Disease Characteristics, Treatment Tolerance, and Toxicity in Older Patients (≥ 65 y) With Oropharyngeal Cancer and Implications on Outcomes

Abstract Objective: To assess and compare tolerability for standard-of-care treatments and evaluate outcomes in older and younger patients with oropharyngeal cancer (OPC). Methods and Materials: We queried our institutional database for nonmetastatic OPC treated curatively between January 2009 and June 2020, with radiation therapy ± systemic therapy, or surgery ± adjuvant radiation therapy ± systemic therapy. We compared clinicopathological, treatment-related, and therapeutic toxicity features, and survival outcomes between older (≥ 65 y at diagnosis) and younger (< 65 y at diagnosis) patients across human papilloma virus (HPV) subtypes. Multivariate analyses for predictors of survival in all patients were performed. Results: In this retrospective study, we evaluated 340 patients with OPC: 123 (36%) older and 217 (64%) younger. There were 252 patients (74%) with HPV+ve OPC. The HPV+ve older patients showed an increasing trend over the years studied. Definitive radiation therapy ± systemic therapy was utilized in 73.2%, while the remainder had surgery ± adjuvant radiation therapy ± systemic therapy. After a median follow-up of 5.24 (interquartile range: 3.53) years, no significant differences in treatment received, overall, disease-free, locoregional recurrence-free, or distant metastasis-free survival were seen between age groups, regardless of HPV status. Significantly larger proportions of older patients received cetuximab (25.8% vs 11.9%; P < .001), required hospitalization (46.6% vs 26.9%; P < .001), required feeding tubes (63.6% vs 49.5%; P = .02), and were switched to a less-toxic systemic therapy protocol (18.3% vs 7.7%; P = .019). For all patients, factors such as radiation therapy course completion, radiation therapy delays, unplanned hospitalizations, and feeding tubes never removed were independently associated with various survival endpoints. Conclusion: While survival outcomes were equivalent between older and younger patients with OPC, older patients exhibited lower tolerance and higher toxicity from systemic therapy, suggesting a need for enhanced multidisciplinary supportive care including geriatric assessment, for older patients receiving concomittant radiation and systemic therapy.