OBJECTIVES: This study delineates the demographics, clinical characteristics, and real-world management of elderly patients with newly diagnosed locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) in the US.

METHODS: The SEER-Medicare database (elderly patients ≥65) was used. Patients had ≥1 year of baseline information and were diagnosed with stage III, IVa, or IVb LA SCCHN of the oral cavity, oropharynx, hypopharynx, or larynx. Patients were diagnosed between January 2014 and December 2017 and were followed until death, subsequent cancer, enrollment change, or December 2019.

RESULTS: 2,776 patients were eligible. Patients’ mean age was 73.6 years and 74.1% were male, 88.7% white, 6.9% black, and 2.9% Asian. Disease was stage III in 27.1%, stage IVa in 65.9%, and stage IVb in 7.0% of patients. Oropharyngeal cancer was most common (48.6%), followed by oral cavity (25.1%), larynx (20.3%), and hypopharynx cancer (5.9%).

Surgery was the primary treatment modality in 29% (n=817) of patients. Most surgeries were for oral cavity (53%) and oropharyngeal (35%) cancers. Adjuvant treatment was administered to 69%, among whom 55% were treated with concurrent chemoradiotherapy (CRT) (54% cisplatin, 27% cetuximab), 40% RT alone, and 5% other.

Definitive non-surgical therapy (CRT or RT) was administered to 52% (n=1453) of patients. Most had oropharyngeal (59%) or laryngeal (24%) cancer. 72% of patients were treated with concurrent CRT (57% cisplatin, 28% cetuximab), 20% RT alone, and 8% sequential CRT.

2% (n = 57) of patients received systemic therapy alone and 16% (n=449) received no treatment.

CONCLUSIONS: Real-world management of elderly patients with LA SCCHN most often include concurrent adjuvant or definitive chemoradiation. However, a substantial proportion of patients did not receive any treatment, possibly due to patient preference or concern with treatment toxicities. Innovative and effective therapies suitable for elderly patients and beyond are needed.