Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis Journal Article

Authors: O'Neill, C. B.; Baxi, S. S.; Atoria, C. L.; O'neill, J. P.; Henman, M. C.; Sherman, E. J.; Lee, N. Y.; Pfister, D. G.; Elkin, E. B.
Article Title: Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis
Abstract: 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. Cancer 2015. © 2015 American Cancer Society.
Keywords: treatment outcome; treatment response; aged; major clinical study; neutropenia; diarrhea; cancer radiotherapy; infection; anemia; esophagitis; mucosa inflammation; nausea; thrombocytopenia; vomiting; dehydration; radiotherapy; delirium; deep vein thrombosis; kidney failure; radiation injury; fever; lung embolism; medicare; dysphagia; population research; head and neck cancer; heart failure; oropharynx cancer; clinical effectiveness; epidemiology; toxicity; larynx cancer; chemoradiation; chemoradiotherapy; aspiration pneumonia; surveillance; head and neck squamous cell carcinoma; feeding apparatus; very elderly; human; male; female; priority journal; article; and end results (seer)
Journal Title: Cancer
Volume: 121
Issue: 12
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2015-06-15
Start Page: 2083
End Page: 2089
Language: English
DOI: 10.1002/cncr.29262
PROVIDER: scopus
PUBMED: 25728057
PMCID: PMC5018230
Notes: Export Date: 2 July 2015 -- Source: Scopus
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MSK Authors
  1. Eric J Sherman
    152 Sherman
  2. Elena B Elkin
    151 Elkin
  3. Nancy Y. Lee
    550 Lee
  4. David G Pfister
    251 Pfister
  5. Shrujal S Baxi
    70 Baxi
  6. Coral Lynn Atoria
    49 Atoria