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Management of Older Patients with Head and Neck Cancer: A Comprehensive Review

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Abstract

The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Author Contributions

Luiz Kowalski was responsible for concept and design of the study. Leandro Matos and Alvaro Sanabria did the literature review, wrote the manuscript, and performed the revision. All other co-authors (K. Thomas Robbins, Gyorgy Halmos, Primož Strojan, Wai Tong Ng, Robert Takes, Peter Angelos, Cesare Piazza, Remco de Bree, Ohad Ronen, Orlando Guntinas-Lichius, Avraham Eisbruch, Mark Zafereo, Antti Mäkitie, Ashok Shaha, Andres Coca-Pelaz, Alessandra Rinaldo, Nabil Saba, Oded Cohen, Fernando Lopez, Juan Rodrigo, Carl Silver, Timo Strandberg, Alfio Ferlito) wrote parts of the text according to each one's expertise and read, reviewed, and approved the final version of the manuscript.

Disclosures

All authors (Leandro Matos, Alvaro Sanabria, K. Thomas Robbins, Gyorgy Halmos, Primož Strojan, Wai Tong Ng, Robert Takes, Peter Angelos, Cesare Piazza, Remco de Bree, Ohad Ronen, Orlando Guntinas-Lichius, Avraham Eisbruch, Mark Zafereo, Antti Mäkitie, Ashok R. Shaha, Andres Coca-Pelaz, Alessandra Rinaldo, Nabil Saba, Oded Cohen, Fernando Lopez, Juan Rodrigo, Carl E. Silver, Timo Strandberg, Luiz Kowalski, Alfio Ferlito) have read and approved the final version of the manuscript and declare to not have any actual, potential, or apparent conflict of interest concerning with this study.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil

    Leandro L. Matos

  2. Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia

    Alvaro Sanabria

  3. Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA

    K. Thomas Robbins

  4. Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Gyorgy B. Halmos

  5. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

    Primož Strojan

  6. Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China

    Wai Tong Ng

  7. Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

    Robert P. Takes

  8. Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Peter Angelos

  9. Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy

    Cesare Piazza

  10. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

    Remco de Bree

  11. Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

    Ohad Ronen

  12. Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany

    Orlando Guntinas-Lichius

  13. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    Avraham Eisbruch

  14. Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA

    Mark Zafereo

  15. Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland

    Antti A. Mäkitie

  16. Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden

    Antti A. Mäkitie

  17. Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ashok R. Shaha

  18. Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain

    Andres Coca-Pelaz, Fernando Lopez & Juan P. Rodrigo

  19. University of Udine School of Medicine, Udine, Italy

    Alessandra Rinaldo

  20. Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA

    Nabil F. Saba

  21. Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel

    Oded Cohen

  22. Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  23. Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  24. University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Timo E. Strandberg

  25. Center for Life-Course Health Research, University of Oulu, Oulu, Finland

    Timo E. Strandberg

  26. Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil

    Luiz Paulo Kowalski

  27. Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil

    Luiz Paulo Kowalski

  28. Coordinator of the International Head and Neck Scientific Group, Padua, Italy

    Alfio Ferlito

Authors
  1. Leandro L. Matos
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  2. Alvaro Sanabria
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  15. Antti A. Mäkitie
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  21. Fernando Lopez
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  23. Carl E. Silver
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Corresponding author

Correspondence to Luiz Paulo Kowalski.

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This article was written by members and invitees of the International Head and Neck Scientific Group (http://www.IHNSG.com).

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Matos, L.L., Sanabria, A., Robbins, K.T. et al. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 40, 1957–1974 (2023). https://doi.org/10.1007/s12325-023-02460-x

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