Patient-related prognostic factors in older adults with head and neck cancer: The EGeSOR clinical trial.

BACKGROUND: Due to its anatomic site, the treatment of head and neck cancer (HNC) significantly affects activities of daily living. Clinical heterogeneity and accelerated aging in older adults make it crucial to identify patient-related, prognostic factors. The objective of the present study was to assess the prognostic value of patient-related factors for 2-year overall survival (OS) in older adults with HNC, after adjustment for tumor-related factors. METHODS: This was a secondary analysis of the EGeSOR randomized, controlled trial conducted in France between 2013 and 2018. Patients with HNC aged 65 or over and who were candidates for either curative or palliative treatment were randomized to receive a geriatric assessment with result-driven interventions and follow-up (the intervention group) or the standard of care (the control group) and followed up for 24 months. The primary outcome was two-year OS. RESULTS: 475 patients were included. There was no intergroup difference in the 2-year OS rate (hazard ratio (HR) [95 %CI] = 0.82 [0.60;1.12], p = 0.208). In two multivariable models, female sex was a protective factor against all-cause death (p = 0.008 and p = 0.003). Older age (p < 0.001) and the number of comorbidities were associated with poor 2-year OS. The frailty risk (G8 score) was not associated with 2-year OS. When considering the geriatric assessment variables, low autonomy (an instrumental activities of daily living score <8), poor mobility (a one-leg standing test result <5 s), nutritional status (an abnormal Mini Nutritional Assessment score) and cognitive status (a Mini Mental State Examination score <24) were associated with poor 2-year OS. CONCLUSION: The study's results highlighted several patient-related, prognostic factors. Chronological age and tumor-related variables should not be the only factors taken into account when making treatment decisions.