Geriatric Assessment as a Predictor of Tolerance, Quality of Life, and Outcomes in Older Patients with Head and Neck Cancers and Lung Cancers Receiving Radiotherapy

Publication date: Available online 2 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Noam A. VanderWalde, Allison M. Deal, Elizabeth Comitz, Lori Stravers, Hyman Muss, Bryce B. Reeve, Ethan Basch, Joel Tepper, Bhishamjit Chera
Purpose/ObjectiveTo evaluate the association between functional status based on a Geriatric Assessment (GA) and outcomes of tolerance to treatment in patients with lung or head and neck cancer (HNC) receiving radiation (RT) or chemoradiation (CRT).Methods and MaterialsA prospective cohort study was conducted in patients ≥ 65 years with HNC or lung cancer undergoing curative intent RT or CRT. Pre-treatment GA, Health Related Quality of Life (HRQoL), and Patient Reported Outcomes (PRO) were obtained. Questionnaires were repeated biweekly during RT and at 6 weeks post treatment. Dysfunction was defined as scores <14 on the Instrumental Activities of Daily Living (I-ADL) scale. Poor tolerance to treatment was defined by hospitalization, > 3 day treatment delay, change in RT or CRT regimen, or death. Associations of dysfunction with tolerance to radiotherapy, HRQoL changes, and PRO ratings were evaluated.ResultsOf the 50 patients accrued, 46 had evaluable data. Mean age was 72.5 (range 65-92). At baseline, 37% had dysfunction. Poor tolerance to RT or CRT occurred in 39%. There was no association between dysfunction and tolerance. Patients with dysfunction had lower baseline HRQoL scores. From baseline to end of RT, those with baseline dysfunction had less of a decline in Role Functioning (RF) (p= .01) and Global Health Score (GHS) (p= .04) domains. However, from end of RT to 6 week follow up, those with dysfunction were more likely to continue to drop in the physical, RF and Social domains (all p<0.01). Dysfunction at baseline was also associated with higher severity of certain PROs.ConclusionsPre-treatment dysfunction was associated with continued decline and lack of recovery of HRQoL in this patient population. Larger studies could further elucidate the GA's predictive value.

Teaser

In this prospective observational study of older head and neck or lung cancer patients, pre-treatment dysfunction as measured by domains in a geriatric assessment were not associated with the pre-defined outcome of poor tolerance to treatment. However, dysfunction was associated with post treatment quality of life and severity of patient reported outcomes. Pre-treatment geriatric assessment may help identify older patients who experience lack of recovery following treatment of their lung or head and neck cancers.


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