Head and Neck Cancer among Older Adults: A lifecourse perspective on disease development and treatment decision making

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to the need for satisfactory patient participation in quality treatment decision-making (TDM). This qualitative study sought to explore the TDM process of older adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Forty one patients completed in depth semi structured interviews. Using a grounded theory approach, transcripts were coded for key themes. Results indicated that HNSCC in older patients is often preceded by lifelong alcohol, tobacco, and substance use. Despite frequent interaction with health and substance abuse treatment professionals, very few patients had prior knowledge of HNSCC risk or had been screened for these cancers. Experience with addiction treatment programs appears to influence the decision making process. The following themes were identified: (1) dynamic time perspectives including taking time, making time, junk time and time out; (2) recovery from disease; (3) the role of Hope; (4) the role of healing vs. cure; and (5) patient's moving forward. Results of this investigation suggest that patients with a history of lifelong substance use and treatment participation could benefit from earlier detection and improved awareness and knowledge of HNSCC risk. Results can be applied to improve access to oral cancer screening through addiction and cessation programs, reduce lags in diagnosis, improve prognosis and contribute to the development of satisfactory TDM tools.