Quality of life for the elderly head and neck cancer patient: a systematic review

Background:
With the extension in life expectancy, elderly people represents the fastest growing cancer population, especially in Western society. In line with global projections, the demographics of head and neck cancer is also marked by a growing number of older people. Consequently, this poses unique treatment and supportive care challenges for the head and neck cancer team. Management of this subgroup of patients has become a source of much debate, heightened by the paucity of clinical studies recruiting elderly patients, therefore a high-level evidence-base consensus to guide clinical decision making is lacking. Head and neck cancer and its treatment, which is often aggressive, can have a significant impact on quality of life; therefore, should be given careful consideration by care providers.

Aim: The purpose of this systematic review is to identify the impact on quality of life when managing the elderly head and neck cancer patient.

Methods: The following MeSh terms and keyword searches were applied to three electronic databases (OVID Medline, CINHAL and PsycINFO) in September 2019: ‘head and neck neoplasms’, ‘aging’, ‘elderly person’ and ‘quality of life’. All published articles between August 2009 and August 2019 were searched and findings summarised.

Results: There is a growing body of evidence that standard treatment for elderly head and neck cancer treatment confer with similar impact on quality of life, as for younger patients. Such patients can employ effective coping strategies and maintain quality of life, comparable with their younger counterparts. However, worse survival rates have been noted due to higher comorbidity status and competing causes of mortality, resulting in older patients having standard therapy less often than younger patients.

Aging is a highly indiviudalised process, and a patient’s chronological age does not necessarily reflect physiological age. Age should not merely be a marker for treatment choice, as outcomes in head and neck cancer are much more complex. Other factors that appear to have relevance in this elderly population include desires and motivation of the patient, support available to include marital status, personal opinions about length of life and quality of life, and prevalence of symptoms such as pain. It is imperative that the head and neck team ensure elderly patients are comprehensively assessed, treatment options discussed with potential effects on their quantity and quality of life and patient preferences considered. In this way, carefully planned and appropriately delivered person-centred care for the elderly patient can result in therapeutic benefits while maintaining an acceptable quality of life.

Conclusion: Elderly patients are an extremely heterogeneous group, hence, identifying the right treatment for an elderly patient remains a complex clinical challenge. One of the main conclusions of this review, is that the majority of treatment strategies and supportive care interventions have not been rigorously studied in this patient population. Clinical studies and patient-orientated research is keenly required, to include impact on quality of life, to better serve this growing population of elderly patients.