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Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions. Eur Arch Otorhinolaryngol 2023; 280:1893-1902. [PMID: 36484854 PMCID: PMC9988738 DOI: 10.1007/s00405-022-07728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC. METHODS In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors. RESULTS In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients. CONCLUSIONS Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
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Shah HP, Cohen O, Sukys J, Dibble J, Mehra S. The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-A retrospective study using two independent frailty scores. Oral Oncol 2022; 132:106006. [PMID: 35835056 DOI: 10.1016/j.oraloncology.2022.106006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, no studies have investigated potential associations between frailty and adjuvant treatment delivery after reconstructive surgery. We examine the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after reconstructive surgery for head and neck cancers (HNCs). METHODS A retrospective review of patients who underwent free flap reconstruction for HNC at a single institution from 2015 to 2021 and received adjuvant radiation was performed. Frailty was assessed using two independent scales: the 11-item modified frailty index (mFI) score and binary Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Timely adjuvant initiation (within six weeks of surgery), duration of adjuvant treatment, and completion were compared between frail and non-frail patients. RESULTS Of the 163 patients included for analysis, 52 (31.9%) were identified as frail by the ACG indicator and 24 (14.7%) were identified as frail with an mFI score ≥ 3. Frail patients (mFI score ≥ 3) were significantly less likely than non-frail patients to initiate adjuvant treatment within six weeks (OR:0.21, CI:0.04-0.85, p = 0.046). Frailty designated by either frailty scale was not significantly associated with adjuvant treatment duration. Likelihood of adjuvant treatment completion was significantly lower for frail compared to non-frail patients by both scales: ACG indicator (OR 0.02, CI:9.05 × 10-4-0.25, p = 0.007) and mFI score ≥ 3 (OR:0.01, CI:6.85 × 10-4-0.13, p = 0.007). CONCLUSIONS Frailty is associated with decreased likelihood of timely adjuvant treatment initiation and completion in patients with HNCs after free flap reconstruction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Oded Cohen
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jordan Sukys
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jacqueline Dibble
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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Kunz V, Wichmann G, Wald T, Pirlich M, Zebralla V, Dietz A, Wiegand S. Frailty Assessed with FRAIL Scale and G8 Questionnaire Predicts Severe Postoperative Complications in Patients Receiving Major Head and Neck Surgery. J Clin Med 2022; 11:jcm11164714. [PMID: 36012953 PMCID: PMC9409964 DOI: 10.3390/jcm11164714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Frailty represents a complex geriatric syndrome associated with elevated rates of postoperative complications as shown for several malignant entities, including head and neck cancer. A specific screening instrument to assess frailty in head and neck patients does not exist. Both the FRAIL Scale and the G8 questionnaire are well-established and easy to use as screening tools. The present study’s aim was to assess the potential of frailty screening to predict postoperative complications in head and neck patients prior to surgery. Patients and methods: We recorded demographic data, pre-existing medical conditions and clinical characteristics in a prospective cohort of 104 head and neck cancer patients undergoing major head and neck surgery and assessed frailty prospectively on the day of admission utilizing the G8 questionnaire and the FRAIL Scale. We analyzed the link between occurrence of postoperative complications up to the twenty-first postoperative day and age, frailty and other covariates using χ2 tests and receiver operating characteristic (ROC) curves. Results: There was no significant correlation between patients’ pre-existing medical conditions and postoperative complications. Whereas chronological age alone did not predict the occurrence of postoperative complications, frailty posed the highest risk for complications. Frailty according to either the G8 questionnaire or the FRAIL Scale predicted occurrence of complications with an area under the curve (AUC) of 0.64 (p = 0.018) and 0.62 (p = 0.039) and severe complications with an AUC of 0.72 (p = 0.014) and 0.69 (p=0.031), respectively. Neither frailty score correlated with age or with each other. Conclusion: Prospective screening using the FRAIL Scale or the G8 questionnaire reliably detected frailty in our sample group. Frailty is linked to increased risk of postoperative complications. The correct prediction of severe postoperative complications as shown identifies vulnerable cases and triggers awareness of potential complications. Anticipating risk allows for a more comprehensive view of the patient and triggers decision making towards risk adjustment, and therefore a selective view of alternative treatment modalities.
