Time-dependent analysis of HUS change in older patients aged > 75 years with head and neck cancer

Abstract

Previous longitudinal evidence has suggested that patients aged > 75 years may be associated with a poorer Health Utility Index Mark 3 (HUI-3) trajectory. We compared the longitudinal health utility scores (HUS) of older (>75 years) versus younger patients with head and neck cancers across various clinical subgroups and identified factors associated with decline in quality of life. The study prospectively collected clinical information and follow-up data from head and neck cancer patients. The HUI-3 scale was used to assess changes in health-related quality of life at baseline, post-surgery, mid-radiation therapy, and at 3, 6, and 12 months. A linear mixed model was employed to evaluate the changes in HUS and age categories over time. We included 859 patients with head and neck cancer, of whom 647 were included in the longitudinal analytic cohort. In descriptive analyses, patients aged > 75 years showed less complete recovery in mean HUS after early treatment-related decline compared with younger patients. In the primary mixed-effects model, younger age groups had more positive average HUS slopes than patients aged > 75 years. However, these age-related differences were attenuated and were no longer statistically supported after adjustment for clinical stage, Eastern Cooperative Oncology Group (ECOG) performance status, and treatment modality. Subgroup findings were exploratory and were not consistently supported across all model-based comparisons. Patients aged > 75 years may be at risk for slower or incomplete post-treatment recovery in HUI-3–derived health utility. These findings should be interpreted cautiously given potential selection bias, missing data, and attenuation after covariate adjustment. Larger studies with detailed geriatric and domain-specific functional measures are needed to confirm these patterns.