Outcome of Head and Neck Cancer Patients Who Did Not Receive Curative-Intent Treatment

Purpose: There exists a subgroup of patients with head and neck cancer (HNC) who neither warrant nor request curative-intent treatment and who progress to a terminal-care paradigm. The purpose of this study was to determine the frequency of and reasons for an HNC terminal-care referral and the time to and place of death for such patients.

Materials And Methods: The authors undertook a retrospective cohort study of all attendees with HNC who had undergone multidisciplinary team (MDT) assessment at the Calvary Mater Hospital (Newcastle, Australia) from January 2013 through December 2014. The primary predictor variables were a heterogeneous set of factors grouped together into logical demographic (age and gender) and clinicopathologic (tumor histology, site, and stage) categories and the reason for referral to terminal care. The secondary outcome variables were survival and place of death. A descriptive statistical analysis was undertaken and survival data were graphically displayed as Kaplan-Meier estimates.

Results: Of the 412 attendees with HNC who underwent MDT assessment, 74 (18%) were identified as having been immediately referred for terminal care. Their median survival was 6 months (95% confidence interval, 4.75-7.50). The most common reason for referral for terminal care was tumor extent. The most common place of death recorded for the group was a hospice facility.

Conclusion: This study serves as a timely reminder that when curative-intent HNC treatment options have been exhausted, dialog and action need to be directed to transitioning the patient to a terminal-care management paradigm.