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4
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Cheng D, Dumontier C, Sheikh AR, La J, Brophy MT, Do NV, Driver JA, Tuck DP, Fillmore NR. Prognostic value of the veterans affairs frailty index in older patients with non-small cell lung cancer. Cancer Med 2022; 11:3009-3022. [PMID: 35338613 PMCID: PMC9359868 DOI: 10.1002/cam4.4658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Older patients with non-small cell lung cancer (NSCLC) are a heterogeneous population with varying degrees of frailty. An electronic frailty index such as the Veterans Affairs Frailty Index (VA-FI) can potentially help identify vulnerable patients at high risk of poor outcomes. METHODS NSCLC patients ≥65 years old and diagnosed in 2002-2017 were identified using the VA Central Cancer Registry. The VA-FI was calculated using administrative codes from VA electronic health records data linked with Medicare and Medicaid data. We assessed associations between the VA-FI and times to mortality, hospitalization, and emergency room (ER) visit following diagnosis by Kaplan-Meier analysis and multivariable stratified Cox models. We also evaluated the change in discrimination and calibration of reference prognostic models after adding VA-FI. RESULTS We identified a cohort of 42,204 older NSCLC VA patients, in which 55.5% were classified as frail (VA-FI >0.2). After adjustment, there was a strong association between VA-FI and the risk of mortality (HR = 1.23 for an increase of four deficits or, equivalently, an increase of 0.129 on VA-FI, p < 0.001), hospitalization (HR = 1.16 for four deficits, p < 0.001), and ER visit (HR = 1.18 for four deficits, p < 0.001). Adding VA-FI to baseline prognostic models led to statistically significant improvements in time-dependent area under curves and did not have a strong impact on calibration. CONCLUSION Older NSCLC patients with higher VA-FI have significantly elevated risks of mortality, hospitalizations, and ER visits following diagnosis. An electronic frailty index can serve as an accessible tool to identify patients with vulnerabilities to inform clinical care and research.
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Affiliation(s)
- David Cheng
- Massachusetts General HospitalBostonMAUnited States
- Department of MedicineHarvard Medical SchoolBostonMAUnited States
| | - Clark Dumontier
- Department of MedicineHarvard Medical SchoolBostonMAUnited States
- VA Boston Healthcare SystemBostonMAUnited States
- Brigham and Women's HospitalBostonMAUnited States
| | | | - Jennifer La
- VA Boston Healthcare SystemBostonMAUnited States
| | - Mary T. Brophy
- VA Boston Healthcare SystemBostonMAUnited States
- Boston UniversityBostonMAUnited States
| | - Nhan V. Do
- VA Boston Healthcare SystemBostonMAUnited States
- Boston UniversityBostonMAUnited States
| | - Jane A. Driver
- Department of MedicineHarvard Medical SchoolBostonMAUnited States
- VA Boston Healthcare SystemBostonMAUnited States
- Boston UniversityBostonMAUnited States
- Dana‐Farber Cancer InstituteBostonMAUnited States
| | - David P. Tuck
- VA Boston Healthcare SystemBostonMAUnited States
- Boston UniversityBostonMAUnited States
| | - Nathanael R. Fillmore
- Department of MedicineHarvard Medical SchoolBostonMAUnited States
- VA Boston Healthcare SystemBostonMAUnited States
- Dana‐Farber Cancer InstituteBostonMAUnited States
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Paillaud E, Brugel L, Bertolus C, Baron M, Bequignon E, Caillet P, Schouman T, Lacau Saint Guily J, Périé S, Bouvard E, Laurent M, Salvan D, Chaumette L, de Decker L, Piot B, Barry B, Raynaud-Simon A, Sauvaget E, Bach C, Bizard A, Bounar A, Minard A, Aziz B, Chevalier E, Chevalier D, Gaxatte C, Malard O, Liuu E, Lacour S, Gregoire L, Lafont C, Canouï-Poitrine F. Effectiveness of Geriatric Assessment-Driven Interventions on Survival and Functional and Nutritional Status in Older Patients with Head and Neck Cancer: A Randomized Controlled Trial (EGeSOR). Cancers (Basel) 2022; 14:cancers14133290. [PMID: 35805060 PMCID: PMC9265581 DOI: 10.3390/cancers14133290] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Due to population ageing, there is an increasing number of older patients with head and neck cancers (HNC). Management of HNCs is complex. This population may be frailer than other patients with solid cancer. The Geriatric Assessment (GA) is a multidimensional diagnostic and therapeutic tool focused on frailty to propose a coordinated treatment plan and long-term follow-up. Several trials assessed the efficacy of GA-driven interventions on diverse outcomes but no recent randomized controlled trial demonstrated the impact on mortality, functional, or nutritional status as a primary outcome in this particular population. This trial highlighted several difficulties in implementation of geriatric interventions and suggested that the assessment of other models as co-management with oncologists and/or experienced practice nurses could be useful in clinical routine practice. Abstract This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status.
