Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_35_2840 - Patterns of Care Among Elderly US Veterans treated for Head and Neck Cancer with Radiation Therapy

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patterns of Care Among Elderly US Veterans treated for Head and Neck Cancer with Radiation Therapy
L. Vitzthum1, C. H. Feng1, K. Zakeri1, E. Sojourner1, J. D. Murphy2, and L. K. Mell1; 1University of California, San Diego, La Jolla, CA, 2Department of Radiation Medicine, University of California, San Diego, La Jolla, CA

Purpose/Objective(s): Elderly patients are underrepresented in prospective clinical trials. Accordingly, there is controversy over whether elderly head and neck cancer (HNC) patients treated with definitive radiation therapy (RT) should undergo treatment intensification with concurrent chemo-radiation (CRT) and/or which chemotherapy regimen should be used. We report on differences in patterns of care between elderly HNC patients treated with definitive RT and younger patients.

Materials/Methods: We identified veterans undergoing curative treatment with definitive RT or CRT for oral cavity, oropharynx, hypopharynx or larynx HNC diagnosed between 2006 and 2015 from within the Veterans Affairs Informatics and Computing Infrastructure. Patient demographics, tumor characteristics, treatment intensification with CRT and type of chemotherapy were compared between elderly (≥70 years old) and non-elderly groups (50-69 years old) using a χ2 test. Logistical regression was used to evaluate the effect of age, T stage, N stage, Charlson Comorbidity Index (CCI) and primary location on the likelihood of receiving RT versus CRT.

Results: The study included 8,417 patients (2,042 elderly, 6,375 non-elderly) that met eligibility criteria. A lesser proportion of elderly patients were treated with concurrent CRT compared to RT alone (63 vs 85%, p<0.001). Among patients treated with chemotherapy, a lesser proportion of elderly patients were treated with cisplatin (48 vs 73%, p<0.001). The elderly group had a greater proportion of patients with T stage ≥ 3 (65 vs 59%, p<0.001) but a lesser proportion of those with N stage ≥ 2 (54 vs 67%, p<0.001). Age as a continuous variable was independently associated with the likelihood of receiving RT alone on logistic regression (OR 1.06; 1.056-1.07). Other variables predictive of receiving RT alone included N stage ≤ 1 (OR 1.7; 1.4-2.0) and high CCI (OR 1.3; 1.1-1.6). Among elderly patients, 1,284 (63%) received concurrent chemotherapy with cisplatin (n=618), cetuximab (n=294), carboplatin/paclitaxel (n=84), carboplatin alone (n=65) or another (n=223) regimen.

Conclusion: Elderly veterans treated with radiation therapy for head and neck cancer presented with different cancer and comorbidity factors and were less likely to receive concurrent chemotherapy compared to younger patients. The optimal strategy for individualized treatment intensification in this population remains unclear and further research is needed.

Author Disclosure: L. Vitzthum: None. C.H. Feng: None. E. Sojourner: None.

Lucas Vitzthum, MD

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