Table 2.

Prospective studies reporting health-reported quality of life in elderly patients ^a .

Author	Year	n	Location	Handling of age a	H&N subsite	Treatment	Instruments	Study design	Global QoL findings	Other HRQL findings
Global QoL favoring older
Berg et al. (60)	2021	311	Sweden	<70 vs ≥70 years; <80 vs ≥80 years	OCC, 31% OPC, 35% LC, 17% Other, 27%	Sx, 15% Sx + aRT/CRT, 22% RT, 19% RT/CRT, 44%	QLQ-C30 QLQ-H&N35 QLQ-ELD14	Prospective: pretreatment, 3m, 6m, 12m post Rx	Global QoL favored elderly at 3 months only: ≥70 (<70 vs ≥70: 52 vs 61, p=0.006); and ≥80 (<80 vs ≥80: 54 vs 67, p=0.024)	Most HRQL scores similar or better in older patients, with exception of PF; older patients less appetite loss and FD; oldest (≥80 years) worse fatigue, RF and feeling ill at 12months
Citak and Tulek (61)	2013	54	Turkey	<60 vs ≥60 years	LC, 67% OCC, 19% Pharynx, 15%	All received RT Sx, 69% Any RT, 63% Any CRT, 38%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, end of RT, 1m and 3m post RT; factors analysed at end of RT;	Global QoL better in older (53 vs 41, p=0.021)	Only senses problems (25 v 47, p=0.011) and weight loss (59 v 87, p=0.017) SS and worse in younger patients; remainder not SS
Global QoL favoring younger
Aoki et al. (62)	2019	172	Japan	<75 vs ≥75 years	OCC, 100%	Sx, 100% aRT/CRT, 10%	FACT-H&N	Prospective: pretreatment, 1, 3 and 6 months post Rx	Global score similar at start but younger better at 6 months posttreatment in favour of younger (106 vs 97)	SWB and HNC additional concerns worse at 6m in elderly group; non-elderly group showed improvement at 6m in PWB, EWB and FWB, while the elderly group did not
Age associated with other HRQL domain scores other than global QoL
De Graeff et al. (63)	2000	107	The Netherlands	<60 vs ≥60 years	OCC, 46% OPC, 6% HPC, 3% LC, 43% Other, 2%	Sx alone, 27% RT, 45% Sx + aRT, 28%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 6, 12, 24, 36m post Rx	Global QoL not SS (absolute values not reported)	PF worse in older SS (absolute difference not reported); remaining items/scales not SS
De Graeff et al. (64)	2000	153	The Netherlands	<60 vs ≥60 years	4 groups based on site and treatment	LC, RT, 44% OCC/OPC, Sx, 22% OCC/OPC, Sx + aRT, 26% HPC/LC, Sx + aRT - 7%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 6m and 12m post Rx;	Global QoL not SS	Older patients’ worse fatigue, PF, social eating and speech; remainder NS
Derks et al. (65)	2004	183	The Netherlands	45-60 vs ≥75 years	OCC, 48% Pharynx, 37% LC, 15%	Sx, 23% Sx ± adj RT, 48% RT, 16% CRT, 11%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, and 3m, 6m and 12m post Rx	Global QoL similar at all time points;	PF better* in younger at baseline (78 v 69), 3m (65 v 57), 6m (72 vs 62), not SS at 12m (70 vs 62); Pain worse in younger (37 vs 17) only at 6m post; remainder NS or trivial differences
Dziegielewski et al. (66)	2013	81	USA	<55 vs ≥55 years	OPC	All TORS aRT/CRT, 87%	HNCI	Prospective: pretreatment, and 3w, 3m, 6m and 12m post Sx	Global QoL NS (81 v 70, p=0.11)	No difference in other functional outcomes; younger patients reported lower attitude (satisfaction) on speech (71 vs 88) and aesthetic (73 v 91)
Funk et al. (67)	2012	337	USA	≤58 vs ≥59 years		Mixed subsite; Mixed Rx	SF-36 HNCI	Prospective, multiple time points; baseline at pretreatment; current study reports at 5 years;	Age not SS (72.0 vs 76.0, NS)	Older age SS better aesthetics, social disruption, mental health and depressive symptoms but worse physical health
Hammerlid et al. (68) and Bjordal et al. (69)	2001	357	Norway Sweden	<65 vs ≥65 years	OCC, 38% LC, 24% OPC, 10% HPC, 8% Other, 20%	–	QLQ-C30 QLQ-H&N35	Prospective: pretreatment to 12m	Global QoL not SS at baseline (68 v 70) or change from baseline to 12m (3 v 1)	At baseline: Older tended to report worse scores, but only significant for PF, constipation, dyspnoea and coughing; Older patients better EF 12m post: Older higher sexuality and sticky saliva problems; Older better RF, EF, but reported Change from baseline to 12m Older better RF and smaller increase in dry mouth scale; Older larger changes in senses (16 v 10), sexuality (17 v 4) and nutritional supplements (10 v 5)
Hammerlid et al. (68)	2001	232	Sweden	<65 vs ≥65 years	OCC, 32% Pharynx, 28% LC, 29% Other, 22%	Sx alone, 5% Sx + aRT, 25% Sx + aCRT, 9% CRT, 31% RT, 30%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 6 times in year 1, then year 3	Global QoL not SS (76 vs 79)	Older reported worse mucous production, more problems with sexuality and feeling ill; but less financial difficulties and better EF and less insomnia; SS in PF favoring younger (89 vs 81)