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Affiliation(s)
- Elena Paillaud
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
- Correspondence: ; Tel.: +33-156-09-33-10
| | - Lydia Brugel
- Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France; (L.B.); (E.B.)
| | - Chloe Bertolus
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, Hôpital Pitié Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75013 Paris, France; (C.B.); (T.S.)
| | - Melany Baron
- Service de Soins de Suites et de Réadaptation Gériatrique, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94205 Ivry sur Seine, France;
| | - Emilie Bequignon
- Service d’ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France; (L.B.); (E.B.)
| | - Philippe Caillet
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Paris Cancer Institute CARPEM, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Thomas Schouman
- Service de Chirurgie Maxillo-Faciale, Sorbonne Université, Hôpital Pitié Salpétrière, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75013 Paris, France; (C.B.); (T.S.)
| | - Jean Lacau Saint Guily
- Département d’ORL, Sorbonne Université, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France; (J.L.S.G.); (S.P.)
- Département d’ORL, J Lacau St Guily Exerce à l’Hôpital-Fondation Rothschild, S Périé Exerce à la Clinique Hartmann, F-92200 Neuilly Sur Seine, France
| | - Sophie Périé
- Département d’ORL, Sorbonne Université, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France; (J.L.S.G.); (S.P.)
- Département d’ORL, J Lacau St Guily Exerce à l’Hôpital-Fondation Rothschild, S Périé Exerce à la Clinique Hartmann, F-92200 Neuilly Sur Seine, France
| | - Eric Bouvard
- Service de Gériatrie, Hôpital Tenon, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75020 Paris, France;
| | - Marie Laurent
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Département de Gériatrie, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
| | - Didier Salvan
- Service ORL et Cervico-Facial, Centre Hospitalier Sud Francilien, F-91100 Corbeil-Essonnes, France;
| | - Laurence Chaumette
- Service de Court Sejour Gériatrique, Centre Hospitalier Sud Francilien, F-91100 Corbeil-Essonnes, France;
| | - Laure de Decker
- Service de Gériatrie, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Benoit Piot
- Service de Chirurgie Maxillo-Faciale et Stomatologie, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Beatrix Barry
- Service ORL et Chirurgie Cervico-Faciale, Université de Paris, Hôpital Bichat, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75018 Paris, France;
| | - Agathe Raynaud-Simon
- Service de Gériatrie, Université Paris Cité, Hôpital Bichat, Assistance-Publique Hôpitaux de Paris (AP-HP), F-75018 Paris, France;
| | - Elisabeth Sauvaget
- Service ORL et Chirurgie Cervico-Faciale, Groupe Hospitalier Paris-Saint Joseph, F-75014 Paris, France;
| | | | - Antoine Bizard
- Unité de Gériatrie Aigue, Hôpital Foch, F-92150 Suresnes, France;
| | - Abderrahmane Bounar
- Unité de Gériatrie Aigue, Centre Hospitalier Intercommunal Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France;
| | - Aurelien Minard
- Service de Gériatrie, Hôpital Léopold Bellan, F-75014 Paris, France;
| | - Bechara Aziz
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France;
| | - Eric Chevalier
- Service ORL et Chirurgie Cervico-Faciale, Groupement Hospitalier Intercommunal Le Raincy-Montfermeil, F-93370 Montfermeil, France;
| | - Dominique Chevalier
- Service ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Lille, Hôpital Huriez, F-59000 Lille, France;
| | - Cedric Gaxatte
- Service de Médecine Gériatrique, Centre Hospitalier Universitaire de Lille, F-59000 Lille, France;
| | - Olivier Malard
- Service d’ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire de Nantes, F-44093 Nantes, France;
| | - Evelyne Liuu
- Service de Gériatrie, Centre Hospitalier Universitaire de Poitiers, F-86021 Poitiers, France;
| | - Sandrine Lacour
- Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, F-94010 Créteil, France;
| | - Laetitia Gregoire
- Unité de Recherche Clinique (URC-Mondor), Hôpital Henri-Mondor, AP-HP, F-94010 Créteil, France;
| | - Charlotte Lafont
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
| | - Florence Canouï-Poitrine
- IMRB, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Est Créteil, F-94010 Créteil, France; (P.C.); (M.L.); (C.L.); (F.C.-P.)
