title: Factors that influence treatment decision in older patients with resectable head and neck cancer.
abstract: OBJECTIVE
  To find clinical factors related to administration of substandard treatment in older patients with head and neck cancer.
  
  
  METHODS
  Historic cohort.
  
  
  METHODS
  Patients of 70 years of age of older with diagnosis of resectable head and neck cancer were included. Treatment offered to patients was classified as standard or substandard by experienced surgeons. Relation of age, clinical stage, comorbidities, performance status, and treatment with substandard treatment was explored. The effect of substandard treatment on survival was assessed.
  
  
  RESULTS
  Three hundred twelve patients were included. Substandard treatment was offered to 19.9% of patients. Associated factors related to selection of substandard treatment were higher age, oro/hypopharynx tumor site, severe comorbidity, advanced clinical stage, and low Karnofsky Index. Patients submitted to substandard treatment had lower overall and cancer-specific survival (45.9% vs. 19.9% and 63.0% vs. 33.1%, respectively).
  
  
  CONCLUSIONS
  Selection of substandard treatment decreases overall and cancer-specific survival. Selecting substandard treatment for reasons such as chronologic age, tumor site, or moderate or mild comorbidities worsen patient prognosis.
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, Hospital do Câncer AC Camargo, Fundação Antonio Prudente, São Paulo, Brazil. alvarosanabria@gmail.com
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanabria
authors.forename: André Lopes
authors.initials: AL
authors.lastname: Carvalho
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Vartanian
authors.forename: José
authors.initials: J
authors.lastname: Magrin
authors.forename: Mauro Kasuo
authors.initials: MK
authors.lastname: Ikeda
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D013514:Surgical Procedures, Operative / Q000592:standards*; D015996:Survival Rate