title: Patterns of Care for Elderly Patients With Locally Advanced Head and Neck Cancer.
abstract: To compare patterns of care for elderly patients aged ≥70 years with locally advanced head and neck cancer versus those of younger patients treated for the same disease.
  
  
  
  The medical records of 421 consecutive patients over the age of 50 years treated at a single institution between April 2011 and June 2016 for stage III/IV squamous cell carcinoma of the head and neck were reviewed. The primary treatment approach was compared using a t test statistic among 3 age cohorts: 50 to 59 years (118 patients); 60 to 69 years (152 patients); and 70 years and older (151 patients). Logistical regression was used to determine variables that influenced the likelihood of receiving surgery versus nonsurgical treatment, as well as radiation alone versus chemoradiation.
  
  
  
  There was no difference in sex, T stage, N stage, Karnofsky performance status, or the number of chronic comorbid conditions among the 3 age cohorts (P>.05 for all). A greater proportion of elderly patients aged ≥70 years were treated by radiation alone compared with those aged 50 to 59 and 60 to 69 years (44% vs 16% and 24%, P=.01). Increasing age was associated with a greater likelihood of receiving primary nonsurgical versus surgical treatment (odds ratio 1.023, 95% confidence interval 1.004-1.042) and radiation alone compared with chemoradiation (odds ratio 1.054; 95% confidence interval 1.034-1.075). Ten chemotherapy regimens were used concurrently with radiation for patients aged ≥70 years, including carboplatin/paclitaxel (19%), carboplatin/cetuximab (19%), cisplatin (17%), and cetuximab (17%).
  
  
  
  Despite similar performance status and comorbidity burden compared with their younger counterparts, patients aged ≥70 years were more commonly treated with less-aggressive strategies, including radiation alone. The variability of concurrent chemotherapy regimens used further suggests that the standard of care remains to be defined for this population.
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Juarez
authors.affiliation: Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Jehee
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Maie
authors.initials: M
authors.lastname: St John
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Elliot
authors.initials: E
authors.lastname: Abemayor
authors.affiliation: Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Mindi
authors.initials: M
authors.lastname: TenNapel
authors.affiliation: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas. Electronic address: achen5@kumc.edu.
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000592:standards / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D000068818:Cetuximab / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000592:standards / Q000706:statistics & numerical data; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D003657:Decision Making; D003695:Delivery of Health Care / Q000592:standards*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008875:Middle Aged; D016017:Odds Ratio; D017239:Paclitaxel / Q000008:administration & dosage; D011878:Radiotherapy / Q000592:standards / Q000706:statistics & numerical data; D012044:Regression Analysis
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel; D000068818:Cetuximab; D002945:Cisplatin