Cetuximab plus platinum-based chemotherapy in elderly patients with recurrent or metastatic head and neck squamous cell carcinoma: A French experience from a single institution

Abstract

management of cancer in the older person have unfortunately been well established (Moller et al., 2011). A review by Solomons et al. (2013) indicated that there is a dearth of research investigating the possibility of even further disparity secondary to cognitive impairment. Objectives: To investigate the differences in investigation and treatment of elderly patients with cancer when cognitive impairment is present Methods: We used data from COCOC (Comprehensive Care for Older People with Cancer), a UK hospital initiative working in partnership with The British Red Cross and Macmillan Cancer Support to improve support and access to hospital treatments and community services. Patients (n = 285) included in the study had been referred to the COCOC service over a two year period with breast, lung or colorectal cancer, at any stage or type. Cognitive assessment was undertaken to establish dementia or cognitive deficits. Results: A comparison between the cognitively impaired (n = 28) and unimpaired (n = 257) indicated that they were similarly matched for cancer type and stage. However, 29% of the cognitively impaired group did not have their malignancy confirmed histopathologically, as opposed to only 6% in the unimpaired group. Treatment aims showed significant difference between expected and observed frequencies (χ2 (2, N = 28) = 10.423, p b 0.01), with 17% of the cognitively impaired versus 39% of the unimpaired receiving potentially curative treatment. A palliative approach was undertaken in 68% of the cognitively impaired as opposed to 38% of unimpaired. Significant differences were also seen in the types of treatment received (χ2 (3, N = 28) = 26.628, p b 0.01) with surgery being undertaken in 47% of the intact group but only 21% in the cognitively impaired. However, most noticeable was the difference in palliative treatments, with basic symptom management approach taken in 64% of the cognitively impaired but only 23% of the non-impaired. Conclusion: The findings indicate a marked disparity in both investigation and treatment of cancer in elderly patients with cognitive impairment, and highlights the need for open and documented decision making at multidisciplinary team meeting regarding how cognitive deficits affect treatment options.