In a prospective evaluation of the role of comprehensive geriatric assessment in personalizing therapy for elderly patients with locally advanced head and neck squamous cell carcinoma (HNSCC), geriatric intervention changed therapeutic choices in about 1 out of 10 patients and played an important role in tailoring supportive care needs. Furthermore, a G8 screening tool showed good sensitivity in identifying unfit patients who need full comprehensive geriatric assessment. Results from the ELDERLY study were presented by Bossi et al during the European Society for Medical Oncology (ESMO) Congress 2021 (Abstract 864MO).
Methodology
Researchers told the audience that approximately 45% of patients with HNSCC are older than age 65 years, and that rates of the disease are expected to increase in this age group. Patients who were at least 65 years old, had stage III to IVB HNSCC according to the American Joint Committee on Cancer 7th classification, and were potentially suitable for curative treatment were enrolled into the trial.
The multidisciplinary team defined a therapeutic indication based on clinical situation and standard evidence-based recommendations, and a geriatrician performed comprehensive geriatric assessment, preceded by a G8 screening tool. Subsequently, the same team rediscussed the curative strategy in the context of the comprehensive geriatric assessment results.
The primary objective was to define the proportion of changes in therapeutic indications after comprehensive geriatric assessment. Secondary aims were to assess the distribution of elderly patients with locally advanced HNSCC in three geriatric categories—fit, vulnerable, and frail—according to comprehensive geriatric assessment and the accuracy of the G8 geriatric screening tool in this setting.
Between December 2017 and March 2021, they study team enrolled 101 patients, of whom 33.7% were classified as fit, 39.6% vulnerable, and 26.7% frail.
Role of Comprehensive Geriatric Assessment
After geriatric assessment, the major therapeutic strategy was changed in 12 patients (11.8%); in particular, therapy was deintensified in 7, intensified in 4, and was changed from surgery to chemoradiation in 1.
Furthermore, the authors reported that comprehensive geriatric assessment resulted in increased attention to supportive care needs, such as referral to nutritional consultation (in 27.7% at first head and neck multidisciplinary team evaluation compared to 49.5% after comprehensive geriatric assessment), psychological support and psychiatric treatments (3.9% before vs 19.8% after), and chronic therapy modification (1% vs 9%).
G8 score > 14 corresponded to fit patients at comprehensive geriatric assessment in 83.3% of patients, whereas a score of ≤ 14 corresponded to vulnerable/frail in 87.3%. The authors reported that G8 score with a cut-off of ≤ 14 had sensitivity and specificity of 92.5% and 73.5%, respectively.
The authors also showed that the rate of hospitalization for toxicities was quite high (34%) and the acute/subacute mortality index was 8%, thus underlying the overall frailty of this population.
The study authors concluded, “Geriatric intervention changed major therapeutic choices in about 1 out of 10 patients. In addition, comprehensive geriatric assessment played an important role in tailoring elderly patients’ supportive care needs. Moreover, G8 can be used as a screening tool in locally advanced HNSCC, with a good sensitivity in identifying unfit patients who then need a complete geriatric evaluation, even if with limited specificity.”
Disclosure: This academic study was funded by the Associazione Italiana Oncologia Medica (AIOM). For full disclosures of the study authors, visit oncologypro.esmo.org.