- Service de Santé Publique, Hôpital Henri-Mondor, Assistance-Publique Hôpitaux de Paris (AP-HP), F-94010 Créteil, France
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Cleere EF, Davey MG, O'Neill JP. "Age is just a number"; frailty as a marker of peri-operative risk in head and neck surgery: Systematic review and meta-analysis. Head Neck 2022; 44:1927-1939. [PMID: 35653114 DOI: 10.1002/hed.27110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frailty refers to a patient's reduced capacity to withstand stressors due to a reduction in physiologic reserves. We assessed the impact of frailty on outcomes following head and neck surgery. METHODS We performed a systematic review in accordance with the PRISMA guidelines. Meta-analysis was performed using the Mantel-Haenszel method. RESULTS Fourteen studies incorporating 182 059 patients were included in qualitative synthesis with 15 953 (8.8%) of patients deemed as frail. Meta-analysis incorporating nine studies demonstrated that frailty is associated with an increased 30 day postoperative morbidity (OR 2.74; 95% CI 1.98-3.80; p < 0.01) and meta-analysis with six studies suggested increased 30-day mortality (OR 2.94; 95% CI 2.62-3.31; p < 0.01). Preliminary meta-analyses between two and five studies suggested that frail patients had reduced overall survival and were more likely to be discharged to a nonhome location or readmitted within 30 days. CONCLUSIONS Frailty appears to be associated with poor short-term outcomes following head and neck surgery and may improve understanding of an individual patient's peri-operative risk.
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Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James P O'Neill
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
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Corry J, Ng WT, Ma SJ, Singh AK, de Graeff P, Oosting SF. Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439036 DOI: 10.1200/edbk_359482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.
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Affiliation(s)
- June Corry
- Division Radiation Oncology, GenesisCare Radiation OncologySt Vincent's Hospital, Melbourne, Australia.,Department of MedicineThe University of Melbourne, Parkville, Australia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of MedicineThe University of Hong Kong, Hong Kong, China.,Clinical Oncology CentreThe University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pauline de Graeff
- University Center for Geriatric MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Amini A, Morris L, Ludmir EB, Movsas B, Jagsi R, VanderWalde NA. Radiation Therapy in Older Adults With Cancer: A Critical Modality in Geriatric Oncology. J Clin Oncol 2022; 40:1806-1811. [PMID: 35417248 DOI: 10.1200/jco.21.02656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Radiation therapy (RT) is a commonly used modality in the treatment of older adults with cancer, and RT represents an attractive oncologic treatment option, providing a noninvasive local therapy with limited systemic side effects. The Journal of Clinical Oncology (JCO) recently published a special series on Geriatric Oncology providing a comprehensive overview of multiple treatment modalities available to older adults with cancer. The purpose of this short review is to highlight the importance of RT in the treatment of older adults and encourage multidisciplinary participation in their care.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Lucinda Morris
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Noam A VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, Memphis, TN
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9
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Mady LJ, Baddour K, Hodges JC, Magaña LC, Schwarzbach HL, Borrebach JD, Nilsen ML, Johnson JT, Hall DE. The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm. Oral Oncol 2022; 126:105766. [PMID: 35168191 PMCID: PMC9642850 DOI: 10.1016/j.oraloncology.2022.105766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compare survival of head and neck cancer (HNC) patients treated with surgical or non-surgical management according to frailty, quantify frailty with the Risk Analysis Index (RAI), a validated 14-item instrument. MATERIALS AND METHODS Prospective cohort study of newly diagnosed HNC patients (≥18 years) who had frailty assessment from April 13, 2016 to September 30, 2016. Primary outcome was overall survival at 1- and 3-years. Cox proportional hazard models were utilized to examine mortality with predictor variables. Adjusted and unadjusted (Kaplan-Meier) survival curves stratified by either RAI scores or treatment modality were plotted. Kruskal-Wallis and likelihood ratio chi-square tests were used for comparing clinicodemographic variables. RESULTS Of 165 patients, 54 (32.7%) were managed non-surgically, 49 (29.7%) were treated with definitive surgery only, and 62 (37.6%) were treated with multimodality (surgery + adjuvant) therapy. Among the full cohort and subgroup analysis of the frail/very frail (RAI ≥ 37), non-surgical patients had worse or similar 3-year survival than those treated with surgery +/- adjuvant therapy. Multivariable Cox proportional hazard models demonstrate that frail patients treated non-surgically experienced worse survival than their counterparts treated with surgery (HR = 2.50, p = 0.015, 95% CI: 1.19, 5.23) or multimodality therapy (HR = 3.91, p < 0.001, 95% CI: 1.94-7.89). CONCLUSION Across all levels of frailty, long term survival of HNC patients treated without surgery is either worse than or like those treated with surgery. These findings (1) challenge current practices of steering patients "too frail for surgery" towards non-surgical, "non-invasive" therapy, and (2) suggest equipoise warranting randomized trials to clarify treatment of frail patients.
