Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy.

Wenyan Ji,Kristopher Attwood,Fangyi Gu,Sung Jun Ma,Mary E. Platek,Mark Farrugia,Elizabeth Wendel,Kayleigh Erickson,Anurag K. Singh,Andrew D. Ray

doi:10.3390/cancers13071638

Wenyan Ji, Kristopher Attwood

Open Access

https://doi.org/10.3390/cancers13071638

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Journal: Cancers	Publication Date: Apr 1, 2021
Citations: 9	License type: CC BY 4.0

Affiliation: Roswell Park Cancer Institute, D'Youville College

Abstract

Simple SummaryQuality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies.Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.

Highlights

Head and neck cancers (HNC) of the mouth, salivary glands, pharynx and larynx represent one of the top 10 most diagnosed cancers for men in the United States (US), with an estimated 53,260 new cases and 10,750 deaths from the disease [1]
We hypothesize that treatment-related decline of physical performance, as measured by the Short Physical Performance Battery (SPPB), correlates with quality of life (QoL) and frailty status and could be used to identify patients who may benefit from early rehabilitation
Change in SPPB was significantly correlated with physical functional domain scores among both groups and transition to frailty in the concurrent chemoradiation therapy (CCRT) group, with a trend observed in the radiation group

Summary

Introduction

Head and neck cancers (HNC) of the mouth, salivary glands, pharynx and larynx represent one of the top 10 most diagnosed cancers for men in the United States (US), with an estimated 53,260 new cases and 10,750 deaths from the disease [1]. Researchers have found post-treatment decline of global health status and physical functioning scores to be associated with survival in HNC [14,15,19]. Frailty or increased physical, functional, psychological, and social deficiencies associated with aging has been correlated with increased morbidity from treatment, reduced QoL, and survival in HNC [20,21,22,23]. Physical functioning is an important factor regarding outcome in cancer patients [24,25] and rehabilitation interventions have been shown to be safe and effective at reducing impairment and improving QoL HNC [26]. We hypothesize that treatment-related decline of physical performance, as measured by the Short Physical Performance Battery (SPPB), correlates with QoL and frailty status and could be used to identify patients who may benefit from early rehabilitation

Methods

Results

Conclusion