title: Changes in quality of life over 1 year in patients with head and neck cancer. Age-specific nonpersistence of endocrine therapy in postmenopausal patients diagnosed with hormone receptor-positive breast cancer: a TEAM study analysis. A global clinical measure of fitness and frailty in elderly people Characteristics of Randomized Controlled Trials Designed for Elderly: A Systematic Review Risk factors for surgical-site infections in head and neck cancer surgery Prediction of survival by pretreatment health-related quality-of-life scores in a prospective cohort of patients with head and neck squamous cell carcinoma. Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Effect of education level on outcome of patients treated on Radiation Therapy Oncology Group Protocol 90‐03 Pretreatment quality of life predicts for locoregional control in head and neck cancer patients: a radiation therapy oncology group analysis. Health-related quality of life in head and neck cancer survivors: impact of pretreatment depressive symptoms. Predictors of competing mortality in advanced head and neck cancer. Comorbidity and Karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four RTOG studies. Radiation Therapy Oncology Group. Health-related quality of life as a survival predictor for patients with oral cancer: is quality of life associated with long-term overall survival? Quality of life scores as prognostic factors of overall survival in advanced head and neck cancer: analysis of a phase III randomized trial of pemetrexed plus cisplatin versus cisplatin monotherapy. Predictors of 1-Year Mortality in a Prospective Cohort of Elderly Patients With Cancer. Preoperative identification of patients at risk for delirium after major head and neck cancer surgery. Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma. Influence of pretreatment social support on health-related quality of life in head and neck cancer survivors: results from a prospective study.
abstract: OBJECTIVES To characterize and compare quality of life ( QOL ) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year . DESIGN Prospect i ve cohort study . SETTING Three otolaryngology clinics . PATIENTS Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer . MAIN OUTCOME MEASURE Health-related QOL was assessed using the  36-item Short-Form Health Survey  and a head and neck cancer-specific QOL scale .  RESULTS Over 1 year , QOL decreased for physical functioning measures and eating but improved for mental health QOL . Depression and smoking were major predictors of poor QOL at baseline . Major predictors of change in QOL from baseline to 1 year were treatment factors , especially feeding tube placement ( 9 scales ) , chemotherapy ( 3 scales ) , and radiation therapy ( 3 scales ) . Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year . CONCLUSIONS Health-related physical QOL tended to decline over 1 year and mental health QOL improved . The major predictors of change in QOL were treatment factors , smoking , and depressive symptoms . Physicians should alert patients to the relative effects on QOL one may experience with different treatments BACKGROUND Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients . The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status . METHODS Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included . Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events , intercurrent illness , patient refusal , or other reasons . Endpoints were the breast cancer-specific and overall survival times . Analyses were stratified by age at diagnosis ( < 65 years , 65 - 74 years , ≥75 years ) . RESULTS Overall , 3,142 postmenopausal breast cancer patients were included : 1,682 were aged < 65 years , 951 were aged 65 - 74 years , and 509 were aged ≥75 years . Older age was associated with a higher proportion of nonpersistence within 1 year of follow-up . In patients aged < 65 years , nonpersistent patients had lower breast cancer-specific and overall survival probabilities . In patients aged 65 - 74 years and patients aged ≥75 years , the survival times of persistent and nonpersistent patients were similar . CONCLUSION Nonpersistence within 1 year of follow-up was associated with lower breast cancer-specific and overall survival probabilities in patients aged < 65 years , but it was not associated with survival outcomes in patients aged 65 - 74 years or in patients aged ≥75 years . These results suggest that extrapolation of outcomes from a young to an elderly breast cancer population may be insufficient and urge age-specific breast cancer studies Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Objectives To quantify the proportion of r and omized controlled trials ( RCTs ) specifically design ed for elderly , and to assess their characteristics , as compared to RCTs not specifically design ed for elderly . Design Review and synthesis of published