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Affiliation(s)
- Leila J. Mady
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Linda C. Magaña
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah L. Schwarzbach
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marci L. Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E. Hall
- Wolff Center at UPMC, Pittsburgh, PA, USA,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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10
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Wiegand S, Dietz A, Wichmann G, Kunz V. [Frailty in Head and Neck Oncology]. Laryngorhinootologie 2022; 101:249-258. [PMID: 35226958 DOI: 10.1055/a-1525-6600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since treatment of elderly patients with head and neck cancer is often challenging due to preexisting comorbidities, continuous efforts are required to raise awareness for frailty, which is a multidimensional state of diminished physiologic reserve resulting in decreased resiliency and increased vulnerability to stressors. Frailty is a predictor of poor clinical outcomes in head and neck cancer patients, but until now there is no standardization of frailty assessment. Pretherapeutic frailty assessment among head and neck cancer patients should be incorporated into routine multidisciplinary management to predict adverse outcomes and tailor a personalized treatment. This article would like to explain the complex syndrome frailty and its importance for head and neck oncology.
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Affiliation(s)
- Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig
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11
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Haehl E, Rühle A, Spohn S, Sprave T, Gkika E, Zamboglou C, Grosu AL, Nicolay NH. Patterns-of-Care Analysis for Radiotherapy of Elderly Head-and-Neck Cancer Patients: A Trinational Survey in Germany, Austria and Switzerland. Front Oncol 2022; 11:723716. [PMID: 35047384 PMCID: PMC8761738 DOI: 10.3389/fonc.2021.723716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/08/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The number of elderly head-and-neck squamous cell carcinoma (HNSCC) patients is increasing, and clinical trials defining the standard of care either excluded or underrepresented elderly patients. This leaves physicians with a challenging and highly individual treatment decision largely lacking clinical evidence. METHODS A tri-national patterns-of-care survey was sent to all members of the German (DEGRO), Austrian (ÖGRO), and Swiss (SRO/SSRO) national societies of radiation oncology. The online questionnaire consisted of 27 questions on the treatment of elderly HNSCC patients, including 6 case-based questions. Frequency distributions and subgroup comparisons were calculated using SPSS statistics software. RESULTS A total of 132 answers were collected, including 46(35%) form universities, 52(39%) from non-university-hospitals and 34(26%) from private practices. 83(63%) treat 1-5 and 42(32%) >5 elderly HNSCC patients per month. Target volumes are defined analog current guidelines by 65(50%) of responders and altered based on age/comorbidities or tumor stage by 36(28%) and 28(22%), respectively. Chemotherapy is routinely administered by 108(84%) if indicated, with weekly 40mg/m2 of cisplatin being the favored regimen by 68(53%) in the definitive situation and 60(47%) in the adjuvant setting. Hypofractionation and hyperfractionation/acceleration are used by 26(20%) and 11(9%), respectively. Only 7(5%) clinicians routinely recommend inpatient treatment for elderly HNSCC patients. In a typical definitive patient case, 73(63%) responders recommended chemoradiation with bilateral elective node irradiation analog current guidelines. In an adjuvant example case recommendations regarding elective volume and chemotherapy were heterogeneous. Differences between responders' institutions concern the frequency of PET-CT in staging, preventive port-catheter and PEG implantation, the choice of chemotherapy regimens and the use of alternative fractionations. CONCLUSION Treatment of elderly HNSCC-patients in the German-speaking countries mainly follows guidelines established for younger patients. Algorithms for patient stratification and treatment de-escalation for "unfit" elderly patients are needed.
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Affiliation(s)
- Erik Haehl
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Simon Spohn
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
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12
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Brain Prehabilitation for Oncologic Surgery. Curr Oncol Rep 2022; 24:1513-1520. [PMID: 35900715 PMCID: PMC9606060 DOI: 10.1007/s11912-022-01312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current research on postoperative cognitive complications, such as delirium and cognitive dysfunction. This includes discussion on preoperative preventive strategies, such as physical and nutritional prehabilitation as well as up-to-date information on neuroprehabilitation. RECENT FINDINGS Current recommendations for prevention of postoperative delirium have focused on multicomponent interventions. The optimal composition of surgical prehabilitation programs targeting exercise and nutrition has not yet been established. The Neurobics Trial shows that cognitive prehabilitation improves cognitive reserve and may be a useful addition to multimodal surgical prehabilitation. Perioperative management of oncologic patients is often associated with a myriad of challenges, such as the management of tumor-related pathologies, adverse events from neoadjuvant therapy, and chronic metabolic and immunological changes associated with malignancy. In addition, oncologic patients are at increased risk of developing frailty, which adversely affects postoperative recovery and further cancer treatment. As a result, oncologic patients are at considerable risk of developing postoperative cognitive complications, such as delirium and cognitive dysfunction. In this review, we discuss the effect of prehabilitation on postoperative cognitive outcomes.
