Assessment for Vulnerability Improves Outcomes for Patients With HNC Undergoing Concurrent Chemoradiotherapy

Patients with head and neck cancer (HNC) who have greater vulnerability to adverse events (AEs) related to cancer or treatment show worse survival outcomes and a greater risk of complications from concurrent chemoradiotherapy (CCRT), according to a recent study with results published in the International Journal of Radiation Oncology • Biology • Physics.

This multicenter, prospective study based in Taiwan included patients (N=461) with primary HNC assigned to treatment with CCRT. Patients were aged 20 years or older, and a comprehensive geriatric assessment was used to rate all patients for vulnerability to AEs from cancer and treatment prior to beginning CCRT. Those whose assessment showed impairments in 2 or more areas were considered vulnerable. Multiple outcomes were analyzed with respect to vulnerability.

Vulnerability was identified among 22.2% of patients 20 to 34 years old, 27.3% of patients 35 to 49 years old, 30.2% of patients 50 to 64 years old, and 27.9% of patients 65 years and older.

Vulnerable patients showed poorer survival than did nonvulnerable patients (hazard ratio, 1.97; 95% CI, 1.26-3.07; P =.003). The 12-month overall survival rate was 76.8% for vulnerable patients, whereas it was 88.7% for nonvulnerable patients.

Among the study groups, 34.6% of vulnerable patients and 23.5% of nonvulnerable patients were hospitalized (P =.02), and hospitalizations lasted a median of 8.1 days for vulnerable patients compared with 4.0 days for nonvulnerable patients (P =.004). Vulnerable patients were also more likely to require tubal feeding compared with nonvulnerable patients (29.3% vs 11.8%; P <.001).