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. 2015 Nov 9:15:875.
doi: 10.1186/s12885-015-1800-1.

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

Lies Pottel  1 , Michelle Lycke  2 , Tom Boterberg  3 , Hans Pottel  4 , Laurence Goethals  5 , Fréderic Duprez  6 , Sylvie Rottey  7 , Yolande Lievens  8 , Nele Van Den Noortgate  9 , Kurt Geldhof  10 , Véronique Buyse  11 , Khalil Kargar-Samani  12 , Véronique Ghekiere  13 , Philip R Debruyne  14   15
Affiliations

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

Lies Pottel et al. BMC Cancer. .

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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Figures

Fig. 1
Fig. 1
Patient flowchart. Abbreviations: W, week; CVA, cerebrovascular accident
Fig. 2
Fig. 2
Evolution of health-related quality of life, assessed by EQ-5D, from treatment start to 36 months of follow-up. a-b Data presented as boxplots, graphically displaying median, inter-quartile range and minimum and maximum data values. c Data presented as mean ± standard deviation. a Evolution of HRQOL, assessed by EQ-5D, in ‘fit’ older HNCA patients, as defined by G-8. b Evolution of HRQOL, assessed by EQ-5D, in ‘vulnerable’ older HNCA patients, as defined by G-8. c Evolution of HRQOL, assessed by EQ-5D, in ‘fit’ and ‘vulnerable’ older patients
Fig. 3
Fig. 3
Overall survival, represented by Kaplan-Meier curves, of the ‘fit’ and ‘vulnerable’ older HNCA patient. a Overall survival of patients classified as ‘fit’ or ‘vulnerable’, by G-8. b Overall survival of patients classified as ‘fit’ or ‘vulnerable’, by CGA. Log-rank test was applied to measure the difference between the curves
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