Patient-centered care has become increasingly important with providers focusing on collaborating with patients and their families to provide care that respects the patient’s values and preferences. To successfully provide patient-centered care, it is critical to understand patients’ health-related priorities and goals. Previous studies have examined the priorities of head and neck cancer patients; however, elderly head and neck cancer patients are a uniquely vulnerable population, and little is known about their health-related priorities.
Methods: Following Institutional Review Board approval, a cross-sectional study was conducted to examine the priorities of elderly head and neck cancer patients. Patients who presented in 2019 and 2020 and were at least 75 years of age at first diagnosis of head and neck cancer were considered for the study. Patients who were newly diagnosed and not yet treated (pre-treatment group) or patients who were more than 1-year post-diagnosis (post-treatment group) were included in the study. Clinicopathologic data were collected. A comprehensive geriatric assessment was conducted on each patient including a depression screen (PHQ8), a dementia screen (Mini-Cog), walk speed (time to walk 15 feet), frailty (Fried’s), quality of life (FACT-H&N v4), social support (MOS SS), and functional status (ADLs, IADLs). The primary outcome was the Chicago Priority Scale which consists of ranking 12 health-related priorities relevant to head and neck cancer patients.
Results: A total of 32 patients met inclusion criteria, 13 in the pre-treatment group and 19 in the post-treatment group. Median age was 82 years. The cohort included 17 males and 15 females. There were 18 primary mucosal malignancies and 12 salivary or cutaneous malignancies, and there were 13 patients who presented with early-stage disease and 18 patients with advanced-stage disease. In the geriatric assessment, there was no difference between pre-treatment and post-treatment groups. Cure was the highest ranked priority for both pre-treatment and post-treatment groups and was ranked significantly higher than any other priority (p<0.001). Longevity was the next highest priority. There were no significant differences in priorities between pre-treatment and post-treatment groups. Among post-treatment patients, both swallowing and taste/smell were ranked significantly higher priorities for patients treated non-surgically compared to patients treated with surgery alone (p<0.001 and p<0.001). Conversely, appearance was ranked significantly higher priority for patients who were treated surgically compared to patients treated non-surgically (p<0.001).
Conclusions: Cure is the most important health-related priority among elderly head and neck cancer patients. Overall, priorities did not differ significantly between pre-treatment and post-treatment groups. The majority of clinicopathologic and geriatric variables did not reliably predict patient priorities. This emphasizes the importance of good communication with patients and their families to determine what is uniquely important to each individual patient.