Survival and risk factors for death in older adults with primary head and neck cancer: A retrospective observational cohort study

Introduction: Decisions on the treatment of head and neck cancers (HNCs) in older adults are challenging, as there is a vast diversity in biological age, comorbidities, geriatric syndromes, and the capacity to tolerate oncological treatments among coeval individuals. This study investigated factors affecting the overall survival in older patients with HNC. Materials and Methods: This retrospective, observational cohort study included 163 patients aged 70 and older who were diagnosed with a primary HNC and treated at a tertiary care centre between 2010 and 2015. The primary outcome was an overall survival of up to 3.5 years for all patients, including 142 patients treated with curative intent and 17 patients treated with palliative intent. The Kaplan-Meier estimate with the log-rank test was used to draw the lifetime graph for overall survival, and univariate and multivariate Cox regression analyses were used to assess the associations between patient characteristics and survival in the curative intent treatment group. Results: The cohort included 163 patients (median age [interquartile range] of 77 (83–73) years. Most patients were male (n =112, 69%), functionally independent (n = 107, 66%), diagnosed with two or more chronic diseases (n = 130, 80%), used at least five regular medications (n = 90, 55%), and could walk without assistive devices (n = 124, 76%). The survival rate of all patients during the 3.5-year follow-up was 42% (n = 69/163). All patients who underwent palliative treatment died (n = 17). Of the curatively treated patients, 69 (47%) were alive at the end of the follow-up. In the univariate analysis, the use of mobility aids, living in a nursing home, need for help with daily activities, diagnosis of depression, number of comorbidities and medications, anaemia, and tumour characteristics were associated with mortality. In multivariate analysis, the use of mobility aids, need for help in daily activities, anaemia, and tumour stage remained significantly associated with mortality. Discussion: The need for help in daily activities, use of mobility aids, high tumour stage, and anaemia should be considered as risk factors for death in older patients with potentially curable HNC. Further assessment of a patient's holistic situation should be performed to assist in decision-making before and during HNC treatment.