Older Patients with Head and Neck Cancer: A Scoping Review of Differences Regarding Diagnosis and Outcomes

Background: Understanding the relationship between age and diagnostic challenges, as well as outcomes in older patients with head and neck cancer, is crucial. The significance of age as a prognostic factor and how it should influence treatment decisions is debated, highlighting the need for tailored insights to help physicians make more informed choices. Objective: This scoping review aims to address the diagnostic challenges/differences and patient outcomes as infection, pain, treatment-related complications (either postmedical or postoperative), treatment toxicities, disease control, morbidity, and/or survival/mortality in older patients (above the cut-off age of 60 years) with head and neck cancer. Methods: PubMed, Embase, Scopus, Web of Science, and LILACS were searched, as well as gray literature and reference lists of included articles. Results: A total of 5029 articles were retrieved and 57 studies were included, among which 5 appraised evidence on diagnostic challenges/differences, 53 addressed clinical (as postoperative complications, the impact of comorbidities in the occurrence of complications and treatment, postoperative delirium, swallowing outcomes, the correlation between age and infections, pain and opioid use, morbidity rates, treatment-related toxicities), and 26 reported survival. Evidence on diagnostic challenges and outcomes between older and younger patients is mixed, but age, comorbidities, and complications must be considered. While many studies show no significant differences in complications according to age, comorbidities often correlate with worse outcomes and are more frequent in the older group. Despite variable age cut-offs, survival rates between older and younger patients are similar. Conclusion: Treatment decisions should be based on a thorough medical evaluation and patient preferences rather than chronological age alone, as age itself does not account for outcome differences.