literature . Measurements We search ed PubMed for articles published in the year 2012 . We included RCTs . Articles were excluded if not conducted with human subjects or if findings of secondary analyses were reported . A r and om sample of 10 % was drawn and of this selection the following trial characteristics were extracted : sample size , disease category , age of sample , and age-related inclusion criteria . Clinical trials were defined to be specifically design ed for elderly if a lower age cut-off of ≥ 55 years was used , or when participants had an average age of ≥ 70 years . Results The search strategy yielded 26,740 articles , from which a r and om sample was drawn , result ing in 2375 articles . After exclusion , data was extracted from 1369 publications . Of these 1369 RCTs , 96 ( 7 % ) were specifically design ed for elderly . In comparison with trials not design ed for older adults , trials design ed for elderly contained a significantly larger median number of participants  ( 125 vs. 80 , p = 0.008 ) significantly more trials design ed for elderly fell into the disease categories eye ( 6 % vs. 2 % , p = 0.005 ) , musculoskeletal ( 13 % vs. 7 % , p = 0.023 ) and circulatory system ( 16 % vs. 9 % , p = 0.039 ) . No significant difference was observed with regard to the other disease categories . Conclusion There is a low proportion of RCTs specifically design ed for elderly . As older patients will increasingly form the majority in medical practice , there is an urgent need for stronger evidence for the formulation of treatment guidelines specifically for older adults Objective The aim of this study was to identify risk factors for surgical-site infections ( SSIs ) in patients with head and neck cancer su bmi tted to major clean-contaminated surgery . Study Design This is a prospect i ve study conducted in a tertiary cancer center hospital . Subjects and Methods This study includes 258 patients su bmi tted to a major clean-contaminated head and neck oncologic surgery .  Results The overall SSI rate was 38.8 % . The univariate analysis showed the following significant risk factors : race , tobacco consumption , clinical stage , comorbidities , time duration of the surgical procedure , and flap reconstruction . The final model by logistic regression identified the following independent predictors for SSI : tobacco consumption ( odds ratio [ OR ] = 2.96 ) , presence of metastatic lymph nodes ( OR = 2.05 ) , flap reconstruction ( OR = 2.20 ) , and antimicrobial prophylaxis exceeding 48 hours ( OR=1.89 ) . Conclusion The high-risk patients for SSI in head and neck oncologic surgery were those with cancer at advanced stages , those who were smokers , those presenting comorbidities , those who needed major reconstruction of the surgical wound , or those who were su bmi tted to inadequate antibiotic prophylaxis OBJECTIVE To evaluate the association between pretreatment health-related quality -of-life ( HRQOL ) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma ( HNSCC ) . DESIGN Prospect i ve cohort study . SETTING University hospital and referral center in Western Norway . PATIENTS A total of 106 patients with intact cognitive functioning who were younger than 78 years , were diagnosed as having HNSCC , and underwent treatment with curative intent from November 1 , 2002 , through June 30 , 2005 . MAIN OUTCOME MEASURES Overall survival and HRQOL scores obtained at the time of diagnosis . RESULTS All dichotomized HRQOL sum scores except the functional score ( P = .20 ) were significantly predictive of survival in univariate analyses . The hazard ratios of the dichotomized general symptom , global quality -of-life , and head and neck sum score were 3.66 , 0.31 , and 2.28 , respectively . All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics , neuroticism , choice of psychological coping , current smoking and alcohol consumption , and comorbidities . Similar findings were found for specific HRQOL indices of physical functioning , dyspnea , sleep disturbance , appetite loss , swallowing , and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Question naire , version 3.0 , and the Quality of Life-Head and Neck Cancer Module . Moreover , patients in the highest scoring quartiles for the symptom sum scores and /or the lowest scoring quartile for the global score had overall mortality rates of 50 % to 64 % compared with 23 % to 26 % among the other patients . CONCLUSION The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors Background Head and neck cancer ( HNC ) is a debilitating disease due in part to its effects on function , including speech , swallowing , and cosmesis . Previous studies regarding depression in HNC have focused on demographic predictors , incidence , and quality of life studies . There is , however , a paucity of studies that objective ly address depressive symptoms in HNC patients