Aims:Older patients (≥70y) with mucosal Head&Neck SCC (mHNSCC) present complex management challenges. Their underrepresentation in clinical trials leads to variation in their care influenced by performance status, comorbidities and treatment toxicity. Understanding treatment patterns and outcomes in this cohort is essential for optimising care. We compared treatment patterns and outcomes between older and younger patients with mHNSCC. Methods:Retrospective multicentre review of patients diagnosed at 6 centres, between 2010-18. Patient, tumour and treatment (intent and modality) characteristics, and overall survival(OS) and progression-free survival(PFS) were collected. Multivariable analyses examined factors associated with standard-of-care(SOC) treatment allocation, OS and PFS. Results:432 of 1553 patients were ≥70y. Older patients were less likely to receive curative treatment (75.7% vs 91.6%,p<0.01), SOC treatment (59.6% vs 74.0%,p<0.01), or concurrent chemotherapy (33.0% vs 67.8%,p<0.001). Among those receiving primary radiotherapy, fewer older patients were prescribed ≥66Gy (83.9% vs 89.9%,p=0.004). Older age, unpartnered marital status, lower ECOG status, higher stage and tumour subsite were associated with non-SOC allocation. OS and PFS were lower in older patients; five-year OS was 67.3% vs 51.5% (p <0.01) and PFS 70.2% vs 62.2% (p=0.02) in younger versus older patients receiving curative treatment. Lower ECOG status, lower stage, oropharynx subsite and SOC treatment were significantly associated with higher OS and PFS. Older age and smoking status were significantly associated with lower OS but not PFS. Conclusion: Older patients were less likely to receive SOC treatment, which was significantly associated with both OS and PFS. Inferior OS in older patients may reflect competing mortality risks. The absence of an independent association between age and PFS suggests that appropriately selected older patients should be offered SOC treatment to optimise outcomes