Frailty and restrictions in geriatric domains are associated with surgical complications but not with radiation-induced acute toxicity in head and neck cancer patients: A prospective study

Linda Bras,Julius De Vries,Suzanne Festen,Roel J.H.M Steenbakkers,Johannes A Langendijk,Max J.H Witjes,Bernard F.A.M Van Der Laan,Geertruida H De Bock,Gyorgy B Halmos

doi:10.1016/j.oraloncology.2021.105329

Linda Bras, Julius De Vries + Show 7 more

Open Access

https://doi.org/10.1016/j.oraloncology.2021.105329

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Abstract

ObjectivesWe aimed to evaluate the association between frailty screening and geriatric assessment (GA) on short term adverse events in patients treated for head and neck cancer (HNC) for the first time in a prospective study. Materials and methodsNewly diagnosed HNC patients undergoing curative treatment were prospectively included in OncoLifeS, a data biobank. Prior to the start of treatment, frailty was assessed with a GA, Groningen Frailty Indicator (GFI) and Geriatric-8 (G8). The GA included comorbidity (Adult Comorbidity Evaluation – 27), nutritional status (Malnutrition Universal Screening Tool), functional status ((instrumental) Activities of Daily Living), mobility (Timed Up & Go), psychological (Geriatric Depression Scale 15) and cognitive (Mini Mental State Examination) measures. Clinically relevant postoperative complications (Clavien-Dindo ≥ grade 2) and acute radiation-induced toxicity (Common Terminology Criteria for Adverse Events version 4.0 ≥ grade 2) were defined as outcome measures. Univariable and multivariable logistic regression analyses were performed, yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). ResultsOf the 369 included patients, 259 patients were eligible for analysis. Postoperative complications occurred in 41/148 (27.7%) patients and acute radiation-induced toxicity was present in 86/160 (53.7%) patients. Number of deficit domains of GA (OR = 1.71, 95%CI = 1.14–2.56), GFI (OR = 2.54, 95%CI = 1.02–6.31) and G8 (OR5.59, 95%CI = 2.14–14.60) were associated with postoperative complications, but not with radiation-induced toxicity. ConclusionFrailty and restrictions in geriatric domains were associated with postoperative complications, but not with radiation-induced acute toxicity in curatively treated HNC patients. The results of this prospective study further emphasizes the importance of geriatric evaluation, particularly before surgery.

Highlights

A challenging clinical problem for head and neck oncologists is the increase of the proportion of older patients [1]
Radiation-induced toxicity (CTCAE v4.0) None Grade I Grade II Grade III Grade IV Grade V Total patients with recurrent disease, palliative treatment and incomplete data, 259 patients remained eligible for inclusion and analysis (Fig. 1)
The analyses reveal that both geriatric assessment (GA) and frailty screeners are independently associated with postoperative complications in head and neck cancer (HNC) pa tients, but not with acute radiation-induced toxicity

Summary

Introduction

A challenging clinical problem for head and neck oncologists is the increase of the proportion of older patients [1]. This is a consequence of the ageing population in the Western world [2]. It is known that frail patients have a higher chance of adverse treatment outcome and loss of functioning [5]. This results in a complex treatment decisionmaking process for oncologists and their patients, in which ideally both undertreatment of fit older patients and overtreatment of frail younger patients should be avoided

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