Aims: Patients undergoing head and neck surgery or radiotherapy experience quality of life changes due to their disease, acute toxicity and late toxicity from treatment. It is often assumed in clinical practice and multidisciplinary settings that older patients will suffer more from treatment than younger patients. This study tests this assumption in a quantitative manner.  

Methods: A prospective quality of life (QOL) database has been maintained for head and neck patients at Royal Prince Alfred Hospital since 2001. Ethics committee approval was obtained for a secondary analysis using this database. EORTC QLQ C30 and HN35 questionnaires were answered pretreatment and at 3, 6 and 12 months. Data from 368 patients who completed at least one questionnaire between 2001 and 2011 were analysed for changes in QOL domains and functional outcomes, and whether these changes varied by age (dichotomised at age 70).

Results: Bimodality treatment with chemoradiotherapy (39%) or surgery-radiotherapy (39%) was most common, with older patients more likely to receive monotherapy and not recieve chemotherapy. As expected, older patients had worse baseline global health status, physical and role functioning, but similar emotional, social and cognitive functioning. At 6 months (during recovery from treatment), differences in global and physical function persisted, but other domains equalised. At 12 months, older patients showed further decline in global, physical, role and cognitive domains compared to younger patients.

Conclusions: Although treatment selection bias certainly exists, older patients fit for radical treatment of head and neck cancer appear to recover from the immediate effects of treatment as well as their younger counterparts. Late functional declines after treatment may be due to increased late toxicity, greater recurrence or more comorbidities in older patients.