Surviving Elderly Patients with Head-and-Neck Squamous Cell Carcinoma-What Is the Long-Term Quality of Life after Curative Radiotherapy?

Simple Summary As the long-term effects of radiotherapy on the quality of life (QoL) of elderly (>= 65 years) patients with head-and-neck squamous cell carcinoma (HNSCC) are not well understood, we examined the QoL of surviving elderly HNSCC patients who were treated with radiotherapy. In this cross-sectional study, long-term quality of life (QoL) at >= 1 year after radiotherapy completion was comparable to the general German population of the same age and gender. Patients whose HNSCC was induced by human papillomavirus (HPV) exhibited a superior long-term global QoL than elderly patients with HPV-negative tumors. Interestingly, concomitant chemotherapy administration did not deteriorate patients' global QoL in the long-term. We did not observe differences in patients' health-related QoL in dependence of the treatment (definitive versus adjuvant (chemo)radiotherapy). Our data are important for clinicians treating elderly HNSCC patients as well as for elderly HNSCC patients themselves. The effects of radiotherapy on the long-term quality of life (QoL) of surviving elderly HNSCC patients are not well understood, therefore, we analyzed QoL in this population. A cross-sectional analysis was performed at a tertiary cancer center to assess long-term QoL in elderly HNSCC patients. Eligible patients were >= 65 years at the time of treatment who had to be alive for >= 1 year after radiotherapy and without current anti-cancer treatment. QoL and patient satisfaction were assessed using the EORTC QLQ-C30, QLQ-H&N35 and ZUF-8 questionnaires, respectively, and treatment-related toxicities were graded according to CTCAE (Common Terminology Criteria of Adverse Effects) v.5.0. Seventy-four patients met the inclusion criteria, of which 50 consented to participate. Median time between radiotherapy and QoL assessment was 32 months (range 12-113). The QLQ-C30 global QoL median amounted to 66.7 points (interquartile range (IQR) 50.0-83.3), which was comparable to the age- and gender-adjusted German population (median 65.3). Median global QoL was similar between patients undergoing definitive (75.0, IQR 50.0-83.3) and adjuvant (chemo)radiotherapy (66.7, IQR 41.7-83.3, p = 0.219). HPV-positive HNSCC patients had superior global QoL after radiotherapy than their HPV-negative counterparts (p < 0.05), and concomitant chemotherapy did not influence the long-term QoL (p = 0.966). Median global QoL did not correspond with physician-assessed highest-graded chronic toxicities (p = 0.640). The ZUF-8 ranged at 29 points in median (IQR 27-31), showing high patient satisfaction. Surviving elderly HNSCC patients treated by radiotherapy exhibit a relatively high long-term global QoL which is a relevant information for clinicians treating elderly HNSCC patients.

Automated summary

The study found that elderly head and neck squamous cell carcinoma patients treated with radiotherapy exhibit a relatively high long-term global quality of life comparable to the general German population. Patients with HPV-induced HNSCC showed superior long-term global quality of life compared to HPV-negative patients, and concomitant chemotherapy did not negatively impact long-term quality of life.