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Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
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Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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