Abstract
Simple SummaryThe aim of this study was to find predictors for adherence to a therapy recommended by a multidisciplinary tumour board regarding 1125 elderly patients (70–100 years) with head and neck squamous cell carcinoma (HNSCC). The 5-year overall survival was significantly higher in adherent patients (45.1% versus 19.2%). Nonadherent patients were significantly more often smokers, drinkers, and had a worse tumour stage and lower health status (Karnofsky performance status). In contrast to the chronological patient age, the biological age (Charlson Comorbidity Index) was a significant predictor for adherence. The evaluated predictors for nonadherence need to be verified prospectively.Finding a cure may be less important than ensuring the quality of life in elderly patients with head and neck squamous cell carcinoma (HNSCC). The aim of this study was to determine predictors for adherence. Clinical and pathological data from patients ≥70 years with HNSCC (initial diagnoses 2004–2018) were investigated retrospectively. Evaluated clinical predictors included biological age (Charlson Comorbidity Index; CCI), patient health (Karnofsky Performance Status; KPS) and therapy data. A total of 1125 patients were included. The median age was 75 years, 33.1% reached CCI ≥ 6, and 53.7% reached KPS ≤ 70%. In total, 968 patients were adherent, whereas 157 were nonadherent. Nonadherent patients were significantly more often smokers (p = 0.003), frequent drinkers (p = 0.001), had a worse health status (p ≤ 0.001) and a lower biological age (p = 0.003), an advanced T classification and lymph node involvement or UICC stage (each p ≤ 0.001). Approximately 88.0% of the included patients received a curative treatment recommendation. A total of 6.9% discontinued the therapy, and 7.0% refused the therapy. With the increasing complexity of a recommended therapy, adherence decreased. The 5-year overall survival was significantly higher in adherent patients (45.1% versus 19.2%). In contrast to the chronological patient age, biological age is a significant predictor for adherence. The evaluated predictors for nonadherence need to be verified prospectively.
Highlights
Life expectancy in the European Union has increased significantly from 77 in 2000 to 81 years in 2018 [1]
The need for standardised guidelines for the elderly is further supported by the fact that the older patients become, the more likely they are not to receive therapy according to the current standard
1353 patients aged 70 years or older were diagnosed with head and neck squamous cell carcinoma (HNSCC) at the Charité-Universitätsmedizin Berlin
Summary
Life expectancy in the European Union has increased significantly from 77 in 2000 to 81 years in 2018 [1]. The proportion of patients ≥75 years generally represents less than 10% of study populations [4] Due to this current data gap, a standard of care for this patient subgroup needs to be established [5]. The need for standardised guidelines for the elderly is further supported by the fact that the older patients become, the more likely they are not to receive therapy according to the current standard. Older HNSCC patients have a significantly higher probability of being treated with palliative rather than curative therapy compared to younger patient groups [6,7,8]
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