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Han SH, Cho D, Mohammad R, Jung YH, Ahn SH, Cha W, Jeong WJ. Use of the comprehensive geriatric assessment for the prediction of postoperative complications in elderly patients with head and neck cancer. Head Neck 2021; 44:672-680. [PMID: 34918845 DOI: 10.1002/hed.26958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To determine the efficacy of preoperative Comprehensive Geriatric Assessment (CGA) in predicting postoperative complications in elderly patients undergoing head and neck cancer surgery. METHODS Medical records of patients aged ≥70 who underwent elective head and neck cancer surgery were reviewed. CGA scores were prospectively collected prior to surgery and analyzed to determine their association with postoperative complications. RESULTS Of the 65 patients enrolled in this study, 34 (52.3%) with deficits in two or more preoperative CGA domains were categorized as "frail." Fourteen patients (21.5%) experienced postoperative complications. Age was not a risk factor for the complications (p = 0.504). The multivariate analysis indicated that major postoperative complications were significantly associated with frailty (odds ratio [OR] = 21.9, p = 0.039), operation time (OR = 39, p = 0.048), and estimated blood loss (OR = 19.8, p = 0.043). CONCLUSIONS Frailty assessed by preoperative CGA, but not chronological age, was significantly associated with major postoperative complications in elderly patients undergoing head and neck cancer surgery.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Deuktae Cho
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ramla Mohammad
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.,Department of Otolaryngology - Head & Neck Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, South Surra, Kuwait
| | - Young Ho Jung
- Department of Otorhinolaryngology - Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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14
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Mootassim‐Billah S, Van Nuffelen G, Schoentgen J, De Bodt M, Dragan T, Digonnet A, Roper N, Van Gestel D. Assessment of cough in head and neck cancer patients at risk for dysphagia-An overview. Cancer Rep (Hoboken) 2021; 4:e1395. [PMID: 33932152 PMCID: PMC8551981 DOI: 10.1002/cnr2.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This literature review explores the terminology, the neurophysiology, and the assessment of cough in general, in the framework of dysphagia and regarding head and neck cancer patients at risk for dysphagia. In the dysphagic population, cough is currently assessed perceptually during a clinical swallowing evaluation or aerodynamically. RECENT FINDINGS Recent findings have shown intra and inter-rater disagreements regarding perceptual scoring of cough. Also, aerodynamic measurements are impractical in a routine bedside assessment. Coughing, however, is considered to be a clinically relevant sign of aspiration and dysphagia in head and cancer patients treated with concurrent chemoradiotherapy. CONCLUSION This article surveys the literature regarding the established cough assessment and stresses the need to implement innovative methods for assessing cough in head and neck cancer patients treated with concurrent chemoradiotherapy at risk for dysphagia.
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Affiliation(s)
- Sofiana Mootassim‐Billah
- Department of Radiation Oncology, Speech Therapy, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Jean Schoentgen
- BEAMS (Bio‐, Electro‐ And Mechanical Systems)Université Libre de BruxellesBrusselsBelgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery, University Rehabilitation Center for Communication DisordersAntwerp University HospitalAntwerpBelgium
- Department of Translational Neurosciences, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
- Department of Logopaedics and Audiological Sciences, Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Tatiana Dragan
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Antoine Digonnet
- Department of Surgical Oncology, Head and Neck Surgery Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
| | - Nicolas Roper
- Department of Oto‐Rhino‐Laryngology and Head & Neck Surgery, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules BordetUniversité Libre de BruxellesBrusselsBelgium
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15
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Nehlsen A, Agarwal P, Mazumdar M, Dutta P, Goldstein NE, Dharmarajan KV. Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer). J Geriatr Oncol 2021; 13:46-52. [PMID: 34362714 DOI: 10.1016/j.jgo.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/16/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND While radiation therapy (RT) improves function, and quality of life for patients with advanced cancers, patients frequently experience a period of acute toxicity during which functional abilities may decline. Little is understood about changes in functional outcomes after RT in older adults. This study aims to examine changes in daily function at 1 and 6 months following RT. METHODS We reviewed the charts of 117 patients who underwent palliative RT on a prospective registry. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scores ranging from 0 to 6 and 0-8, respectively, were collected at baseline, one-month, and six months post-RT. Patients were classified as low deficit for ADL/IADL if they had 0-1 deficits and high deficit if they had 2+ deficits. RESULTS One-hundred seventy RT courses were identified; 99 were evaluable at each time point. The median age was 67 years. At baseline, 29.5 and 29.9% of patients were classified as high-deficit for ADL and IADL functioning, respectively. At one-month, the majority of patients who were low-deficit at baseline remained so for both measures while approximately one quarter of high-deficit patients showed improvement. Most patients identified as low-deficit at one-month remained so at six-months, while no high-deficit patients improved from one- to six-months. Factors associated with high ADL and IADL deficits included: time (six months), increasing age, and Hispanic/other race. Compared to those with ECOG score of 3, patients with lower scores (0-2) had lower odds of high deficit. CONCLUSION ADL and IADL tools may be useful in describing changes in daily function after palliative RT and in identifying groups of patients who may benefit from additional supportive geriatric care interventions.
