Elderly Patients with H&N Cancer: To Operate or to Not? Part 1 - Mucosal Malignancies

PROGRAM DESCRIPTION: As the average age of individuals across the world continues to rise, the elderly represent an increasing proportion of patients with head and neck cancer. Comorbid conditions, restricted life expectancy, and other factors must be carefully considered when exploring treatment options for these patients, including traditional modalities of therapy (surgery, radiation, and systemic therapy) and palliative options. However, these patients also pose unique challenges when undergoing treatment, as elderly patients are more likely to experience complications and treatment interruptions. In this seminar, we will provide a two-part tumor board discussion that will cover the full spectrum of making complex decisions regarding treatment options among elderly head and neck cancer patients. The tumor board discussion will provide a rich foundation of patient cases, with discussion and debate by widely renowned panelists. Part 1 of the tumor board discussion will primarily cover mucosal malignancies, including a discussion of surgical approaches that can be offered without significantly affecting functional status, as well as when it is appropriate to offer non-surgical approaches or palliative care. Part 2 of the tumor board will cover cutaneous malignancies, with discussions ranging on the management of elderly immunosuppressed patients to reconstructive approaches for large cutaneous defects. Patient indices other than age, which can be helpful in the medical decision-making process, will also be discussed, along with palliative care and the surgeon’s role in facilitating palliation. Audience participation and feedback via live, interactive polling, throughout the cases will be integrated to help shed further insight into practice patterns, audience preferences, and changes in opinion as the seminar progresses. Given the challenges posed by this unique set of patients, this topic should be of value to otolaryngologists across diverse practice settings.

OUTCOME OBJECTIVE 1: Incorporate measures other than age (e.g. frailty) in the treatment selection process.

OUTCOME OBJECTIVE 2: Define the role of the head and neck cancer surgeon in end-of-life discussions and palliative care.

OUTCOME OBJECTIVE 3: Identify and manage decision-making quandaries in this challenging patient cohort.

BACKGROUND STATEMENT: We presented this topic for several years with good feedback and good attendance/ratings. The topic is of wide spread and increasing interest, especially in the era of immunotherapy as a palliative option with some efficacy. The proposal is supported by the micro and geriatric committees.

Comprehensive Otolaryngology Track Statement :