and the result ant effects on post-treatment functional performance status . The aim of this study was to assess the relationship between preoperative depressive symptoms  ( PDS ) and postoperative functional performance status ( PFPS ) , in addition to other predictors of rehabilitation and survival . Methods A prospect i ve cohort study was undertaken at the University of Alberta , including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014 . Baseline depressive symptoms  were measured on the Quick Inventory of Depressive Symptoms ( QIDS ) question naire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck ( FACT-HN ) scale . Secondary outcomes included completion of adjuvant therapy , narcotic dependence , return to detrimental habits , loss of follow-up , and length of hospital stay ( LOHS ) . Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann – Whitney and Fischer Exact statistical analyses . Results Seventy-one patients were included in the study . Mild and Moderate-Severe PDS were 35.2 % and 18.3 % , respectively . Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months ( p = 0.03 ) . The risk ratio ( RR ) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66 . In addition , significantly lower completion of adjuvant treatment ( p = 0.03 ) , significantly higher incidence of narcotic dependence ( p = 0.004 ) , and significantly higher LOHS ( 24 days vs. 18 days ; p = 0.02 ) was observed in the Moderate-Severe group . There was no significant difference in loss of follow-up between the 2 groups ( p = 0.64 ) . Conclusions The incidence and severity of PDS in HNC patients treated with surgery is high ( 53.5 % ) . Patients with Moderate-Severe PDS have significantly decreased PFPS , increased narcotic use , decreased completion of adjuvant therapy , and a longer LOHS . HNC patients should be monitored closely for depressive symptoms OBJECTIVE To examine the association between the outcomes of a pre-operative comprehensive geriatric assessment ( CGA ) and the risk of severe post-operative complications in elderly patients electively operated for colorectal cancer . METHODS One hundred seventy-eight consecutive patients ≥ 70 years electively operated for all stages of colorectal cancer were prospect ively examined . A pre-operative CGA was performed , and patients were categorized as fit , intermediate , or frail . The main outcome measure was severe complications within 30 days of surgery . RESULTS Twenty-one patients ( 12 % ) were categorized as fit , 81 ( 46 % ) as intermediate , and 76 ( 43 % ) as frail . Eighty-three patients experienced severe complications , including three deaths ; 7/21 ( 33 % ) of fit patients , 29/81 ( 36 % ) of intermediate patients and 47/76 ( 62 % ) of frail patients ( p=0.002 ) . Increasing age and ASA classification were not associated with complications in this series . CONCLUSION CGA can identify frail patients who have a significantly increased risk of severe complications after elective surgery for colorectal cancer It has been hypothesized that people in lower socioeconomic groups have worse outcomes because they present with advanced‐stage cancers or receive inadequate treatment . The authors investigated this hypothesis by using  education level as a proxy for  socioeconomic status in patients treated on Radiation Therapy Oncology Group ( RTOG ) Protocol 90‐03 PURPOSE To analyze the prospect ively collected  health-related quality -of-life ( HRQOL )  data from patients enrolled in two Radiation Therapy Oncology Group r and omized Phase III head and neck cancer trials ( 90 - 03 and 91 - 11 ) to assess their value as an independent prognostic factor for locoregional control ( LRC ) and /or overall survival ( OS ) . METHODS AND MATERIAL S HRQOL question naires , using a vali date d instrument , the Functional Assessment of Cancer Therapy-Head and Neck ( FACT-H&N ) , version 2 , were completed by patients before the start of treatment . OS and LRC were the outcome measures analyzed using a multivariate Cox proportional hazard model . RESULTS Baseline FACT-H&N data were available for 1,093 patients and missing for 417 patients . No significant difference in outcome was found between the patients with and without baseline FACT-H&N data ( p = 0.58 ) . The median follow-up time was 27.2 months for all patients and 49 months for surviving patients . Multivariate analyses were performed for both OS and LRC . Beyond tumor and nodal stage , Karnofsky performance status , primary site , cigarette use , use of concurrent chemotherapy , and altered fractionation schedules , the FACT-H&N score was independently predictive of LRC ( but not OS ) , with p = 0.0038 . The functional well-being component of the FACT-H&N predicted most significantly for LRC ( p = 0.0004 ) . CONCLUSIONS This study represents , to our knowledge , the largest analysis of HRQOL as a prognostic factor in locally