemotherapy may not be seen in older patients. Pignon and colleagues8 performed a meta-analysis of 93 head and neck cancer clinical trials and found

Elderly screening

Selection of the appropriate therapy for head and neck cancer in an elderly patient requires a thorough understanding of their comorbidities, functional status, values, and social support network. The clinician and patient must decide whether the oncologic benefit relative to life expectancy is outweighed by the toxicity of treatment. There are numerous metrics that have been proposed to standardize this process.

The comprehensive geriatric assessment (CGA) is an in-depth evaluation to assess

Summary

Treatment of head and neck cancer in the elderly patient warrants special consideration of patient wishes, anticipated life span, acceptable morbidity, comorbidities, functional status, social support, and nutrition. There has not been shown to be a difference in efficacy of treatment for head and neck cancer in elderly patients. Elderly patients, however, typically have more comorbidities, and are more likely to experience toxicity related to treatment, particularly secondary to chemotherapy.

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    Disclosure: The authors have nothing to disclose.

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