Abstract 932P
Background
Population’s aging leads to an increased diagnosis of head and neck cancer (HNC) in older patients (pts). Treatment can involve surgery, radiation, systemic therapy or multimodal therapy. Due to heterogeneity of older pts, the comprehensive geriatric assessment (CGA) is considered the gold standard tool to classify pts according to frailty profile. Multidisciplinary approach including a geriatrician is essential. CGA may be helpful to personalize treatment plan and to detect geriatric conditions that can be reversible through geriatric interventions. We aim to evaluate the impact of CGA on therapeutic decisions.
Methods
Pts presented at the mutidisciplinary team meeting aged>70 years were prospectively included. All pts underwent CGA by a geriatrician including validated instruments to assess comorbidity, polypharmacy, functional status, geriatric syndromes, mood, cognition and social status. According to CGA pts were classified in 3 frailty groups: “fit”, “medium fit” and “unfit”. We compared the standard treatment plan according to cancer stage with the one based on CGA classification.
Results
From January 2018 to March 2020, 124 pts were included. Median age was 80 years (range 71-96) and 87 (70.2%) were men. Primary site included oral cavity 38 (30.6%), larynx 33 (26.6%), oropharynx 11 (8.9%), hypopharynx 10 (8.1%), others 32 (25.7%). Twenty pts (16.2%) had initial stages (I-II), 90 (72.5%) locally advanced (LA) (III to IVb) and 14 (11,3%) recurrent or metastatic disease (R/M). Based on CGA, 55 (44.4%) were classified as fit, 47 (37.9%) as medium fit and 22 (17.7%) as unfit. In up to 33.1% of pts, CGA led to a change in therapy intention, mainly involving LA disease in 78% compared to 4.9% in initial stages and 17.1% in R/M. Seventy-eight (62.9%) received geriatric intervention, mostly (39.7%) in medium fit group. Those interventions where physiotherapy, psychological and nutritional support, and polypharmacy in 21.1%, 14.8%, 37.9% and 41,5% of pts respectively.
Conclusions
Selecting older pts with HNC for standard or adjusted treatment remains a great challenge. Incorporation of CGA within multidisciplinary approach brings the opportunity to better classify pts according to frailty profiles so as to guide interventions and treatment decisions.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.