Impact of geriatric assessment on the management of older adults with head and neck cancer: A pilot study

Abstract

Objective: Assess the utility of the G8 screening tool and CGA for older adults with head and neck cancer.

Methods: Patients 65years or older with a primary malignancy of the head and neck region were presented at the multidisciplinary team (MDT) meeting. The Geriatric 8 (G8) questionnaire was administered prior. Clinicians, blinded to the G8 result, made a recommendation on appropriate treatment, including potential referral for CGA. Patients considered vulnerable (G8 score≤14) were also to be referred for CGA. Treatment outcomes were recorded.

Results: Over 6months, 35 patients were recruited, median age 74 (range 65-93). Seventeen (49%) patients were assessed as vulnerable by the G8 score, including 7 (20%) whom the MDT referred for CGA. Seven with G8 scores≤14 did not receive a CGA. Thirty (85.7%) underwent curative intent treatment, including 6 of 7 who had CGA. Of 10 vulnerable patients who did not have CGA, 70% received curative-intent treatment. Mean length of post-operative stay was 12.2 vs. 6.5days in patients deemed vulnerable or fit by G8 scores, respectively (p=0.46); completion rate of radical radiotherapy was 75% vs. 100% in each group, respectively (p=0.13). Mean post-operative length of stay in vulnerable patients who underwent a CGA was 6.2days vs. 17.3days in those who were not referred (p=0.79).

Conclusions: The G8 tool identified twice the number of patients as vulnerable compared to the MDT. There was a trend towards longer postoperative stay and lower radiotherapy completion rates in patients deemed vulnerable by G8 scores.

Keywords: Comprehensive geriatric assessment; G8; Head and neck cancer.