Evaluation of a new two-step frailty assessment of head and neck patients in a prospective cohort

Purpose Assessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between ger...

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Published in:	European archives of oto-rhino-laryngology Vol. 281; no. 8; pp. 4291 - 4304
Main Authors:	Padovan, Beniamino Vincenzoni, Bijl, M. A. J., Langendijk, J. A., van der Laan, H. P., Van Dijk, B. A. C., Festen, S., Halmos, G. B.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2024
Subjects:	Aged Aged, 80 and over Female Frailty - diagnosis Geriatric Assessment - methods Head and Neck Head and Neck Neoplasms - surgery Head and Neck Neoplasms - therapy Head and Neck Surgery Humans Male Medicine Medicine & Public Health Middle Aged Neurosurgery Otorhinolaryngology Postoperative Complications - epidemiology Prospective Studies Referral and Consultation Retrospective Studies Adverse outcomes Frailty Head and neck oncology Geriatric screening
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Summary:	Purpose Assessing frailty, in head and neck cancer (HNC) patients is key when choosing appropriate treatment. Optimal screening is challenging, as it should be feasible and should avoid over-referral for comprehensive geriatric assessment (CGA) This study aims to evaluate the association between geriatric assessment using a new two-step care pathway, referral to geriatrician and adverse outcomes. Methods This institutional retrospective analysis on a prospective cohort analysed the multimodal geriatric assessment (GA) of newly diagnosed HNC patients. Uni- and multivariable logistic regression was performed to study the association between the screening tests, and referral to the geriatrician for complete geriatric screening, and adverse outcomes. Results This study included 539 patients, of whom 276 were screened. Patients who underwent the GA, were significantly older and more often had advanced tumour stages compared to non-screened patients. Referral to the geriatrician was done for 30.8% of patients. Of the 130 patients who underwent surgery, 26/130 (20%) experienced clinically relevant postoperative complications. Of the 184 patients who underwent (radio)chemotherapy, 50/184 (27.2%) had clinically relevant treatment-related toxicity. Age, treatment intensity, polypharmacy and cognitive deficits, were independently associated with referral to geriatrician. A medium to high risk of malnutrition was independently associated with acute radiation induced toxicity and adverse outcomes in general. Conclusion The current study showed a 30.8% referral rate for CGA by a geriatrician. Age, treatment intensity, cognitive deficits and polypharmacy were associated with higher rates of referral. Furthermore, nutritional status was found to be an important negative factor for adverse treatment outcomes, that requires attention.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0937-4477 1434-4726 1434-4726
DOI:	10.1007/s00405-024-08651-8