Abstract
To determine the effect of frailty on Health Related Quality of Life (HRQoL) after treatment for Head and Neck Cancer (HNC). Patients were prospectively included in OncoLifeS, a data-biobank. Before treatment, patients underwent geriatric screening, including the Groningen Frailty Indicator (GFI) and Geriatric 8 (G8). Patients' HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) at three, six, twelve and twenty four months after treatment. Linear mixed models were used for statistical analysis. All models were adjusted for baseline HRQoL values, relevant confounders at baseline and yielded estimates (β), 95% confidence intervals and p-values. 288 patients were included. The mean age was 68.4years and 68.8% were male. During follow-up, 84 patients had tumor recurrence and 66 died. Response to EORTC-QLQ-C30 ranged from 77.3% to 87.8%. Frail patients, defined by GFI, had significantly worse Global Health Status/Quality of Life (GHS/QoL) (β=-8.70(-13.54;-3.86), p<0.001), physical functioning (β=-4.55(-8.70;-0.40), p<0.032), emotional functioning (β=-20.06(-25.65;-15.86), p<0.001), and social functioning (β=-8.44(-13.91;-2.98), p<0.003) three months after treatment compared to non-frail patients. Furthermore, frail patients had a significantly worse course of GHS/QoL (β=-7.47(-11.23;-3.70), p=0.001), physical functioning (β=-3.28(-6.26;-0.31), p=0.031) and role functioning (β=-7.27(-12.26;-2.28), p=0.005) over time, compared to non-frail patients. When frailty was determined by G8, frailty was significantly associated with worse GHS/QoL (β=-6.68(-11.00;-2.37), p=0.003) and emotional functioning (β=-5.08(-9.43;-0.73), p=0.022) three months after treatment. Frail patients are at increased risk for decline in HRQoL, and further deterioration during follow-up after treatment for HNC.
Highlights
With the incidence of cancer and the proportion of el derly with cancer rising, oncologists may increasingly encounter the geriatric syndrome of frailty [1]
In the present prospective study, we investigated how frailty affects Health Related Quality of Life (HRQoL) shorty after treatment for Head and Neck Cancer (HNC), and how frailty affects the course of HRQoL during long-term follow-up after treatment
Histopathology, stage and treatment type did not differ between frail and non-frail patients; frail patients had significantly higher age and more severe comorbidity (Table 1)
Summary
With the incidence of cancer and the proportion of el derly with cancer rising, oncologists may increasingly encounter the geriatric syndrome of frailty [1]. Frailty results from the heterogenic process of aging, leaving great diversity in populations with respect to physical, functional, psychological and social status, and is defined as ‘a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes’ [2]. One of the populations that is thought to be very frail are patients with Head and Neck Cancer (HNC). In this population, functional and cognitive impairment, depressive symptoms and social isolation have shown to be highly prevalent [3]. Pa tient related factors such as lifelong tobacco and alcohol abuse, which are etiological factors for HNC, increase frailty status as well [6,7]
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