Reeve et al. (70)	2016	587	USA	<50 vs 50-64 vs 65-74 vs ≥75 years	OCC, 53% LC, 38% Pharynx, 10%	Sx, 57% RT, 77% Chemo, 41%	FACT-H&N	Prospective: (baseline = mean 3m post diagnosis, + 2 other time points	Total FACT-H&N not reported	Older patients reported better PWB, EWB, FWB and fewer symptoms than younger patients but not SWB
Rettig et al. (71)	2016	1653	USA	<67 vs 68-72 vs 73-77 vs >78 years	LC, 38% OCC, 23% OPC, 18% Lip 12% HPC, 4% Other, 5%	RT, 59%	Combined SF-36 PCS/MCS score or Veterans RAND	Prospective, baseline within 5 years of diagnosis and follow up with 10y posttreatment	–	Composite PCS/MCS estimated differences: UVA (p<0.001); Ref group <67 68-72: 3.9 (1.5,6.3) 73-77: 2.6 (-.1,5.1) >78: -2.0 (-4.6,0.5) MVA: (p=0.01) Ref group <67 68-72: 1.9 (-0.1,3.9) 73-77: 1.0 (-1.0,3.0) >78: -1.3(-3.4,0.9)
Van Der Schroeff et al. (72)	2006	59	The Netherlands	45-60 vs ≥70 years	OCC,51% Pharynx, 30% LC, 19%	Mixed site; mixed Rx	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 12m, 3-6y	Global QoL NS at all time points	Older group worse PF at 12m (81 v 66) and 3-6y (81 vs 67); older group worse symptoms on QLQ-H&N35, including social eating at 12m, swallowing at 12m and 3-6y and speech 12m and 3-6y
Age not associated with any HRQL domain scores
Bozec et al. (73)	2008	65	France	<70 vs ≥70 years	Mixed subsite (61/65 SCC) OCC, 87% HPC, 11% PNS, 2%	All Sx with microvascular reconstruction; Preop RT 20% aRT 65%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 6m, 12m; analysis of factors limited to 6m post	Global QoL at 6m similar (63 vs 67; p=0.74)	No differences in functioning scales or other domains
Bozec et al. (74)	2018	60	France	<70 vs ≥70 years	Primary or recurrent OPC SCC	All Sx and RFFF aRT, 41% aCRT, 35%	QLQ-C30 QLQ-H&N35 (included other PROMs)	Prospective: pretreatment and ≥12m post Rx; analysis of factors after treatment	Global QoL not SS (absolute values not reported; p=0.43)	No differences in functioning scales or other domains
Bozec et al. (75)	2019	200	France	<65 v >65 years	OCC, 41% OPC, 20% HPC, 10% LC, 28%	All Sx; aRT, 21% aCRT, 24%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment and 6m post Rx; analysis of factors after treatment	Global QoL not SS (absolute values not reported; p=0.89)	No differences in functioning scales or other domains
Derks et al. (76)	2003	129	The Netherlands	45-60 vs ≥75 years	OCC, 64% OPC/HPC, 27% LC, 9%	All Sx aRT, 69%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment and then 2-3 months, adj RT completed at beginning of RT	Global QoL not SS	No other domains different either at baseline or in changes from baseline
Durmus et al. (77)	2014	22	USA	<55 vs >55 years	CUP	All TORS + aRT/CRT	HNCI	Prospective: pretreatment, 3w, 3m, 6m, 12m post Sx	Age NS for global QoL	Age NS for all items/scales
Segna et al. (78)	2018	30	Italy	<70 vs ≥70 years	OCC	All reconstructive microsurgery aRT, 43% aCRT 17%	SF-36/SF-12	Prospective: pretreatment and 12m post Sx	–	No differences in any domains or composite scores
Yin et al. (79)	2020	294	China	<60 vs ≥60 years	HPV OP SCC	Sx alone, 35% Sx + aRT, 20% RT, 45%	QLQ-C30 QLQ-H&N35	Prospective: pretreatment and 3-6m post Rx; factors analyzed post Rx	Age not a factor on MVA for global QoL	Age not a factor for other reported outcomes
Yoshimura et al. (80)	2009	56	Japan	≤65 vs >65 years	OCC	OCC treated with LDR-BT	QLQ-C30 QLQ-H&N35	Prospective: pretreatment, 3m, 6m and 12m post LDR-BT	Age NS for global QoL	Age NS for any outcome

aRT/CRT, adjuvant radiotherapy/chemoradiotherapy; CRT, chemoradiotherapy; EF, emotional functioning; EWB, emotional wellbeing FACT-HN, Functional Assessment of Cancer Therapy-Head &Neck; FWB, functional wellbeing; H&N, head and neck; HNC, head neck cancer; HNCI, Head Neck Cancer Inventory; HRQL, health-related quality of life; HPC, hypopharyngeal cancer; LC, laryngeal cancer; MCS, Mental Component Summary; MVA, multivariate/variable analysis; NS, not statistically significant; OC, oral cavity; OPC, oropharyngeal cancer; PCS, Physical Component Summary; PF, physical functioning; PWB, physical wellbeing; QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; QLQ-ELD14, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Elderly Cancer Patients module; QLQ-H&N35, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck module; QOL, quality of life; RF, Role functioning; RT, radiotherapy; Rx, treatment; SF-12, Short Form-12 Health Survey; SF-36, Short Form-36 health survey; SS, statistically significant; SWB, social wellbeing; Sx, surgery; UVA, univariate/variable analysis.

^aDefinition of elderly and age groups based on categorizations used in the analysis of Global QoL scores.