Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

Daniel R Dickstein,1,* Ann E Powers,2,* Dragan Vujovic,1 Scott Roof,2 Richard L Bakst1 1Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA*These authors contributed equally to this workCorrespondence: Richard L Bakst, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue 1st Fl, Box 1236, New York, NY, 10029, USA, Tel/Fax +1 212 241 3545, Email Richard.Bakst@mountsinai.orgAbstract: Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.Keywords: elderly, older adult, geriatric, head and neck squamous cell carcinoma, oropha