ESTRO: When Treating Elderly Patients with Head and Neck Cancer, Consider Comorbidities
(ChemotherapyAdvisor) – At least 44% of 12,596 patients registered in the DAHANCA database of all Danish head and neck cancers diagnosed between 1992 and 2008 had at least one comorbidity, a negative prognostic factor for overall survival, according to a presentation at the 31st conference of the European Society for Radiotherapy and Oncology (ESTRO 31) in Barcelona, Spain, May 11.
This finding underscores that a proper assessment of comorbidities is necessary when deciding on a course of treatment for elderly patients with head and neck cancer. They are often long-term users of tobacco and/or alcohol, which can cause lung, heart, and cerebrovascular disorders in addition to having a carcinogenic effect, noted Charlotte Rotbøl Bøje, MD, of Aarhus University Hospital, Aarhus, Denmark.
The DAHANCA database includes information on tumor morphology, patient characteristics, treatment, and complete follow-up. Information on comorbidity prior to a diagnosis of head and neck cancer was obtained from the National Patient Registry, which contains discharge diagnoses from all hospital admissions and outpatient visits in Denmark.
In this analysis, median age of the patients was 62 years (range, 10–100) and 73% were male. A total of 37% were diagnosed with pharyngeal carcinoma, 33% with laryngeal carcinoma, and 30% with oral carcinoma. Although increasing age was significantly associated with comorbidities, gender was not, and there was no difference between genders.
Dr. Rotbøl Bøje found the most common comorbidities to be cerebrovascular disease (11%), chronic pulmonary disease (11%), and cardiovascular disease (10%). Survival rates and risk of death were strongly associated with comorbidities; for those >60 years of age, HR was 1.41 and, for advanced T-stage, 2.05 and nodal disease, 1.48.
“There are some problems in treating older patients with radiotherapy, but this is not only due to their chronological age but also to the fact that there is more comorbidity among the elderly,” she said. “This can affect quality of life and can lead to treatment interruptions and hospitalization. We believe that an accurate assessment of comorbidities before starting treatment in elderly patients is essential in order to decide on the best and most appropriate treatment for this patient group.”
Dr. Rotbøl Bøje recommended that comorbidity be added to the TNM classification system so that a “more reliable and valid assessment of survival” is possible among patients with head and neck cancer.