Clinical characteristics,treatment intent,and outcome in a consecutive 10-year cohort of oral cancer patients aged 75 years and older |
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| Authors: | CY. Chieng A. Davies D. Lowe F. Bekiroglu O. Khattak A. Schache R. Shaw S.N. Rogers |
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| Affiliation: | 1. Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK;2. Astraglobe Ltd, Congleton, Cheshire;3. Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road;1. The Welsh Centre for Cleft Lip & Palate, Morriston Hospital Swansea, UK;2. Swansea Bay Health Board;3. Cleft Care Scotland, Royal Hospital for Children, Glasgow;1. Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom;2. University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom;3. Health Education England (West Midlands), 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, United Kingdom;4. NHS Education for Scotland, Westport 102, West Port, Edinburgh, EH3 9DN, United Kingdom;5. Health Education England (South West), Park House, Newbrick Rd, Stoke Gifford, Bristol BS34 8YU, United Kingdom;6. Health Education England (East Midlands), Westbridge Place, 1 Westbridge Close, Leicester, LE3 5DR, United Kingdom;7. Health Education England (South London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom;8. Health Education England (North West), 3 Piccadilly Place, Manchester, M1 3BN, United Kingdom;9. Health Education England (North Central and East London, North West London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom;10. Health Education England (Thames Valley), Chancellor Court, John Smith Drive, Oxford Business Park, Oxford, OX4 2GX, United Kingdom;11. Health Education England (Kent, Surrey & Sussex), 7 Bermondsey Street, London, SE1 2DD, United Kingdom;1. Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona;2. Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona;3. Department of Surgical and Special Odontostomatology, Umberto I General Hospital, Ancona;4. Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Ancona;1. King’s College Hospital NHS Foundation Trust;2. University College London Division of Surgery and Interventional Science, Division of Surgery and Interventional Science;3. University College London Hospital Foundation Trust;4. Royal Free NHS Foundation Trust;5. University College London Hospitals NHS Foundation Trust, Department of Anaesthesia and Preoperative Medicine;6. University Hospital Southampton NHS Foundation Trust;7. University College London Hospitals NHS Foundation Trust;1. Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany;2. Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait;3. Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany;4. Carinthia University of Applied Sciences, Europastrasse 4, 9524 Villach, Austria |
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| Abstract: | The prevalence of oral squamous cell carcinoma (OSCC) in the elderly is expected to increase by nearly a third in the next decade. Its management in older patients is potentially more challenging due to their pre-existing medical comorbidities, frailty, reduced life expectancy, and social issues. The aim of this retrospective review was to report on treatment given to patients aged 75 years and over, case mix, and survival. All patients aged 75 years and over who were diagnosed with OSCC in Merseyside between 1 January 2007 and 31 December 2016, and treated with either curative or palliative intent, were included. Their hospital notes were reviewed. Fisher’s exact test and Kaplan-Meier analysis were used for data analysis. There were 236 patients (median (IQR) age 81 (78-86) years); 67% were treated curatively and 33% palliatively. Factors associated with palliation included older age, advanced tumour stage, cognitive impairment, and residence in a nursing or residential home. Of the 165 patients who were offered curative treatment, six (4%) declined due to personal or family reasons. Overall survival for palliative patients was 12% at one year and 7% at two years, whereas for patients treated curatively it was 74% at one year, 56% at two years, and 34% at five years. Patients over 85 years of age were less likely to have composite free flaps and postoperative radiotherapy. Perioperative mortality was 2.6%. Improvements in surgical techniques and perioperative management have enabled clinicians to offer treatment with curative intent to older frail patients, and with careful case selection outcomes can be very good. |
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| Keywords: | Oral cancer elderly curative palliative survival |
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