Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes

Anna Luíza Damaceno Araújo; Luiz Paulo Kowalski; Alvaro Sanabria; Alan Roger Santos-Silva; Andrés Coca-Pelaz; Kevin Thomas Robbins; Juan P Rodrigo; Orlando Guntinas-Lichius; Fernando López; Antti A Mäkitie; Remco de Bree; Timo Strandberg; Alessandra Rinaldo; Cesare Piazza; Robert P Takes; Nabil F Saba; Alfio Ferlito

doi:10.1002/hed.28168

Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes

Anna Luíza Damaceno Araújo^*
, Luiz Paulo Kowalski
, Alvaro Sanabria
, Alan Roger Santos-Silva
, Andrés Coca-Pelaz
, Kevin Thomas Robbins
, Juan P Rodrigo
, Orlando Guntinas-Lichius
, Fernando López
, Antti A Mäkitie
, Remco de Bree
, Timo Strandberg
, Alessandra Rinaldo
, Cesare Piazza
, Robert P Takes
, Nabil F Saba
, Alfio Ferlito

^*Corresponding author for this work

Cancer

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Understanding the relationship between age and diagnostic challenges, as well as outcomes in older patients with head and neck cancer, is crucial. The significance of age as a prognostic factor and how it should influence treatment decisions is debated, highlighting the need for tailored insights to help physicians make more informed choices.

OBJECTIVE: This scoping review aims to address the diagnostic challenges/differences and patient outcomes as infection, pain, treatment-related complications (either postmedical or postoperative), treatment toxicities, disease control, morbidity, and/or survival/mortality in older patients (above the cut-off age of 60 years) with head and neck cancer.

METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS were searched, as well as gray literature and reference lists of included articles.

RESULTS: A total of 5029 articles were retrieved and 57 studies were included, among which 5 appraised evidence on diagnostic challenges/differences, 53 addressed clinical (as postoperative complications, the impact of comorbidities in the occurrence of complications and treatment, postoperative delirium, swallowing outcomes, the correlation between age and infections, pain and opioid use, morbidity rates, treatment-related toxicities), and 26 reported survival. Evidence on diagnostic challenges and outcomes between older and younger patients is mixed, but age, comorbidities, and complications must be considered. While many studies show no significant differences in complications according to age, comorbidities often correlate with worse outcomes and are more frequent in the older group. Despite variable age cut-offs, survival rates between older and younger patients are similar.

CONCLUSION: Treatment decisions should be based on a thorough medical evaluation and patient preferences rather than chronological age alone, as age itself does not account for outcome differences.

Original language	English
Pages (from-to)	2570-2583
Number of pages	14
Journal	Head & neck
Volume	47
Issue number	9
Early online date	25 Apr 2025
DOIs	https://doi.org/10.1002/hed.28168
Publication status	Published - Sept 2025

Keywords

comorbidities
diagnosis
outcomes
survival
toxicities

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10.1002/hed.28168

Head Neck - 2025 - Araújo - Older Patients with Head and Neck Cancer A Scoping Review of Differences Regarding DiagnosisFinal published version, 483 KBLicence: Taverne

Cite this

Araújo, A. L. D., Kowalski, L. P., Sanabria, A., Santos-Silva, A. R., Coca-Pelaz, A., Robbins, K. T., Rodrigo, J. P., Guntinas-Lichius, O., López, F., Mäkitie, A. A., de Bree, R., Strandberg, T., Rinaldo, A., Piazza, C., Takes, R. P., Saba, N. F., & Ferlito, A. (2025). Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes. Head & neck, 47(9), 2570-2583. https://doi.org/10.1002/hed.28168

@article{56008498fd1d48c1a55d327e392136cd,

title = "Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes",

abstract = "BACKGROUND: Understanding the relationship between age and diagnostic challenges, as well as outcomes in older patients with head and neck cancer, is crucial. The significance of age as a prognostic factor and how it should influence treatment decisions is debated, highlighting the need for tailored insights to help physicians make more informed choices.OBJECTIVE: This scoping review aims to address the diagnostic challenges/differences and patient outcomes as infection, pain, treatment-related complications (either postmedical or postoperative), treatment toxicities, disease control, morbidity, and/or survival/mortality in older patients (above the cut-off age of 60 years) with head and neck cancer.METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS were searched, as well as gray literature and reference lists of included articles.RESULTS: A total of 5029 articles were retrieved and 57 studies were included, among which 5 appraised evidence on diagnostic challenges/differences, 53 addressed clinical (as postoperative complications, the impact of comorbidities in the occurrence of complications and treatment, postoperative delirium, swallowing outcomes, the correlation between age and infections, pain and opioid use, morbidity rates, treatment-related toxicities), and 26 reported survival. Evidence on diagnostic challenges and outcomes between older and younger patients is mixed, but age, comorbidities, and complications must be considered. While many studies show no significant differences in complications according to age, comorbidities often correlate with worse outcomes and are more frequent in the older group. Despite variable age cut-offs, survival rates between older and younger patients are similar.CONCLUSION: Treatment decisions should be based on a thorough medical evaluation and patient preferences rather than chronological age alone, as age itself does not account for outcome differences.",

