Abstract
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.