Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiotherapy.

Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiotherapy.:

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Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiotherapy.

Int J Radiat Oncol Biol Phys. 2020 Jan 24;:

Authors: Chou WC, Chang PH, Chen PT, Wang HM, Yeh KY, Lu CH, Hung YS, Tung-Chieh Chang J, Tsang NM, Ho YW, Chen SY, Lee SH, Hung CY, Wang LJ, Liao KC, Lin CH, Tang WR, Lin YC

Abstract

PURPOSE: This study aimed to identify the vulnerable head and neck cancer patients undergoing concurrent chemoradiotherapy (CCRT) who are susceptible to higher treatment related adverse effects and poorer treatment tolerance, and to determine if the comprehensive geriatric assessment (CGA), developed in the geriatric population, could predict vulnerability to treatment related adverse events and survival, even in non-geriatric head and neck cancer patients, as well as the vulnerability prevalence and its effect on toxicities and survival among these patients.

METHODS: This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016-2017 at 3 medical centers across Taiwan. Vulnerability is defined as the 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. It 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 were analyzed.

RESULTS: The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20-34, 35-49, 50-64, and >65 years, respectively. Survival was poorer in vulnerable patients than in non-vulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26-3.07; p=0.003). Vulnerable patients showed a higher tendency of CCRT incompletion (19.5% vs. 6.1%, p<0.001), hospitalization (34.6% vs. 23.5%, p=0.020), need for tubal feeding (29.3% vs. 11.8%, p<0.001), and longer length of hospital stay (8.1 days vs. 4.0 days, p=0.004) than non-vulnerable patients. Hematologic and non-hematologic toxicities were more severe in vulnerable patients than in non-vulnerable patients.

CONCLUSION: Vulnerability, an urgent need to be concerned with presentation among head and neck cancer patients, 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, and not only in such patients who are geriatric.

PMID: 31987971 [PubMed - as supplied by publisher]