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BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy

Authors: Lies Pottel, Michelle Lycke, Tom Boterberg, Hans Pottel, Laurence Goethals, Fréderic Duprez, Sylvie Rottey, Yolande Lievens, Nele Van Den Noortgate, Kurt Geldhof, Véronique Buyse, Khalil Kargar-Samani, Véronique Ghekiere, Philip R. Debruyne

Published in: BMC Cancer | Issue 1/2015

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Abstract

Background

Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population.

Methods

All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in ‘fit’ and ‘vulnerable’ patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups.

Results

One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones.

Conclusions

G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient.
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Literature
1.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.CrossRefPubMed
2.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.CrossRefPubMed
3.
4.
Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Evensen JF, Biorklund A, et al. A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis. Laryngoscope. 2001;111(4 Pt 1):669–80.CrossRefPubMed
5.
Hammerlid E, Silander E, Hornestam L, Sullivan M. Health-related quality of life three years after diagnosis of head and neck cancer--a longitudinal study. Head Neck. 2001;23(2):113–25.CrossRefPubMed
6.
Langius A, Bjorvell H, Lind MG. Oral- and pharyngeal-cancer patients’ perceived symptoms and health. Cancer Nurs. 1993;16(3):214–21.PubMed
7.
Long SA, D’Antonio LL, Robinson EB, Zimmerman G, Petti G, Chonkich G. Factors related to quality of life and functional status in 50 patients with head and neck cancer. Laryngoscope. 1996;106(9 Pt 1):1084–8.CrossRefPubMed
8.
Horiot JC. Radiation therapy and the geriatric oncology patient. J Clin Oncol. 2007;25(14):1930–5.CrossRefPubMed
9.
Lin LL, Hahn SM. Combined modality therapy in the elderly population. Curr Treat Options Oncol. 2009;10(3–4):195–204.CrossRefPubMed
10.
Pignon JP, le Maitre A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92(1):4–14.CrossRefPubMed
11.
Ortholan C, Benezery K, Dassonville O, Poissonnet G, Bozec A, Guiochet N, et al. A specific approach for elderly patients with head and neck cancer. Anticancer Drugs. 2011;22(7):647–55.CrossRefPubMed
12.
Lycke M, Pottel L, Boterberg T, Ketelaars L, Wildiers H, Schofield P, et al. Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now. Eur J Cancer Care. 2015;24(2):143–6.CrossRef
13.
Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer. 2010;46(9):1502–13.CrossRefPubMed
14.
Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, et al. International society of geriatric oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595-603.
15.
16.
17.
Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13(10):e437–44.CrossRefPubMed
18.
Kenis C, Decoster L, Van Puyvelde K, De Greve J, Conings G, Milisen K, et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol. 2014;32(1):19–26.CrossRefPubMed
19.
Pottel L, Boterberg T, Pottel H, Goethals L, Van Den Noortgate N, Duprez F, et al. Determination of an adequate screening tool for identification of vulnerable elderly head and neck cancer patients treated with radio(chemo)therapy. J Geriatr Oncol. 2012;3(1):24–32.CrossRef
20.
Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, et al. Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life. Eur J Cancer Care. 2014;23(3):401–12.CrossRef
21.
Ghadjar P, Simcock M, Zimmermann F, Betz M, Bodis S, Bernier J, et al. Predictors of severe late radiotherapy-related toxicity after hyperfractionated radiotherapy with or without concomitant cisplatin in locally advanced head and neck cancer. Secondary retrospective analysis of a randomized phase III trial (SAKK 10/94). Radiother Oncol. 2012;104(2):213–8.CrossRefPubMed