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Affiliation(s)
- Anthony Nehlsen
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Parul Agarwal
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Pinaki Dutta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, United States of America; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Geriatrics Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, United States of America.
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16
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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17
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Jones AJ, Campiti VJ, Alwani M, Novinger LJ, Bonetto A, Sim MW, Yesensky JA, Moore MG, Mantravadi AV. Skeletal Muscle Index's Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction. Otolaryngol Head Neck Surg 2020; 165:59-68. [PMID: 33290190 DOI: 10.1177/0194599820973232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the role of skeletal muscle index (SMI) in the assessment of frailty and determination of discharge to post-acute care facilities (PACF) after head and neck cancer free flap reconstruction (HNCFFR). STUDY DESIGN Retrospective cohort. SETTING Single-institution, academic tertiary referral center. METHODS Adult patients undergoing HNCFFR from 2014 to 2019 with preoperative abdominal computed tomography imaging were retrospectively analyzed. Patient demographics, 5-factor modified frailty index (5-mFI), body mass index (BMI), SMI at the third lumbar vertebra, oncologic history, perioperative data, and Clavien-Dindo (CD) complications were collected. Binary logistic regression was used to identify independent predictors of discharge disposition. RESULTS The cohort consisted of 206 patients, 62 (30.1%) of whom were discharged to PACF. Patients discharged to PACF were of older age (65.4 vs 57.1 years, P < .0001) and had a lower SMI (38.8 vs 46.8 cm2/m2, P < .0001), higher 5-mFI (≥3; 25.8% vs 4.2%, P < .0001), and greater incidence of stage IV (80.6% vs 64.1%, P = .0211) aerodigestive cancer (80.6% vs 66.7%, P = .0462). Patients discharged to PACF experienced more blood transfusions (74.2% vs 35.4%, P < .0001), major postoperative complications (CD ≥3, 40.3% vs 12.9%, P < .0001), and delirium (33.9% vs 4.2%, P < .0001). After adjusting for pre- and postoperative factors, multivariate binary logistic regression identified age (P = .0255), 5-mFI (P < .0042), SMI (P = .0199), stage IV cancer (P = .0250), aerodigestive tumor (P = .0366), delirium (P < .0001), and perioperative blood transfusion (P = .0144) as independent predictors of discharge to PACF. CONCLUSIONS SMI and 5-mFI are independently associated with discharge to PACF after HNCFFR and should be considered in preoperative planning and assessment of frailty.
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Affiliation(s)
- Alexander Joseph Jones
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mohamedkazim Alwani
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah J Novinger
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Bonetto
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W Sim
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica A Yesensky
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Chow JC, Cheung KM, Bao KK, Leung AK. In Regard to Chou et al. Int J Radiat Oncol Biol Phys 2020; 108:831-832. [DOI: 10.1016/j.ijrobp.2020.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/21/2020] [Indexed: 10/23/2022]
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Shinde A, Vazquez J, Novak J, Sedrak MS, Amini A. The role of comprehensive geriatric assessment in radiation oncology. J Geriatr Oncol 2020; 11:194-196. [DOI: 10.1016/j.jgo.2019.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/18/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
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20
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Coca‐Pelaz A, Halmos GB, Strojan P, Bree R, Bossi P, Bradford CR, Rinaldo A, Vander Poorten V, Sanabria A, Takes RP, Ferlito A. The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review. Head Neck 2019; 41:2410-2429. [DOI: 10.1002/hed.25696] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrés Coca‐Pelaz
- Department of OtolaryngologyHospital Universitario Central de Asturias Oviedo Spain
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Primož Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Remco Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical SpecialtiesRadiological Sciencesand Public HealthUniversity of Brescia, ASST‐Spedali Civili Brescia Italy
| | - Carol R. Bradford
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Michigan Ann Arbor Michigan
| | | | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery and Department of Oncology, Section Head and Neck OncologyUniversity Hospitals Leuven, KU Leuven Leuven Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of MedicineUniversidad de Antioquia, Clínica Vida Medellín Colombia
| | - Robert P. Takes
- Department of Otolaryngology – Head and Neck SurgeryRadboud University Medical Center Nijmegen The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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21
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Rodrigo JP, García‐Velasco F, Ambrosch P, Vander Poorten V, Suárez C, Coca‐Pelaz A, Strojan P, Hutcheson K, Folz BJ, Bernal‐Sprekelsen M, Rinaldo A, Silver CE, Ferlito A. Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety. Head Neck 2019; 41:1816-1823. [DOI: 10.1002/hed.25616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/25/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Fabian García‐Velasco
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck SurgeryChristian‐Albrechts‐University of Kiel Kiel Germany
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck SurgeryUniversity Hospitals Leuven Leuven Belgium
- Department of Oncology, Section Head and Neck OncologyKU Leuven Leuven Belgium
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Andrés Coca‐Pelaz
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Primoz Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Kate Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and AudiologyMD Anderson Cancer Center Houston Texas
| | | | | | - Alessandra Rinaldo
- Otorhinolaryngology‐Head and neck surgery, University of Udine School of Medicine Udine Italy
| | - Carl E. Silver
- Department of SurgeryUniversity of Arizona College of Medicine Phoenix Arizona
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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22
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Sutton JL, Gould RL, Coulson MC, Ward EV, Butler AM, Smith M, Lavelle G, Rosa A, Langridge M, Howard RJ. Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review. J Am Geriatr Soc 2018; 67:1085-1095. [PMID: 30589075 DOI: 10.1111/jgs.15710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders. METHODS A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion. PARTICIPANTS Adults aged 60 years or older. RESULTS A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48). CONCLUSIONS Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019.
