Table 3.
Cross-sectional studies reporting health-reported quality of life in elderly HNSCC cohorts. .
| Author | Year | n | Location | Handling of age | H&N subsite | Treatment | Instrument | Study design | Global QoL findings | Other findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Alicikus et al. (81) | 2008 | 110 | Turkey | ≤60 vs >60 years | LC, 58% NPC, 18% OC/OPC, 14% Other, 6% |
All received RT/CRT RT, 42% CRT, 13% aRT, 43% aCRT, 2% |
QLQ-C30 QLQ-H&N35 |
Cross-sectional (median 29m, range 4-155m) | Global QoL not SS (69 v 70) | PF, RF, SF, CF not different (EF not reported); younger patients reported more problems with teeth (44 vs 18) and opening mouth (30 v 15); |
| Baxi et al. (82) | 2018 | 185 | USA | <65 vs ≥65 years | All HPV+ OPC | All received RT/CRT definitive, 86% Adjuvant, 14% |
EQ-5D, QLQ-H&N35 | Cross-sectional (>12 months from RT) | Global QoL (EQ-5D VAS) similar (86 vs 81; p=0.20) | Older patients worse mobility (EQ-5D), remainder of EQ-5D similar; worse social eating (ED 11.1, p<0.0001) and coughing (ED 11.7, p=0.009) |
| Bonzanini et al. (83) | 2020 | 90 | Brazil | <62 vs ≥62 years | OCC/OPC, 60% LC, 34% HPC, 6% |
All received RT Sx + aRT, 19% Sx + aCRT, 40% RT, 7% CRT, 34% |
UW-QoL | Cross-sectional | Mean scores 60 vs 74; age SS on MVA | Younger patients reported worse pain (64 v 81), appearance (70 vs 81), swallowing (56 v 75), chewing (55 v 70), shoulder problems (56 v 84), saliva (43 v 59) |
| Bozec et al. (84) | 2020 | 64 | France | <80 vs >80 years (inc ≥70 years) | All OC/OPC | All free flap reconstruction Sx alone, 22% aRT, 61% aCRT, 17% |
QLQ-C30 QLQ-H&N35 QLQ-ELD14 |
Cross-sectional (>12 months after Sx) | Global QoL not SS (value NR) | Mobility score on QLQ-ELD14 favouring younger 16.7 vs 22.0, p=0.004); remainder not SS |
| Dwivedi et al. (85) | 2012 | 55 | United Kingdom | <60 vs ≥60 years | OCC and OPC | All Primary Sx Sx alone, 11% Sx + aRT, 49% Sx + aCRT, 40% |
UW-QoL | Cross-sectional | – | Mean composite score of 12 domains used - younger worse (70 vs 80, p=0.01); |
| Infante-Cossio et al. (86) | 2009 | 128 | Spain | <65 vs >65 years | OCC, 55% OPC, 45% |
NR | QLQ-C30 QLQ-H&N35 |
Collected at time of diagnosis | Age not SS for global QoL (median 83.3 vs 83.3, p=NS) | PF, CF, fatigue, pain worse in older patients (all p<0.05, based on median scores, all scores <10 except for fatigue) |
| Laraway (87) | 2012 | 638 | United Kingdom | <55 vs 55-64 vs 65-74 vs ≥75 years | All OCC | Sx, 99% Sx + aRT/CRT, 32% CRT/RT, 1% |
UW-QoL | Cross-sectional; “closest to 1 year after surgery” | Patients ≥65 reported better overall QoL (proportion reporting good or better, p<0.001) | Many domains favored the older age groups in both the physical and socioemotional domains |
| Morimata et al. (88) | 2013 | 100 | Japan | 65 vs >65 years | Maxillectomy, 50% Mandibulectomy, 50% | Maxillectomy, 54% aRT Mandibulectomy, 32% aRT |
UW-QoL (v4.0) | Cross-sectional | Age not SS for global QoL in either maxillectomy (p=0.80) or mandibulectomy population (p=0.54) |
Maxillectomy:
younger patients more anxious (p=0.01) Mandibulectomy: younger patients better swallowing (p=0.01), saliva (p=0.04) and mood (p=0.03) |
| Pierre et al. (89) | 2014 | 80 | France | <70 vs >70 years | OCC, 46% OPC, 54% |
