Impact of geriatric assessment on the management of older adults with head and neck cancer: a pilot study

Abstract

Background: Management of cancer is complex in older adults. Comprehensive geriatric assessment (CGA) has been shown to help discriminate which patients can tolerate aggressive cancer treatment, but has major resource implications. In this pilot study we assessed the utility of incorporating a screening tool to identify older patients with potentially-curable head and neck cancer who may benefit from CGA prior to a decision on definitive management. Methods: Patients aged 65 years or older with a potentially-curable primary malignancy of the head and neck region were presented at the Head and Neck multidisciplinary team (MDT) meeting. The Geriatric 8 (G8) questionnaire was administered prior to the MDT, at which clinicians, blinded to the G8 result, made a recommendation on appropriate treatment, including referral for CGA if considered advisable. Patients considered vulnerable (G8 score < 14) were also to be referred for CGA. Subsequent treatment and outcomes were recorded. Results: Over 6 months 35 patients were recruited into the study, median age 74 (range 65-93) years. Seventeen (49%) patients were assessed as vulnerable by the G8 score, including 7 (20%) patients whom the MDT referred for CGA while blinded to the G8 score. Seven potentially-curable patients with G8 scores < 14 did not receive a CGA. Thirty (85.7%) patients underwent curative-intent treatment, including 6 of 7 patients who had CGA. Of 10 vulnerable patients who did not have CGA, 60% proceeded to curative-intent treatment. Mean length of stay after surgery was 12.2 vs. 6.5 days in patients deemed vulnerable or fit by G8 scores, respectively (p = 0.46); the completion rate of radical radiotherapy was 75% vs. 100% in each group, respectively (p = 0.13). Mean post-operative length of stay in vulnerable patients who underwent a CGA was 6.2 days vs. 17.3 days in those who were not referred (p = 0.79). Conclusions: The G8 tool identified twice the number of patients as vulnerable compared to the MDT. There was a trend towards longer post-operative stay and lower radiotherapy completion rates in patients deemed vulnerable by G8 scores. A larger study is needed to evaluate the impact of G8 screening on resource utilization and patient outcomes in this patient group. Clinical trial information: Trial ID ACTRN12614001159640.