Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis.
BACKGROUND
Despite advantages in terms of cancer control and organ preservation, the benefits of chemotherapy and radiation therapy (CTRT) may be offset by potentially severe treatment-related toxicities, particularly in older patients. The objectives of this study were to assess the types and frequencies of toxicities in older adults with locally or regionally advanced head and neck squamous cell carcinoma (HNSCC) who were receiving either primary CTRT or radiation therapy (RT) alone.


METHODS
With Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims, patients who were 66 years old or older with locally advanced HNSCC, were diagnosed from 2001 to 2009, and received CTRT or RT alone were identified. Differences in the frequency of toxicity-related hospital admissions and emergency room visits as well as feeding tube use were examined, and controlling for demographic and disease characteristics, this study estimated the impact of chemotherapy on the likelihood of toxicity.


RESULTS
Among patients who received CTRT (n = 1502), 62% had a treatment-related toxicity, whereas 46% of patients who received RT alone (n = 775) did. When the study controlled for demographic and disease characteristics, CTRT patients were twice as likely to experience an acute toxicity in comparison with their RT-only peers. Fifty-five percent of CTRT patients had a feeding tube placed during or after treatment, whereas 28% of the RT-only group did.


CONCLUSIONS
In this population-based cohort of older adults with HNSCC, the rates of acute toxicities and feeding tube use in patients receiving CTRT were considerable. It is possible that for certain older patients, the potential benefit of adding chemotherapy to RT does not outweigh the harms of this combined-modality therapy.
Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.|School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
Caitriona B
CB
O'Neill
Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Shrujal S
SS
Baxi
Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
Coral L
CL
Atoria
Department of Head and Neck Surgery, Trinity College, Dublin, Ireland.
James P
JP
O'Neill
School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
Martin C
MC
Henman
Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Eric J
EJ
Sherman
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Nancy Y
NY
Lee
Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
David G
DG
Pfister
Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
Elena B
EB
Elkin
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D059248:Chemoradiotherapy / Q000009:adverse effects; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents
Epidemiology; Medicare; Surveillance; and End Results (SEER); chemoradiation; head and neck cancer; radiotherapy; toxicity