advanced head and neck cancer patients . The results of this study have demonstrated the importance of baseline HRQOL as a significant and independent predictor of LRC in patients with locally advanced head and neck cancer OBJECTIVE Symptoms of depression are common in those with cancer . The authors investigated whether depressive symptoms assessed before the initiation of cancer treatment predicted diminished health-related quality of life ( HRQOL ) at follow-up . DESIGN As part of a large , prospect i ve study of oncologic outcomes , 306 patients with head and neck cancer ( HNC ) were assessed on several clinical and psychosocial characteristics during a pretreatment clinic visit and then at 3- and 12-month follow-up appointments . MAIN OUTCOME MEASURES Depressive symptomatology was assessed with the  Beck Depression Inventory  and HNC-specific HRQOL ( main outcome measure ) was assessed with the  Head and Neck Cancer Inventory .  RESULTS Controlling for age , gender , marital status , cancer site , stage of disease , alcohol and tobacco use , comorbidity status , and pretreatment HRQOL , simultaneous multiple regression analyses revealed that depressive symptoms present at study enrollment , before the initiation of cancer treatment , significantly predicted lower HRQOL at 3- and 12-month follow-up assessment s across the 4 HNC-specific domains of speech , eating , aesthetics , and social disruption ( all ps < or= .01 ) . CONCLUSION Results suggest that depressive symptomatology present near the time of diagnosis can have a significant , deleterious impact on HRQOL over time in HNC survivors . Thus , it may be useful to assess depression at diagnosis to identify individuals at greater risk for poor HRQOL outcomes PURPOSE Death from noncancer causes ( competing mortality ) is an important event in head and neck cancer , but studies identifying predictors of this event are lacking . We sought to identify predictors of competing mortality and develop a risk stratification model for competing events . PATIENTS AND METHODS Cohort study of 479 patients with stage III to IV carcinoma of the head and neck diagnosed between August 1993 and November 2004 . Patients were treated on consecutive prospect i ve clinical trials involving organ-preserving chemoradiotherapy and surgery . We used multivariable competing risks regression models to analyze factors associated with the cumulative incidence of competing mortality , locoregional and distant failure , and second malignancies as first events . Results Median follow-up was 52 months median for survivors . The 5-year cumulative incidence of competing mortality was 19.6 % ( 95 % CI , 15.8 to 23.4 ) . On multivariable analysis , competing mortality was associated with female sex ( hazard ratio [ HR ] , 1.72 ; 95 % CI , 1.13 to 2.63 ) , increasing age ( HR , 1.30 ; 95 % CI , 1.04 to 1.62 ) , increasing Charlson Comorbidity Index ( HR , 1.24 ; 95 % CI , 1.05 to 1.47 ) , decreasing body mass index ( HR , 0.33 ; 95 % CI , 0.13 to 0.84 ) , and decreasing distance traveled to the treating center ( HR , 0.65 ; 95 % CI , 0.44 to 0.98 ) . Patients with zero , one , two , and > or = three risk factors had 5-year competing mortality of 8.9 % ( 95 % CI , 3.0 % to 14.8 % ) , 12.4 % ( 95 % CI , 7.0 % to 17.8 % ) , 22.1 % ( 95 % CI , 14.5 % to 29.7 % ) , and 39.3 % ( 95 % CI , 28.6 % to 50.1 % ) , respectively . CONCLUSION Competing mortality in advanced head and neck cancer is associated with several demographic and health status characteristics . Analyses of risk factors for competing mortality may be useful in outcomes reporting and design ing clinical trials PURPOSE To determine the prognostic role of comorbidity in Stage III non-small cell lung cancer ( NSCLC ) treated definitively with radiotherapy alone . METHODS AND MATERIAL S A total of 112 patients with clinical Stage III NSCLC ( American Joint Commission on Cancer 1997 ) enrolled in four Radiation Therapy Oncology Group studies ( 83 - 11 , 84 - 03 , 84 - 07 , and 88 - 08 nonchemotherapy arms ) at a single institution were analyzed retrospectively for overall survival ( OS ) and comorbidity . Of the 112 patients , 105 ( 94 % ) completed their assigned radiotherapy . The median assigned dose was 50.4 Gy to the lymphatics ( range 45 - 50.4 Gy ) and 70.2 Gy to the primary tumor ( range 60 - 79.2 Gy ) . Comorbidity was rated retrospectively using the Cumulative Illness Rating Scale for Geriatrics ( CIRS-G ) and Charlson scales . Karnofsky performance scores ( KPSs ) and weight loss were prospect ively recorded . Because only 8 patients had a KPS of < 70 , these patients were combined with patients who had a KPS of 70 . The OS of this group was compared with that of the patients with better KPSs ( > 70 ) . RESULTS The median survival was 10.39 months ( range 7.87 - 12.91 ) . The 2- , 3- , and 5-year OS rate was 20.5 % , 12.5 % , and 7.1 % , respectively . On univariate analysis , clinical stage ( IIIA vs. IIIB ) was found to be a statistically significant factor influencing OS ( p = 0.026 ) , and the histologic features , grade , tumor size as measured on CT scans , age , tobacco use , weight loss > or=5 % , and total dose delivered to the primary tumor were not . A KPS of < or=70 ( p = 0.001 ) , the presence of a CIRS-G score of 4 ( extremely severe ; p = 0.0002 ) , and a severity index of > 2 ( p < 0.0001 ) were associated with statistically significant inferior OS . Multivariate analysis with clinical stage , KPS , and comorbidity ( severity index ) of all patients showed that a KPS < or=70 and severity index > 2 were independently associated with inferior OS ; clinical tumor stage was not found to be an independent prognostic factor . CONCLUSION KPS and comorbidity are important independent prognostic factors in Stage III NSCLC . Comorbidity should be included in protocol s study ing advanced stage NSCLC and used for stratification OBJECTIVE The aim of the present prospect i ve study was to obtain further insight into health-related quality of life ( HR-QoL ) as a predictor of survival in a selected cohort of patients with oral cancer . STUDY DESIGN A total of 124 patients were treated with surgery or combined therapy .  All of the recruited patients completed the European Organization for Research and Treatment of Cancer question naires QLQC30 and H&N35 on 4 occasions . Overall survival was assessed . Univariate and multivariate Cox proportional hazards regression models were conducted . RESULTS High baseline HR-QoL score and high pain symptom score were significantly associated with a better survival ( HR 0.86 and 0.92 respectively ) . Swallowing ( HR 0.94 ) , and speech ( HR 0.92 ) high baseline scores were also significantly associated with a better survival in the adjusted analyses . CONCLUSIONS Patients who reported a better HR-QoL  at tumor diagnosis had a better survival than patients with a lower HR-QoL baseline score OBJECTIVES We examined the prognostic factors ( clinical , demographic , and health-related quality of life [ HRQoL ] ) of overall survival ( OS ) and progression-free survival ( PFS ) in patients with recurrent/metastatic head and neck cancer ( HNC ) who were treated with pemetrexed plus cisplatin versus cisplatin in a phase III , multinational , r and omized trial . MATERIAL S AND METHODS Five subscales of the Functional Assessment of Cancer Therapy-Head and Neck Cancer ( FACT-H&N ) , modified to score from 0 to 100 , measured HRQoL at baseline and during treatment . Univariate and multivariate Cox proportional hazards models were used on data pooled from both treatment arms to assess the effect of baseline prognostic factors on OS and PFS . RESULTS Of 795 patients r and omized , 704 completed a baseline FACT-H&N and were included in the analysis . Age ( < 65 versus ⩾65 ; HR=0.74 , 95 % CI : 0.61 - 0.90 ) , race ( Caucasian versus non-Caucasian ; HR=0.83 , 95 % CI : 0.70 - 0.98 per table ) , Eastern Cooperative Oncology Group performance status ( ECOG PS ; 0/1 versus 2 ; HR=0.44 , 95 % CI : 0.35 - 0.56 ) , prior surgery/radiotherapy in the last 6months ( no versus yes ; HR=0.74 , 95 % CI : 0.61 - 0.90 ) , and primary site of disease ( oral cavity versus other ; HR=1.37 , 95 % CI : 1.15 - 1.63 ) were significantly prognostic of OS in univariate models , as were baseline scores on four FACT-H&N subscales ( physical well-being , emotional well-being , functional well-being , additional concerns-H&N ; HRs=0.82 - 0.94 ; all P⩽0.002 ) . In multivariate models , significant prognostic factors were age ( HR=0.78 ) ; race ( HR=0.76 per table ) ; ECOG PS ( HR=0.56 ) ; prior surgery/radiotherapy ( HR=0.76 ) ; and baseline scores of the FACT-H&N subscales of physical well-being , social/family well-being , and additional concerns-H&N ( HRs=0.89 - 0.94 ; all P⩽0.014 per table ) . CONCLUSIONS The results suggest that baseline HRQoL scores are prognostic indicators of OS in recurrent/metastatic HNC in addition to other known clinical and demographic indicators . HRQoL might be considered as a stratification factor in r and omized clinical trials of recurrent/metastatic HNC BACKGROUND Mortality prediction is crucial to select the optimal treatment in elderly cancer patients . Our objective was to identify cancer-related factors and Comprehensive Geriatric Assessment ( CGA ) findings associated with 1-year mortality in elderly in patients and out patients with cancer . METHODS We prospect ively included patients aged ≥70 years who had solid or hematologic malignancies and in whom the CGA was performed by geriatricians in two French teaching hospitals . We identified independent predictors of 1-year mortality after study inclusion , using multivariate Cox models stratified on inpatient/outpatient status . We built three multivariate Cox models , since strong correlations linked activities of daily living ( ADL ) , Eastern Cooperative Oncology Group Performance Status ( ECOG-PS ) , and timed get-up- and -go test ( GUG ) results ; and since physicians ' preferences for these three assessment s vary . A sensitivity analysis was performed using multiple imputation . RESULTS Of the 993 patients ( mean age , 80.2 years ; 51.2 % men ) , 58.2 % were out patients and 46 % had metastatic disease . Colorectal cancer was the most common malignancy ( 21.4 % ) . Mortality rates after 6 and 12 months were 30.1 % and 41.2 % , respectively . In all models , tumor site and metastatic status ( p < .001 ) , age > 80 years ( p < .05 ) , higher number of severe comorbidities ( p < .05 ) , and malnutrition ( p < .001 ) were associated with death independently from impaired ECOG-PS ( p < .001 ) , ADL ( p < .001 ) , and GUG ( p < .001 ) . The adverse effect of metastatic status differed significantly across tumor sites , being greatest for breast and prostate cancer ( p < .001 ) . Multiple imputation produced similar results . CONCLUSION The predictors of 1-year mortality identified in our study may help physicians select the optimal cancer-treatment strategy in elderly patients This study was performed to determine preoperative criteria for identifying patients at risk for delirium after major head and neck cancer surgery . The authors prospect ively evaluated 138 consecutive patients undergoing head and neck cancer surgery lasting more than 2 hours at the Arthur G. James Cancer Hospital and Research Institute , Ohio State University , Columbus , from July 1993 through May 1994 .  Postoperative delirium developed in 24 of 138 patients ( 17 % ; 95 % confidence interval 11 % to 24 % ) . The strongest univariate predictors of delirium were living alone ( P = .005 ) , the American Society of Anesthesiologists class ( P = .003 ) , and the preoperative white blood cell count ( P < .0001 ) . A predictive model for delirium using five criteria --age of 70 or more years , alcohol abuse , poor cognitive status , poor functional status , and markedly abnormal serum sodium , potassium , or glucose level -- stratified the patients into three cohorts with an increasing risk of postoperative delirium ( i.e. , 9 % , 19 % , and 25 % ) BACKGROUND The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status ( PS ) on head and neck squamous cell carcinoma ( HNSCC ) survival . METHODS Six hundred patients with HNSCC were prospect ively recruited .  Comorbidity and PS  were measured using the  Charlson Comorbidity Index ( CCI )  and the Eastern Cooperative Oncology Group ( ECOG ) Scale . Outcomes were overall survival ( OS ) and cancer-specific survival ( CSS ) . RESULTS A total of 48.3 % of the patients had at least 1 comorbidity , and 42.3 % had impaired PS at baseline . There was no correlation between CCI and ECOG ( Spearman 's ρ = 0.033 ; p = .42 ) . In multivariate analysis , CCI score was significantly associated with OS ( p = .01 ) . ECOG was not associated with OS , but seems to act as an effect modifier in the association between comorbidity and OS . CCI and ECOG were not associated with CSS . CONCLUSION CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC , but a significant association with CSS was not observed BACKGROUND Head and neck cancer and its treatment can have considerable impact on health-related quality of life ( HRQOL ) . The present study investigated whether social support , assessed before treatment , predicted HRQOL outcomes up to 12 months later in head and neck cancer survivors . METHODS Using a prospect i ve longitudinal design , patients ( n = 364 ) were assessed on several clinical and psychosocial characteristics at diagnosis and then at 3- and 12-month follow-up appointments . HRQOL was assessed with the Short Form Health Survey ( SF-36 ) and the Head and Neck Cancer Inventory ( HNCI ) .  RESULTS Hierarchical multiple regression analyses demonstrated that greater perceived support present at diagnosis significantly predicted more favorable global and head and neck cancer-specific HRQOL at 3- and 12-month follow-up . CONCLUSION Results suggest that adequate social support at diagnosis can have a significant , positive impact on HRQOL in head and neck cancer survivors . Thus , it may be useful to evaluate support re sources at diagnosis in order to identify individuals at risk for poor HRQOL outcomes
target: Functional and cognitive impairment , depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes .
background: OBJECTIVES Older head and neck cancer patients are at increased risk for adverse health outcomes , but little is known about which geriatric assessment associates with poor outcome .
  The aim is to study the association of functional or cognitive impairment , social environment and frailty with adverse health outcomes in patients with head and neck cancer .