Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiotherapy

Abstract Purpose This study aimed to identify the vulnerable head and neck cancer patients undergoing concurrent chemoradiotherapy (CCRT) who are susceptible to higher treatment related adverse effects and poorer treatment tolerance, and to determine if the comprehensive geriatric assessment (CGA), developed in the geriatric population, could predict vulnerability to treatment related adverse events and survival, even in non-geriatric head and neck cancer patients, as well as the vulnerability prevalence and its effect on toxicities and survival among these patients. Methods This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016–2017 at 3 medical centers across Taiwan. Vulnerability is defined as the susceptibility to cancer- and treatment-related adverse events that result in poor treatment tolerance and unexpected emergent medical needs such as hospitalization and emergency room visits. It was assessed as impairment with ≥2 dimensions on comprehensive geriatric assessment, 7 days before CCRT. The association of vulnerability with treatment-related adverse events and survival were analyzed. Results The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20–34, 35–49, 50–64, and >65 years, respectively. Survival was poorer in vulnerable patients than in non-vulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26–3.07; p=0.003). Vulnerable patients showed a higher tendency of CCRT incompletion (19.5% vs. 6.1%, p Conclusion Vulnerability, an urgent need to be concerned with presentation among head and neck cancer patients, was independently associated with poorer survival and severe treatment-related complications. Vulnerability assessment should be routinely evaluated in all patients with primary head and neck cancer who are undergoing definitive CCRT, and not only in such patients who are geriatric.