Frailty and Increased Levels of Symptom Burden Can Predict the Presence of Each Other in HNSCC Patients

Abstract

Frailty is an important risk factor for adverse events (AEs), especially in elderly patients. Therefore, assessing frailty before therapy is recommended. In head and neck squamous cell carcinoma (HNSCC) patients, frailty is prognostic for severe postoperative complications and declining quality of life (QoL) after HNSCC treatment. Thus, assessment of frailty may help to identify individuals at risk for AE caused by oncologic therapy. We investigated the relationship between frailty and symptom burden to better understand their interaction and impact on HNSCC patients. In this prospectively designed cross-sectional study, the presence of frailty and symptom burden was assessed by using the Geriatric 8 (G8) and Minimal Documentation System (MIDOS2) questionnaires. A total of 59 consecutively accrued patients with a first diagnosis of HNSCC before therapy were evaluated. Patients were considered frail at a total G8 score ≤ 14. The MIDOS2 symptom burden score was considered pathological with a total score ≥ 4 or any severe symptom (=3). Statistical correlations were analyzed using Spearman and Pearson correlation. Receiver operator characteristic (ROC) curves were used to analyze the potential of predicting frailty and MIDOS2. p-values 2 correlated significantly (ρ = −0.487, p r = −0.423, p 2 symptom score (AUC = 0.808, 95% CI 0.698–0.917, p 2 (AUC = 0.750, 95% CI 0.622–0.878, p 2 indicates a coherence of both risk factors in HNSCC patients. Considering at least one of both scores might improve the identification of individuals at risk and achieve higher QoL and reduced complication rates by decision making for appropriate therapy regimens.

Keywords

• frailty
• geriatric questionnaire G8
• Minimal Documentation System (MIDOS²)
• symptom burden
• Edmonton Symptom Assessment System (ESAS)
• head and neck squamous cell carcinoma (HNSCC)