22.
Givens DJ, Karnell LH, Gupta AK, Clamon GH, Pagedar NA, Chang KE, et al. Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2009;135(12):1209–17.CrossRefPubMed
23.
Wildiers H, Mauer M, Pallis A, Hurria A, Mohile SG, Luciani A, et al. End points and trial design in geriatric oncology research: a joint European organisation for research and treatment of cancer--Alliance for Clinical Trials in Oncology--International Society Of Geriatric Oncology position article. J Clin Oncol. 2013;31(29):3711–8.CrossRefPubMed
24.
Gao F, Wee J, Wong HB, Machin D. Quality-of-life-adjusted survival analysis of concurrent chemo radiotherapy for locally advanced (nonmetastatic) nasopharyngeal cancer. Int J Radiat Oncol Biol Phys. 2010;78(2):454–60.CrossRefPubMed
25.
Rogers LQ, Rao K, Malone J, Kandula P, Ronen O, Markwell SJ, et al. Factors associated with quality of life in outpatients with head and neck cancer 6 months after diagnosis. Head Neck. 2009;31(9):1207–14.CrossRefPubMed
26.
Rogers SN. Quality of life for head and neck cancer patients--has treatment planning altered? Oral Oncol. 2009;45(4–5):435–9.CrossRefPubMed
27.
Rogers SN, Miller RD, Ali K, Minhas AB, Williams HF, Lowe D. Patients’ perceived health status following primary surgery for oral and oropharyngeal cancer. Int J Oral Maxillofac Surg. 2006;35(10):913–9.CrossRefPubMed
28.
Ramaekers BL, Joore MA, Grutters JP, van den Ende P, Jong J, Houben R, et al. The impact of late treatment-toxicity on generic health-related quality of life in head and neck cancer patients after radiotherapy. Oral Oncol. 2011;47(8):768–74.CrossRefPubMed
29.
Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49(12):1691–9.CrossRefPubMed
30.
Bellera CA, Rainfray M, Mathoulin-Pelissier S, Mertens C, Delva F, Fonck M, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166–72.CrossRefPubMed
31.
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032–6.CrossRefPubMed
32.
Mohile SG, Bylow K, Dale W, Dignam J, Martin K, Petrylak DP, et al. A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer. 2007;109(4):802–10.CrossRefPubMed
33.
Kellen E, Bulens P, Deckx L, Schouten H, Van Dijk M, Verdonck I, et al. Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol. 2010;75(3):243–8.CrossRefPubMed
34.
Falci C, Brunello A, Monfardini S. Detecting functional impairment in older patients with cancer: is vulnerable elders survey-13 the right prescreening tool? An open question. J Clin Oncol. 2010;28(32):e665–6. author reply e7.CrossRefPubMed
35.
Molina-Garrido MJ, Guillen-Ponce C. Overvaluation of the vulnerable elders survey-13 as a screening tool for vulnerability. J Clin Oncol. 2011;29(23):3201–2. author reply 2–3.CrossRefPubMed
36.
Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H, et al. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One. 2014;9(12), e115060.PubMedCentralCrossRefPubMed
37.
Hamaker ME, Mitrovic M, Stauder R. The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy. Ann Hematol. 2014;93(6):1031–40.CrossRefPubMed
38.
39.
EuroQol G. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
40.
Cleemput I. Economic evaluation in renal transplantation: outcome assessment and cost-utility of non-compliance. Leuven: Acco; 2003.
41.
Gusi N, Olivares PR, Rajendram R. Handbook of Disease Burdens and Quality of Life Measures: The EQ-5D Health-Related Quality of Life Questionnaire. New York, USA: Springer; 2010. pp 87–99.
42.
Glasziou PP, Cole BF, Gelber RD, Hilden J, Simes RJ. Quality adjusted survival analysis with repeated quality of life measures. Stat Med. 1998;17(11):1215–29.CrossRefPubMed
43.
Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005;55(3):241–52.CrossRefPubMed
44.
