Integrated geriatric assessment and intervention in the head and neck oncology care pathway reduces adverse events and does not affect survival

The number of older/frail patients with head and neck cancer (HNC) is increasing. They are more frail compared to patients with other malignancies. Therefore, geriatric care is increasingly integrated into the HNC care pathway. The aim of this study was to investigate how integrated geriatric care affects treatment outcomes in HNC patients irrespective of treatment intention.

This retrospective study compared treatment-related adverse outcomes (grade ≥ 2 Clavien-Dindo surgical complications and grade ≥ 2 CTCAE (chemo)radiotoxicity), and one-year mortality in two patient cohorts. In the first cohort (2014-2016), geriatric screening was only observational i.e. without intervention. In the second cohort (2019-2020), a complete geriatric pathway was integrated into the oncological care pathway, including an onco-geriatric MDT (multidisciplinary team meeting), referral to the geriatrician with intervention, if needed. Multivariable logistic regression analysis was performed to identify factors associated with adverse events and one-year mortality, including the cohort period.

This study included 640 patients; 369 from the first cohort and 271 from the second cohort. The second cohort showed significantly fewer adverse events (34.6 %) compared to the first (65.4 %) (OR 0.41; 95 % CI 0.27-0.63: p < 0.001). Reductions were seen in surgical complications (OR 0.57; 95 % CI 0.32-1.01) as well as (chemo)radiotoxicity (OR 0.39; 95 % CI 0.20-0.76). No significant differences were observed in one-year mortality (OR 0.88; CI 0.59-1.48). Adverse events were significantly linked to malnutrition, advanced tumor stage and concomitant radiotherapy treatment.

Integration of geriatric care in the HNC pathway reduces treatment-related adverse events, without altering one-year mortality.