2827 - From Guidelines to Real-World Practice: Patterns of Care in Elderly Head and Neck Cancer Patients from a Tertiary Care Center

Purpose/Objective(s): Elderly patients with head and neck cancer (HNC) are often underrepresented in clinical trials, raising concerns about their ability to tolerate aggressive multimodality treatments. This study evaluates patterns of care in geriatric HNC patients and identifies key factors influencing treatment decisions and survival outcomes.

Materials/Methods: A retrospective analysis was conducted on patients aged =60 years who presented to the Head and Neck Cancer multidisciplinary clinic between 2021 and 2022, during and post-COVID-19 pandemic. The study included patients across all HNC sites, stages, and histopathological types. Descriptive statistics summarized patient demographics, tumor characteristics, comorbidities, performance status, and treatment patterns. Continuous variables were reported as medians or means, while categorical variables were presented as frequencies and percentages. Survival analysis used the Kaplan-Meier method, with group comparisons via the log-rank test (p < 0.05 considered significant).

Results: A total of 259 patients reported to the clinic, with a median age of 67 years (range: 69–90) and a predominantly male population (89%, n = 233). Oropharyngeal squamous cell carcinoma (SCC) was the most common malignancy (35.5%, n=93), followed by oral cavity (22.9%, n=60) and laryngeal cancer (21.8%, n=57). P16 positivity was observed in 2% of cases. Most patients (92%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, while 28.2% (n=74) had significant comorbidities. Only 13% (n=34) presented with early-stage disease, whereas 87% (n=225) had advanced-stage disease. Treatment intent was curative in 60% (n=158) and palliative in 40% (n=104). Among 89 patients who completed the intended treatment, 62.92% were aged 60-70, 32.58% were between 70-80, and 4.49% were >80 years. Of these, 31.5% (n=28) received curative treatment, while 68.5% (n=61) received palliative care. The median overall survival was 35 months (95% CI: 32.6–37.6). At 36 months, the estimated overall survival (OS) was 75% for curative treatment and 26% for palliative care. The 3-year OS was 50% for patients aged <70 years and 37% for those =70 years (p=0.341).

Conclusion: Despite a significant proportion being planned for curative treatment, treatment completion rates remained low, likely influenced by factors such as comorbidities and the challenges posed by the COVID-19 pandemic. These findings highlight the need for individualized treatment strategies, enhanced support systems, and improved adherence to optimize outcomes in elderly HNC patients. A multidisciplinary approach incorporating geriatric assessment and supportive care may help improve treatment tolerance.