Diaz-Redondo A, Rodriguez-Blazquez C, Ayala A, Martinez-Martin P, Forjaz MJ. Spanish Research Group on Quality of L, et al. EQ-5D rated by proxy in institutionalized older adults with dementia: psychometric pros and cons. Geriatr Gerontol Int. 2014;14(2):346–53.CrossRefPubMed
45.
Couzner L, Crotty M, Norman R, Ratcliffe J. A comparison of the EQ-5D-3L and ICECAP-O in an older post-acute patient population relative to the general population. Appl Health Econ Health Policy. 2013;11(4):415–25.CrossRefPubMed
46.
Milte CM, Walker R, Luszcz MA, Lancsar E, Kaambwa B, Ratcliffe J. How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians. Appl Health Econ Health Policy. 2014;12(1):73–84.CrossRefPubMed
47.
Nguyen NP, Sallah S, Karlsson U, Antoine JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer. 2002;94(4):1131–41.CrossRefPubMed
48.
Nguyen NP, Vos P, Smith HJ, Nguyen PD, Alfieri A, Karlsson U, et al. Concurrent chemoradiation for locally advanced oropharyngeal cancer. Am J Otolaryngol. 2007;28(1):3–8.CrossRefPubMed
49.
Kvamme MK, Kristiansen IS, Lie E, Kvien TK. Identification of cutpoints for acceptable health status and important improvement in patient-reported outcomes, in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2010;37(1):26–31.CrossRefPubMed
50.
Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–709.CrossRefPubMed
51.
Gregoire V, Lefebvre JL, Licitra L, Felip E. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v184–6.CrossRefPubMed
52.
Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol. 2007;14(4):1449–57.CrossRefPubMed
53.
Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16(4):1582–7.PubMed
54.
Ramjaun A, Nassif MO, Krotneva S, Huang AR, Meguerditchian AN. Improved targeting of cancer care for older patients: A systematic review of the utility of comprehensive geriatric assessment. J Geriatr Oncol. 2013;4(3):271–81.CrossRefPubMed
55.
Seling A, Lindenfelser G. Ileus caused by pessary. Zentralbl Chir. 1969;94(27):913–6.PubMed
56.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.CrossRefPubMed
57.
Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17(3):1008–19.PubMed
58.
Devlin NJ, Krabbe PF. The development of new research methods for the valuation of EQ-5D-5L. Eur J Health Econ. 2013;14 Suppl 1:S1–3.CrossRefPubMed
59.
Pasetto LM, Falci C, Compostella A, Sinigaglia G, Rossi E, Monfardini S. Quality of life in elderly cancer patients. Eur J Cancer. 2007;43(10):1508–13.CrossRefPubMed
60.
Kimman ML, Dirksen CD, Lambin P, Boersma LJ. Responsiveness of the EQ-5D in breast cancer patients in their first year after treatment. Health Qual Life Outcomes. 2009;7:11.PubMedCentralCrossRefPubMed
61.
Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Factors that influence treatment decision in older patients with resectable head and neck cancer. Laryngoscope. 2007;117(5):835–40.CrossRefPubMed
62.
Overgaard J. Chemoradiotherapy of head and neck cancer--can the bumble bee fly? Radiother Oncol. 2009;92(1):1–3.CrossRefPubMed
63.
Brugel L, Laurent M, Caillet P, Radenne A, Durand-Zaleski I, Martin M, et al. Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer. 2014;14:427.PubMedCentralCrossRefPubMed
64.
Goon PK, Stanley MA, Ebmeyer J, Steinstrasser L, Upile T, Jerjes W, et al. HPV & head and neck cancer: a descriptive update. Head Neck Oncol. 2009;1(36):36.PubMedCentralCrossRefPubMed
Metadata
Title
G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy
Authors
Lies Pottel
Michelle Lycke
Tom Boterberg
Hans Pottel
Laurence Goethals
Fréderic Duprez
Sylvie Rottey
Yolande Lievens
Nele Van Den Noortgate
Kurt Geldhof
Véronique Buyse
Khalil Kargar-Samani
Véronique Ghekiere
Philip R. Debruyne
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1800-1

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