All Surgical patients with microvascular reconstruction aRT, 69% naRT, 11% |
QLQ-C30 QLQ-H&N35 |
Cross-sectional | Age NS for global QoL | Age NS for all items/scales |
| Pourel et al. (90) | 2002 | 113 | France | ≤62 vs >62 years | All OPC | Sx + RT, 23% BT + RT, 43% RT, 33% |
QLQ-C30 QLQ-H&N35 |
Cross-sectional (≥2y post RT) | Global QoL not SS (66 vs 64, p=0.70) | Other functional scales, fatigue did not differ; pain worse in younger (32 vs 21, p=0.03) |
| Silvieri et al. (91) | 2011 | 289 | Portugal | 40-60 vs ≥65 years |
Younger:
LC, 31% OC, 16% OPC, 11% Older: LC, 30% OC, 13% OPC, 3% |
Younger:
Sx, 71% RT, 8% CT, 10% CRT, 11% Older: Sx, 79% RT, 14% CT, 2% CRT, 5% |
QLQ-C30 QLQ-H&N35 |
Cross-sectional (3-9m post Rx) | Global QoL similar across all groups when analyzed by gender | Some small-sized differences reported (i.e. younger males less constipation, worse financial difficulties; older females worse PF (medium-sized), remainder differences small-sized Few significant differences in QLQ-H&N35 in young vs older males, except for higher sexuality problems in older males (26 vs 39); for females, only speech problems were clinically significant and borderline SS in younger (35 v 18) |
| Verma et al. (92) | 2019 | 58 | USA | <65 vs ≥65 years | HNSCC, further details NR | Definitive RT/CRT, 50% Sx + aRT/naRT, 50% CT, 72% |
QLQ-C30, Dental health, shoulder function | Cross-sectional | Global QoL NS | Older patients’ better RF (95 vs 76), EF (89 vs 79) and lower pain (4 vs 29), insomnia (8 vs 36) an financial problems (8 vs 38) |
| Wells et al. (93) | 2015 | 289 | United Kingdom | <45 vs 45-54 vs 55-64 vs 65-74 vs ≥75 years | OCC, 34% OPC, 20% LC, 33% Other, 13% |
Sx alone, 26% Sx + aRT, 11% Sx + CT, 1% Sx + aCRT, 23% RT, 17% CRT, 18% |
QLACS | Cross-sectional (≥3m but <5y post Rx) |
Generic QoL:
younger not SS (83.8 vs 82.9 vs 79.8 vs 70.0 vs 73.3, p=0.118); higher score = worse) Cancer-specific QoL: younger worse (43.8 vs 46.8 vs 40.5 vs 34.1 vs 31.5, p<0.001) (higher score = worse) |
– |
| Williamson et al. (94) | 2011 | 41 | USA | <70 vs ≥ 70 years | All LC | Sx + aRT/CRT, 27% RT, 63% CRT, 10% |
UW-QoL | Cross-sectional | Age NS for overall QoL (even when ≥75 was compared) | Age NS for other items/scales |
| Woodard et al. (95) | 2007 | 33 | USA | ≤65 vs >65 years | All LC/HPC | Laryngectomy, 100% ± adj and previous RT/CRT |
HNCI | Cross-sectional (mean 37m) | Older SS better global QoL 75 vs 54) | Older SS better in all 4 domains (speech, eating, social disruption, aesthetic) |
aRT/CRT, adjuvant radiotherapy/chemoradiotherapy; CF, cognitive functioning CRT, chemoradiotherapy; ED, estimated difference; EF, emotional functioning; EQ-5D, EuroQoL 5-Dimension; H&N, head and neck; HNCI, Head Neck Cancer Inventory; HPC, hypopharyngeal cancer; LC, laryngeal cancer; MVA, multi- variate/variable analysis; NR, not recorded; OC, oral cavity; OPC, oropharyngeal cancer; QLACS, Quality of Life of Adult Cancer Survivors; 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-Head and Neck module; QoL, Quality of life; PF, physical functioning; RF, Role functioning; RT, radiotherapy; SF, Social functioning; SS, statistically significant; Sx, surgery; UW-QoL, University of Washington Quality of Life instrument.