(ChemotherapyAdvisor) – Atleast 44% of 12,596 patients registered in the DAHANCA database of all Danishhead and neck cancers diagnosed between 1992 and 2008 had at least one comorbidity,a negative prognostic factor for overall survival, according to a presentationat the 31st conference of theEuropean Society for Radiotherapy and Oncology (ESTRO 31) in Barcelona,Spain, May 11.
This finding underscores that a proper assessmentof comorbidities is necessary when deciding on a course of treatment forelderly patients with head and neck cancer. They are often long-term users oftobacco and/or alcohol, which can cause lung, heart, and cerebrovasculardisorders in addition to having a carcinogenic effect, noted Charlotte RotbølBøje, MD, of AarhusUniversity Hospital, Aarhus, Denmark.
TheDAHANCA databaseincludes information on tumor morphology, patient characteristics, treatment,and complete follow-up. Information on comorbidity prior to a diagnosis of headand neck cancer was obtained from the National Patient Registry, which containsdischarge diagnoses from all hospital admissions and outpatient visits inDenmark.
In this analysis, median age of the patients was 62years (range, 10–100) and 73% were male. A total of 37% were diagnosed with pharyngealcarcinoma, 33% with laryngeal carcinoma, and 30% with oral carcinoma. Although increasing age was significantlyassociated with comorbidities, gender was not, and there was no differencebetween genders.
Dr. Rotbøl Bøje found the mostcommon comorbidities to be cerebrovascular disease (11%), chronic pulmonarydisease (11%), and cardiovascular disease (10%). Survival rates and risk ofdeath were strongly associated with comorbidities; for those >60 years ofage, HR was 1.41 and, for advanced T-stage, 2.05 and nodal disease, 1.48.
“Thereare some problems in treating older patients with radiotherapy, but this is notonly due to their chronological age but also to the fact that there is morecomorbidity among the elderly,” she said. “This can affect quality of life andcan lead to treatment interruptions and hospitalization. We believe that anaccurate assessment of comorbidities before starting treatment in elderlypatients is essential in order to decide on the best and most appropriatetreatment for this patient group.”
Dr. Rotbøl Bøje recommended that comorbidity be added to the TNMclassification system so that a “more reliable and valid assessment ofsurvival” is possible among patients with head and neck cancer.