Abstract
Objective: Perioperative management of elderly patients with head and neck cancer poses unique challenges and may benefit from expert input from geriatricians. Our objectives are to 1) describe the implementation and 2) determine the feasibility of a novel intervention designed to improve perioperative care delivery in geriatric head and neck surgery.
Method: In this pilot study, patients with head and neck cancer over age 75 were offered preoperative consultation with fellowship-trained geriatricians. Geriatric-specific assessment included functional and social status, cognitive testing, medication review and nutrition; patients were also optimized and risk-stratified for surgery. Thereafter, patients were seen postoperatively by the geriatric service.
Results: Between 2010 and 2011, a total of 176 head and neck patients (75-93 years old) were seen by the geriatric service. Apart from preoperative medical optimization, geriatricians also assisted in complex decision-making regarding the indications for cancer-directed therapy. From the cohort, 148 (84%) subsequently underwent surgery; the majority of cases involved mucosal lesions (43%), cutaneous lesions (20%), and endocrine disease (16%). Postoperatively, geriatricians assisted in preventing and treating delirium, minimizing inappropriate prescribing and poly-pharmacy, facilitating discharge planning, and initiating prompt rehabilitation. Surgeons, geriatricians, and nursing staff alike were enthusiastic about the initiative, which continues to expand within the institution.
Conclusion: Geriatric perioperative assessment of elderly head and neck cancer patients is feasible and well-received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
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