Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer

Shao-Ming Yu; Chih-Chung Hsu; Shun-Wen Hsueh; Chia-Yen Hung; Chang-Hsien Lu; Kun-Yun Yeh; Hung-Ming Wang; Shinn-Yn Lin; Yu-Shin Hung; Wen-Chi Chou

doi:10.1016/j.oraloncology.2023.106621

Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer

Oral Oncol. 2023 Dec:147:106621. doi: 10.1016/j.oraloncology.2023.106621. Epub 2023 Nov 4.

Authors

Affiliations

¹ Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
² Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
³ Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
⁴ Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
⁵ Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: wenchi3992@yahoo.com.tw.

PMID: 37931492
DOI: 10.1016/j.oraloncology.2023.106621

Abstract

Purpose: Frailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC).

Methods: We prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes.

Results: The prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival.

Conclusions: Frailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.

Keywords: Frailty; Head and neck cancer; Non-elderly adult; Outcome; Tolerance.

MeSH terms

Aged
Early Detection of Cancer
Frailty* / complications
Frailty* / diagnosis
Head and Neck Neoplasms* / complications
Head and Neck Neoplasms* / diagnosis
Head and Neck Neoplasms* / therapy
Humans
Middle Aged
Postoperative Complications / etiology
Quality of Life
Risk Factors