Factors Affecting Treatment Outcome in Elderly Head and Neck Cancer Patients: A Retrospective Pilot Study

Head and neck cancer (HNC), the fifth most common cancer worldwide, is a complicated category of diseases comprised of cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx. Management of HNC can be very complex, with surgery, chemotherapy, and radiation therapy often used in combination to achieve optimal results. The optimal combination of therapies to maximize patient survival and post-treatment quality of life is yet unclear. Only some prognostic factors for HNC are relatively well understood, whereas others are affected by conflicting results of their significance.

The present study will explore and attempt to clarify the prognostic factors affecting HNC patients, focusing specifically on patients aged 80 or older.

A database of HNC patients treated at our center between 2006 and 2011 was generated in Mosaiq (an electronic patient record system); from this, a sample of patients aged 80 or older was selected randomly (n = 40). Various disease-, patient-, and treatment-related factors were collected from these records and compared against the patients' overall survival, disease-free status, rates of recurrence, and rates of radiation toxicity to determine which were significant prognostic indicators.

Disease subsite was found to be a significant indicator of local recurrence (P = .049) and survival rate (P = .014), while anemia was related to poor disease-free status on follow-up (P = .017). Age was not significantly linked to any outcome measure. However, patients treated with palliative intent were significantly older (P = .012) despite not having higher stage disease, and only one radical patient (3.2%) failed to complete their treatment course. Follow-up data, quantitative toxicity data, and human papillomavirus and smoking status were either inconsistently collected or unavailable, identifying areas for improvement to better inform evidence-based practice.