Patients with head and neck cancer (HNC) who have greater vulnerability to adverse events (AEs) related to cancer or treatment show worse survival outcomes and a greater risk of complications from concurrent chemoradiotherapy (CCRT), according to a recent study with results published in the International Journal of Radiation Oncology • Biology • Physics.
This multicenter, prospective study based in Taiwan included patients (N=461) with primary HNC assigned to treatment with CCRT. Patients were aged 20 years or older, and a comprehensive geriatric assessment was used to rate all patients for vulnerability to AEs from cancer and treatment prior to beginning CCRT. Those whose assessment showed impairments in 2 or more areas were considered vulnerable. Multiple outcomes were analyzed with respect to vulnerability.
Vulnerability was identified among 22.2% of patients 20 to 34 years old, 27.3% of patients 35 to 49 years old, 30.2% of patients 50 to 64 years old, and 27.9% of patients 65 years and older.
Vulnerable patients showed poorer survival than did nonvulnerable patients (hazard ratio, 1.97; 95% CI, 1.26-3.07; P =.003). The 12-month overall survival rate was 76.8% for vulnerable patients, whereas it was 88.7% for nonvulnerable patients.
Among the study groups, 34.6% of vulnerable patients and 23.5% of nonvulnerable patients were hospitalized (P =.02), and hospitalizations lasted a median of 8.1 days for vulnerable patients compared with 4.0 days for nonvulnerable patients (P =.004). Vulnerable patients were also more likely to require tubal feeding compared with nonvulnerable patients (29.3% vs 11.8%; P <.001).