Wen-Chi Chou1, Pei-Hung Chang2, Ping-Tsung Chen3, Hung-Ming Wang1, Kun-Yun Yeh2, Chang-Hsien Lu3, Yu-Shin Hung1, Joseph Tung-Chieh Chang4, Ngan-Ming Tsang4, Ya-Wen Ho5, Shih-Ying Chen5, Shu-Hui Lee6, Chia-Yen Hung1, Li-Jen Wang7, Kuo-Chen Liao8, Chung-Hao Lin8, Woung-Ru Tang5, Yung-Chang Lin9. 1. Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyaun, Taiwan. 2. Department of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. 3. Department of Hematology-Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan. 4. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyaun, Taiwan. 5. School of Nursing, College of Medicine, Chang Gung University, Taoyaun, Taiwan. 6. Department of Nursing, Chang Gung University, Taoyaun, Taiwan. 7. Department of Medical Imaging and Intervention, Chang Gung University, Taoyaun, Taiwan. 8. Department of General Internal and Geriatrics Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyaun, Taiwan. 9. Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyaun, Taiwan. Electronic address: yclinof@cgmh.org.tw.
Abstract
PURPOSE: This study aimed to identify vulnerable patients with head and neck cancer undergoing concurrent chemoradiation therapy (CCRT) who are susceptible to higher treatment-related adverse effects and have poorer treatment tolerance. This study also aimed to determine whether comprehensive geriatric assessment, developed in the geriatric population, can predict vulnerability to treatment-related adverse events and survival even in nongeriatric patients with head and neck cancer, as well as the prevalence of vulnerability and its effect on toxicities and survival among these patients. METHODS AND MATERIALS: This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016 to 2017 at 3 medical centers across Taiwan. Vulnerability is defined as susceptibility to cancer- and treatment-related adverse events that result in poor treatment tolerance and unexpected emergent medical needs, such as hospitalization and emergency room visits. Vulnerability was assessed as impairment with ≥2 dimensions on comprehensive geriatric assessment, 7 days before CCRT. The association of vulnerability with treatment-related adverse events and survival was analyzed. RESULTS: The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20 to 34, 35 to 49, 50 to 64, and >65 years, respectively. Survival was poorer in vulnerable patients than in nonvulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26-3.07; P = .003). Vulnerable patients showed a higher tendency toward CCRT incompletion (19.5% vs 6.1%, P < .001), hospitalization (34.6% vs 23.5%, P = .020), need for tubal feeding (29.3% vs 11.8%, P < .001), and longer length of hospital stay (8.1 days vs 4.0 days, P = .004) than nonvulnerable patients. Hematologic and nonhematologic toxicities were more severe in vulnerable patients than in nonvulnerable patients. CONCLUSIONS: Vulnerability, which is an urgent concern when it presents among patients with head and neck cancer, was independently associated with poorer survival and severe treatment-related complications. Vulnerability assessment should be routinely evaluated in all patients with primary head and neck cancer who are undergoing definitive CCRT, not only in such patients who are geriatric.
PURPOSE: This study aimed to identify vulnerable patients with head and neck cancer undergoing concurrent chemoradiation therapy (CCRT) who are susceptible to higher treatment-related adverse effects and have poorer treatment tolerance. This study also aimed to determine whether comprehensive geriatric assessment, developed in the geriatric population, can predict vulnerability to treatment-related adverse events and survival even in nongeriatric patients with head and neck cancer, as well as the prevalence of vulnerability and its effect on toxicities and survival among these patients. METHODS AND MATERIALS: This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016 to 2017 at 3 medical centers across Taiwan. Vulnerability is defined as susceptibility to cancer- and treatment-related adverse events that result in poor treatment tolerance and unexpected emergent medical needs, such as hospitalization and emergency room visits. Vulnerability was assessed as impairment with ≥2 dimensions on comprehensive geriatric assessment, 7 days before CCRT. The association of vulnerability with treatment-related adverse events and survival was analyzed. RESULTS: The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20 to 34, 35 to 49, 50 to 64, and >65 years, respectively. Survival was poorer in vulnerable patients than in nonvulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26-3.07; P = .003). Vulnerable patients showed a higher tendency toward CCRT incompletion (19.5% vs 6.1%, P < .001), hospitalization (34.6% vs 23.5%, P = .020), need for tubal feeding (29.3% vs 11.8%, P < .001), and longer length of hospital stay (8.1 days vs 4.0 days, P = .004) than nonvulnerable patients. Hematologic and nonhematologic toxicities were more severe in vulnerable patients than in nonvulnerable patients. CONCLUSIONS: Vulnerability, which is an urgent concern when it presents among patients with head and neck cancer, was independently associated with poorer survival and severe treatment-related complications. Vulnerability assessment should be routinely evaluated in all patients with primary head and neck cancer who are undergoing definitive CCRT, not only in such patients who are geriatric.
Authors: Remco de Bree; Christiaan D A Meerkerk; Gyorgy B Halmos; Antti A Mäkitie; Akihiro Homma; Juan P Rodrigo; Fernando López; Robert P Takes; Jan B Vermorken; Alfio Ferlito Journal: Front Oncol Date: 2022-05-12 Impact factor: 5.738