A new care paradigm in geriatric head and neck surgical oncology.
Academic Article
Overview
abstract
BACKGROUND AND OBJECTIVES: Perioperative management of elderly patients with head and neck cancer poses unique challenges. Our objective is to describe the implementation and feasibility of a novel intervention designed to improve perioperative care in geriatric head and neck surgery. METHODS: This pilot study was performed in a single-institution, NCI-designated comprehensive cancer center. All surgical patients with head and neck cancer over age 75 were offered perioperative consultation with fellowship-trained geriatricians focusing in geriatric oncology. RESULTS: Between 2010 and 2011, a total of 168 patients requiring head and neck surgery were seen by the geriatric service, of which 94% subsequently underwent surgery. Apart from preoperative medical optimization, geriatricians assisted in complex decision-making regarding the indications for cancer-directed therapy. Postoperatively, they assisted in preventing and treating delirium and poly-pharmacy, facilitating discharge planning, and initiating rehabilitation. Postoperatively, 87% were discharged home, and 13% required placement in skilled nursing facilities. At 24 months, overall survival was 80%. Patients, surgeons and geriatricians alike were enthusiastic about the initiative, which is expanding within the institution. CONCLUSION: Geriatric perioperative support for elderly head and neck cancer patients is well-received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
