title: G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy.
abstract: BACKGROUND
  Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population.
  
  
  METHODS
  All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in 'fit' and 'vulnerable' patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups.
  
  
  RESULTS
  One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones.
  
  
  CONCLUSIONS
  G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient.
authors.affiliation: Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. Lies.Pottel@azsintjan.be.
authors.forename: Lies
authors.initials: L
authors.lastname: Pottel
authors.affiliation: Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. Michelle.Lycke@azgroeninge.be.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lycke
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. Tom.Boterberg@uzgent.be.
authors.forename: Tom
authors.initials: T
authors.lastname: Boterberg
authors.affiliation: Department of Public Health and Primary Care, Subfaculty of Medicine, Catholic University Leuven Kulak, Etienne Sabbelaan 53, B-8500, Kortrijk, Belgium. Hans.Pottel@kuleuven-kortrijk.be.
authors.forename: Hans
authors.initials: H
authors.lastname: Pottel
authors.affiliation: Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. Laurence.Goethals@azgroeninge.be.
authors.forename: Laurence
authors.initials: L
authors.lastname: Goethals
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. Frederic.Duprez@uzgent.be.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Duprez
authors.affiliation: Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. Sylvie.Rottey@uzgent.be.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rottey
authors.affiliation: Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. Yolande.Lievens@uzgent.be.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.affiliation: Department of Geriatrics, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. Nele.vandennoortgate@uzgent.be.
authors.forename: Nele
authors.initials: N
authors.lastname: Van Den Noortgate
authors.affiliation: Department of Internal Medicine, Jan Yperman Hospital, Briekestraat 12, B-8900, Ypres, Belgium. Kurt.Geldhof@yperman.net.
authors.forename: Kurt
authors.initials: K
authors.lastname: Geldhof
authors.affiliation: Department of Internal Medicine, General Hospital OLV Lourdes, Vijfseweg 150, B-8790, Waregem, Belgium. Veronique.Buyse@ziekenhuiswaregem.be.
authors.forename: Véronique
authors.initials: V
authors.lastname: Buyse
authors.affiliation: Department of Oncology, Centre Hospitalier de Wallonie Picarde, RHMS, Chaussée de Saint-Amand 80, B-7500, Tournai, Belgium. Khalil.kargarsamani@chwapi.be.
authors.forename: Khalil
authors.initials: K
authors.lastname: Kargar-Samani
authors.affiliation: Department of Geriatrics, General Hospital Groeninge, Reepkaai 4, B-8500, Kortrijk, Belgium. Veronique.Ghekiere@azgroeninge.be.
authors.forename: Véronique
authors.initials: V
authors.lastname: Ghekiere
authors.affiliation: Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. Philip.Debruyne@azgroeninge.be.|Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, Avery Hill Rd., SE9 2UG, Eltham, London, UK. Philip.Debruyne@azgroeninge.be.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Debruyne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D015577:Geriatric Assessment; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires