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The Use of Geriatric Assessment Tools to Tailor the Treatment in Elderly Patients with Locally Advanced Head and Neck Cancer

The results of the ELDERLY study
17 Sep 2021
Cancer in Special Situations / Population;  Head and neck cancers

In a prospective evaluation of the role of comprehensive geriatric assessment (CGA) to personalise therapy in the elderly patients with locally advanced head and neck squamous cell carcinoma (HNSCC), geriatric intervention changed therapeutic choices in about one out of 10 patients and played an important role in tailoring supportive care needs. Furthermore, G8 screening tool showed a good sensitivity in identifying unfit patients who need full CGA. The results from the ELDERLY study were presented by Prof. Paolo Bossi of the Medical Oncology, Azienda Ospedaliera Spedali Civili di Brescia, University of Brescia in Brescia, Italy and colleagues during the mini oral session on head and neck cancer at ESMO Congress 2021 (16-21 September).

Prof. Bossi told the audience that approximately 45% of patients with HNSCC are older than 65 years and this rate is expected even to increase. Together with colleagues from the Gruppo Oncologico Nord-Ovest (GONO), Prof. Bossi enrolled in this study patients who were at least 65 years old and had stage III-IVb HNSCC according to the AJCC 7th classification and were potentially suitable for curative treatment.

The head and neck multidisciplinary team defined a therapeutic indication based on clinical situation and standard evidence-based recommendations, and a geriatrician performed CGA, preceded by a G8 screening tool. Subsequently, the same head and neck multidisciplinary team re-discussed the curative strategy in the context of the CGA results.

Primary objective was to define the proportion of changes in therapeutic indications after CGA. Secondary aims were to assess the distribution of elderly patients with locally advanced HNSCC in three geriatric categories, in particular fit, vulnerable, and frail, according CGA and the accuracy of the G8 geriatric screening tool in this setting.

Between December 2017 and March 2021, they study team enrolled 101 patients, of whom 33.7% were fit, 39.6% vulnerable, and 26.7% frail. After geriatric assessment, the major therapeutic strategy was changed in 12 patients (11.8%), in particular in 7 it was de-intensified, in 4 intensified, and in one it changed from surgery to chemoradiation.

Furthermore, the authors reported that CGA resulted in increased attention to supportive care needs, such as referral to nutritional consultation (in 27.7% at first head and neck multidisciplinary team evaluation compared to 49.5% after CGA), psychological support and psychiatric treatments (3.9% before versus 19.8% after), and chronic therapy modification (1% versus 9%).

G8 score >14 corresponded to fit patients at CGA in 83.3% patients, whereas ≤14 to vulnerable/frail in 87.3%. The authors reported that G8 score with cut-off ≤14 had sensitivity and specificity of 92.5% and 73.5%, respectively.

The-Use-of-Geriatric-Assessment-Tools-to-Tailor-the-Treatment-in-Elderly-Patients-with-Locally-Advanced-Head-and-Neck-Cancer

Main results of the ELDERLY study in patients with head and neck cancer.

© Paolo Bossi.

The authors also showed that the rate of hospitalisation for toxicities was quite high (34%) and the acute/subacute mortality index was 8%, thus underlying the overall frailty of this population.

The GONO researchers concluded that in their study a geriatric intervention changed major therapeutic choices in about one out of 10 patients and played an important role in tailoring supportive care needs. They found that G8 can be used as a screening tool in this setting with a good sensitivity in identifying unfit patients who need a complete geriatric evaluation, although it showed a limited specificity.

This academic study was funded by - Associazione Italiana Oncologia Medica (AIOM).

Reference

864MO – Bossi P, Esposito A, Vecchio S, et al. Role of geriatric assessment in tailoring treatment of locally advanced head and neck cancer: The ELDERLY study. ESMO Congress 2021 (16-21 September).

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