keywords = "comorbidities, diagnosis, outcomes, survival, toxicities",

author = "Ara{\'u}jo, \{Anna Lu{\'i}za Damaceno\} and Kowalski, \{Luiz Paulo\} and Alvaro Sanabria and Santos-Silva, \{Alan Roger\} and Andr{\'e}s Coca-Pelaz and Robbins, \{Kevin Thomas\} and Rodrigo, \{Juan P\} and Orlando Guntinas-Lichius and Fernando L{\'o}pez and M{\"a}kitie, \{Antti A\} and \{de Bree\}, Remco and Timo Strandberg and Alessandra Rinaldo and Cesare Piazza and Takes, \{Robert P\} and Saba, \{Nabil F\} and Alfio Ferlito",

note = "Publisher Copyright: {\textcopyright} 2025 Wiley Periodicals LLC.",

year = "2025",

month = sep,

doi = "10.1002/hed.28168",

language = "English",

volume = "47",

pages = "2570--2583",

journal = "Head \& neck",

issn = "1043-3074",

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Araújo, ALD, Kowalski, LP, Sanabria, A, Santos-Silva, AR, Coca-Pelaz, A, Robbins, KT, Rodrigo, JP, Guntinas-Lichius, O, López, F, Mäkitie, AA, de Bree, R, Strandberg, T, Rinaldo, A, Piazza, C, Takes, RP, Saba, NF & Ferlito, A 2025, 'Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes', Head & neck, vol. 47, no. 9, pp. 2570-2583. https://doi.org/10.1002/hed.28168

TY - JOUR

T1 - Older Patients with Head and Neck Cancer

T2 - A Scoping Review of Differences Regarding Diagnosis and Outcomes

AU - Araújo, Anna Luíza Damaceno

AU - Kowalski, Luiz Paulo

AU - Sanabria, Alvaro

AU - Santos-Silva, Alan Roger

AU - Coca-Pelaz, Andrés

AU - Robbins, Kevin Thomas

AU - Rodrigo, Juan P

AU - Guntinas-Lichius, Orlando

AU - López, Fernando

AU - Mäkitie, Antti A

AU - de Bree, Remco

AU - Strandberg, Timo

AU - Rinaldo, Alessandra

AU - Piazza, Cesare

AU - Takes, Robert P

AU - Saba, Nabil F

AU - Ferlito, Alfio

PY - 2025/9

Y1 - 2025/9

N2 - BACKGROUND: Understanding the relationship between age and diagnostic challenges, as well as outcomes in older patients with head and neck cancer, is crucial. The significance of age as a prognostic factor and how it should influence treatment decisions is debated, highlighting the need for tailored insights to help physicians make more informed choices.OBJECTIVE: This scoping review aims to address the diagnostic challenges/differences and patient outcomes as infection, pain, treatment-related complications (either postmedical or postoperative), treatment toxicities, disease control, morbidity, and/or survival/mortality in older patients (above the cut-off age of 60 years) with head and neck cancer.METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS were searched, as well as gray literature and reference lists of included articles.RESULTS: A total of 5029 articles were retrieved and 57 studies were included, among which 5 appraised evidence on diagnostic challenges/differences, 53 addressed clinical (as postoperative complications, the impact of comorbidities in the occurrence of complications and treatment, postoperative delirium, swallowing outcomes, the correlation between age and infections, pain and opioid use, morbidity rates, treatment-related toxicities), and 26 reported survival. Evidence on diagnostic challenges and outcomes between older and younger patients is mixed, but age, comorbidities, and complications must be considered. While many studies show no significant differences in complications according to age, comorbidities often correlate with worse outcomes and are more frequent in the older group. Despite variable age cut-offs, survival rates between older and younger patients are similar.CONCLUSION: Treatment decisions should be based on a thorough medical evaluation and patient preferences rather than chronological age alone, as age itself does not account for outcome differences.

AB - BACKGROUND: Understanding the relationship between age and diagnostic challenges, as well as outcomes in older patients with head and neck cancer, is crucial. The significance of age as a prognostic factor and how it should influence treatment decisions is debated, highlighting the need for tailored insights to help physicians make more informed choices.OBJECTIVE: This scoping review aims to address the diagnostic challenges/differences and patient outcomes as infection, pain, treatment-related complications (either postmedical or postoperative), treatment toxicities, disease control, morbidity, and/or survival/mortality in older patients (above the cut-off age of 60 years) with head and neck cancer.METHODS: PubMed, Embase, Scopus, Web of Science, and LILACS were searched, as well as gray literature and reference lists of included articles.RESULTS: A total of 5029 articles were retrieved and 57 studies were included, among which 5 appraised evidence on diagnostic challenges/differences, 53 addressed clinical (as postoperative complications, the impact of comorbidities in the occurrence of complications and treatment, postoperative delirium, swallowing outcomes, the correlation between age and infections, pain and opioid use, morbidity rates, treatment-related toxicities), and 26 reported survival. Evidence on diagnostic challenges and outcomes between older and younger patients is mixed, but age, comorbidities, and complications must be considered. While many studies show no significant differences in complications according to age, comorbidities often correlate with worse outcomes and are more frequent in the older group. Despite variable age cut-offs, survival rates between older and younger patients are similar.CONCLUSION: Treatment decisions should be based on a thorough medical evaluation and patient preferences rather than chronological age alone, as age itself does not account for outcome differences.

KW - comorbidities

KW - diagnosis

KW - outcomes

KW - survival

KW - toxicities

UR - https://www.scopus.com/pages/publications/105003804534

U2 - 10.1002/hed.28168

DO - 10.1002/hed.28168

M3 - Article

C2 - 40275740

SN - 1043-3074

VL - 47

SP - 2570

EP - 2583

JO - Head & neck

JF - Head & neck

IS - 9

ER -

Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes

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