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Affiliation(s)
- Jennifer L Sutton
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca L Gould
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Mark C Coulson
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Megan Smith
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Grace Lavelle
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amy Rosa
- Division of Psychiatry, University College London, London, UK
| | - Margaret Langridge
- Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Howard
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
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23
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Bashjawish B, Patel S, Kılıç S, Svider PF, Hsueh WD, Liu JK, Baredes S, Eloy JA. Effect of elderly status on postoperative complications in patients with sinonasal cancer. Int Forum Allergy Rhinol 2018; 9:220-224. [DOI: 10.1002/alr.22239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/03/2018] [Accepted: 10/14/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Bassel Bashjawish
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Shreya Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Peter F. Svider
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Wayne D. Hsueh
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - James K. Liu
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
- Department of Ophthalmology and Visual Science; Rutgers New Jersey Medical School; Newark NJ
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24
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Noor A, Gibb C, Boase S, Hodge JC, Krishnan S, Foreman A. Frailty in geriatric head and neck cancer: A contemporary review. Laryngoscope 2018; 128:E416-E424. [PMID: 30329155 DOI: 10.1002/lary.27339] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide a summary of the current frailty literature relating to head and neck cancer. DATA SOURCES Ovid MEDLINE, PubMed, Google Scholar. METHODS A comprehensive review of the literature was performed from 2000 to 2017 using key words frailty, elderly, geriatric, surgery, otolaryngology, head and neck cancer. RESULTS The aging population has led to an increased diagnosis of head and neck cancer in elderly patients. The prevalence of comorbidities, disabilities, geriatric syndromes and social issues can make treatment planning and management in this population challenging. Chronological age alone may not be the optimal approach to guiding treatment decisions, as there is marked heterogeneity amongst this age group. Individualization of treatment can be achieved by assessing for the presence of frailty, which has growing evidence as an important marker of health status in geriatric oncology. Frailty is a complex geriatric syndrome characterized by a state of increased vulnerability to stressors and is associated with morbidity, mortality, and treatment toxicity. Screening for frailty may provide an efficient method to identify those who would benefit from further assessment or pretreatment optimization, and to provide prognostic information to assist clinicians and patients in formulating the most ideal treatment plan for the elderly individual with head and neck cancer. CONCLUSIONS Frailty has emerged as an important concept in geriatric oncology, with wide significance in head and neck cancer. Incorporating frailty assessments into clinical practice may provide otolaryngologists pertinent information regarding health status and outcomes leading to optimal care of the elderly cancer patient. Laryngoscope, 128:E416-E424, 2018.
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Affiliation(s)
- Anthony Noor
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Gibb
- Department of Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Sam Boase
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - John-Charles Hodge
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew Foreman
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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25
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Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA. The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment. Int J Radiat Oncol Biol Phys 2017; 98:868-883. [PMID: 28602414 DOI: 10.1016/j.ijrobp.2017.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.
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Affiliation(s)
- Ronald Maggiore
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kelly M Trevino
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Ajeet Gajra
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University Cancer Center, Syracuse, New York
| | | | - Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stewart M Bond
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Ira Parker
- University of California, San Diego School of Medicine, La Jolla, California
| | - Julie A Kish
- Division of Hematology/Oncology, Department of Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center-West Cancer Center, Memphis, Tennessee.
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