Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Differences in frailty and other geriatric parameters between patients with head and neck cancer and other solid malignancies

(2018) Driessen, D.A.J.J. (Daphne)

Objective: The biological age of head and neck cancer (HNC) patients is thought to be
increased due to an unhealthy lifestyle. Choosing the best treatment regarding intention and
modality with respect to predicted outcomes and treatment-related comorbidity can therefore
be challenging in this particular group of patients. Frailty screening and comprehensive
geriatric assessment (CGA) have been proposed to be of significant value when making this
decision. The hypothesis, regarding HNC patients to be more frail and biologically older, has
never been proven in the literature before. In the present study, we aimed to investigate the
differences in frailty, other CGA parameters and quality of life between HNC patients and
patients with other types of solid malignancies by making use of several frailty tests.
Methods: This is an observational retrospective study based on two prospectively collected
datasets. Patients treated for HNC in the University Medical Centre Groningen (UMCG) from
October 2014 till October 2017 are included and patients surgically treated in the UMCG
between August 2014 and December 2016 for a solid tumour of the gynaecological tract,
digestive tract, soft tissue or skin, breast, kidney or thyroid are included. Several screening
instruments, namely Groningen frailty indicator (GFI), mini mental state examination
(MMSE), timed up and go (TUG), activities of daily living (ADL), instrumental activities of
daily living (IADL) and quality of life (EORTC QLQ-C30) are assessed at baseline in both
cohorts. Logistic regression analysis is performed to evaluate the impact of frailty on patient
Results: A total number of 242 and 180 patients were included in the HNC and surgical
oncology cohort, respectively. HNC patients appeared to be more frail on the GFI (p=0.02)
and its subscales ‘daily activities’ (p=0.04) and ‘psychosocial functioning’ (p=0.01). The
latter showed an increased score in multivariate analysis as well (p=0.02). Furthermore, the
HNC cohort had more impairments regarding MMSE and TUG; however, this could not be
further analysed in univariate analysis due to limited values. We found an increased level of
comorbidities in the surgical oncology cohort, compared to the HNC group.
Conclusions: This study suggests higher biological age of HNC patients, as increased frailty,
impaired mental status and mobility was found in this cohort. Interestingly, this study implies
that frailty is independent of comorbidity. Further prospective research in more homogeneous
cohorts needs to be conducted in order to draw more firm conclusions.

To top