title: Impact of comorbidity on initial treatment and overall survival in elderly head and neck cancer patients.
abstract: BACKGROUND
  Comorbidity is a determinant of treatment selection and survival in various cancers including head and neck cancer (HNC) and is often associated with a higher utilization of non-curative intent treatment.
  
  
  METHODS
  In this retrospective study we analyzed 182 consecutively treated HNC patients >65 years old at the Dallas Veterans Affairs Medical Center from January 2000-June 2007. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). Treatment was classified as curative vs. non-curative intent.
  
  
  RESULTS
  Median overall survival was 883 days. Patients with a CCI score 0-2 had non-significant higher rate of curative intent treatment than patients with CCI score >2 (83.8% vs. 74.6%, p=0.13). In multivariate analysis, only stage had significant prognostic importance (hazard ratio (HR) 1.66; 95% confidence interval (CI) 1.29-2.14; p<0.0005). In separate multivariate analyses of patients treated with surgery or chemoradiation, CCI was not a significant predictor of survival with HR of 0.88 (95% CI 0.69-1.11; p=0.29) and 1.13 (95% CI 0.83-1.53; p=0.44), respectively.
  
  
  CONCLUSIONS
  In our elderly HNC population, CCI was not an independent predictor of selection of curative intent treatment or overall survival.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, U.S.A. Saurin.chokshi@phhs.org.
authors.forename: Saurin
authors.initials: S
authors.lastname: Chokshi
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
authors.forename: Armin
authors.initials: A
authors.lastname: Ghobadi
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Athar
authors.affiliation: Texas Tech University Health Sciences Center School of Pharmacy, Veterans Affairs North Texas Healthcare System, Dallas, TX, U.S.A.
authors.forename: Sachin
authors.initials: S
authors.lastname: Shah
authors.affiliation: University of Texas Southwestern Medical Center, Veterans Affairs North Texas Healthcare System, Dallas, TX, U.S.A.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dowell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology
keywords: Charlson comorbidity index; Head and neck cancer; comorbidity; elderly; survival