Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Is patient age associated with treatment approach and survival outcomes in mucosal Head and Neck Squamous Cell Carcinoma? An Australian observational study (#336)

Farhannah Aly 1 2 3 , Puma Sundaresan 4 5 , Joseph Descallar 1 2 , Lois Holloway 1 2 3 6 , Shalini K Vinod 1 3
  1. Southwest Sydney Clinical Campus, University of New South Wales, Sydney, NSW, Australia
  2. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  3. Liverpool and Macarthur Cancer Therapy Centres, Southwest Sydney Local Health District, Sydney, New South Wales, Australia
  4. Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia
  5. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  6. Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia

Background:  Older patients (≥70 years) with mucosal Head and Neck Squamous Cell Carcinoma (mHNSCC) present complex management challenges. Due to their underrepresentation in clinical trials, they may receive non-standard treatment based on their performance status, comorbidities and expected treatment toxicity. Investigating treatment patterns and identifying factors associated with outcomes are important in determining optimal treatment approaches.

Aims: To investigate patterns of care and survival outcomes of older versus younger patients with mHNSCC.

Methods: A retrospective review of patients diagnosed with mHNSCC between 2010-2018, at 6 NSW hospitals was conducted. Pretreatment patient and tumour characteristics, treatment approaches (radiotherapy+chemotherapy), plus overall survival (OS) data were collated. Multivariable analysis of factors influencing curative standard-of-care (SOC) treatment allocation and OS was performed.

Results: Of 1553 eligible patients, 432 were ≥70 years. Older patients were significantly less likely to be offered curative treatment (75.7% vs 91.6%, p<0.001), chemotherapy (33.0% vs 67.8%, p<0.001) or SOC treatment (59.6% vs 74.0%, p<0.001). Fewer older patients receiving primary radiotherapy were prescribed ≥66Gy (83.9% vs 89.9%, p=0.004). Unpartnered marital status and ECOG 1+ performance status were associated with lower SOC treatment allocation for younger patients. ECOG 1 performance status was associated with lower SOC treatment allocation for older patients. Older patients receiving curative SOC treatment had lower median OS (78.8 vs 118.4months, p<0.001). Smoking and ECOG status affected OS for both cohorts. SOC affected OS for older patients.

Conclusion: Age was associated with treatment allocation. Older patients were less likely to receive SOC treatment, which influenced OS. Whilst older patients should ideally receive SOC treatment to optimize OS, other factors such as ECOG performance status and social support should be considered, given their OS was still poorer than for younger patients. These patients may specifically benefit from geriatric assessment and shared decision making in geriatric oncology models of care.