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

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Jan 11

PMID 38202219

Authors

Viktor Kunz

Gunnar Wichmann

Theresa Wald

Andreas Dietz

Susanne Wiegand

Affiliations

Soon will be listed here.

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 (MIDOS) 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 MIDOS 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 MIDOS. -values < 0.05 were considered significant. A total of 41 patients (69.5%) were considered frail, and 27 patients (45.8%) had increased symptom burden. "Tiredness" was the most common (overall rate 57.8%) and "Pain" was the most often stated "severe" symptom (5 patients, 8.5%). G8 and MIDOS correlated significantly (ρ = -0.487, < 0.001; = -0.423, < 0.001). Frailty can be predicted by MIDOS symptom score (AUC = 0.808, 95% CI 0.698-0.917, < 0.001). Vice versa, the G8 score can predict pathological symptom burden according to MIDOS (AUC = 0.750, 95% CI 0.622-0.878, < 0.001). Conclusions: The strong link between frailty and increased symptom burden assessed by G8 or MIDOS 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.

References

Bellera C, Rainfray M, Mathoulin-Pelissier S, Mertens C, Delva F, Fonck M . Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012; 23(8):2166-2172. DOI: 10.1093/annonc/mdr587. View

Kunz V, Wichmann G, Wald T, Pirlich M, Zebralla V, Dietz A . 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(16). PMC: 9409964. DOI: 10.3390/jcm11164714. View

Newcomb R, Nipp R, Waldman L, Greer J, Lage D, Hochberg E . Symptom burden in patients with cancer who are experiencing unplanned hospitalization. Cancer. 2020; 126(12):2924-2933. DOI: 10.1002/cncr.32833. View

Lelond S, Ward J, Lambert P, Kim C . Symptom Burden of Patients with Advanced Pancreas Cancer (APC): A Provincial Cancer Institute Observational Study. Curr Oncol. 2021; 28(4):2789-2800. PMC: 8395517. DOI: 10.3390/curroncol28040244. View

Serrano A, Laurent M, Barnay T, Martinez-Tapia C, Audureau E, Boudou-Rouquette P . A Two-Step Frailty Assessment Strategy in Older Patients With Solid Tumors: A Decision Curve Analysis. J Clin Oncol. 2022; 41(4):826-834. PMC: 9901978. DOI: 10.1200/JCO.22.01118. View

Allen-Ayodabo C, Eskander A, Davis L, Zhao H, Mahar A, Karam I . Symptom burden among head and neck cancer patients in the first year after diagnosis: Association with primary treatment modality. Oral Oncol. 2019; 99:104434. DOI: 10.1016/j.oraloncology.2019.09.026. View

Bozec A, Majoufre C, de Boutray M, Gal J, Chamorey E, Roussel L . Oral and oropharyngeal cancer surgery with free-flap reconstruction in the elderly: Factors associated with long-term quality of life, patient needs and concerns. A GETTEC cross-sectional study. Surg Oncol. 2020; 35:81-88. DOI: 10.1016/j.suronc.2020.08.014. View

Hecht M, Hahn D, Wolber P, Hautmann M, Reichert D, Weniger S . Treatment response lowers tumor symptom burden in recurrent and/or metastatic head and neck cancer. BMC Cancer. 2020; 20(1):933. PMC: 7526421. DOI: 10.1186/s12885-020-07440-w. View

Mendoza T, Kehl K, Bamidele O, Williams L, Shi Q, Cleeland C . Assessment of baseline symptom burden in treatment-naïve patients with lung cancer: an observational study. Support Care Cancer. 2019; 27(9):3439-3447. DOI: 10.1007/s00520-018-4632-0. View

10.

Goldstein D, Sklar M, de Almeida J, Gilbert R, Gullane P, Irish J . Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery. Laryngoscope. 2019; 130(5):E340-E345. DOI: 10.1002/lary.28222. View

11.

Hernandez Torres C, Hsu T . Comprehensive Geriatric Assessment in the Older Adult with Cancer: A Review. Eur Urol Focus. 2018; 3(4-5):330-339. DOI: 10.1016/j.euf.2017.10.010. View

12.

Noel C, Forner D, Chepeha D, Baran E, Chan K, Parmar A . The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology. Oral Oncol. 2021; 123:105595. DOI: 10.1016/j.oraloncology.2021.105595. View

13.

Nixon A, Wilkinson T, Young H, Taal M, Pendleton N, Mitra S . Symptom-burden in people living with frailty and chronic kidney disease. BMC Nephrol. 2020; 21(1):411. PMC: 7513484. DOI: 10.1186/s12882-020-02063-6. View

14.

Richards S, Frizelle F, Geddes J, Eglinton T, Hampton M . Frailty in surgical patients. Int J Colorectal Dis. 2018; 33(12):1657-1666. DOI: 10.1007/s00384-018-3163-y. View

15.

Rostoft S, ODonovan A, Soubeyran P, Alibhai S, Hamaker M . Geriatric Assessment and Management in Cancer. J Clin Oncol. 2021; 39(19):2058-2067. DOI: 10.1200/JCO.21.00089. View

16.

Deng L, Bischoff K, Kent D, ORiordan D, Pantilat S, Lai J . Frailty is strongly associated with self-reported symptom burden among patients with cirrhosis. Eur J Gastroenterol Hepatol. 2021; 33(1S Suppl 1):e395-e400. PMC: 8435043. DOI: 10.1097/MEG.0000000000002113. View

17.

Chen S, Ma T, Cui W, Li T, Liu D, Chen L . Frailty and long-term survival of patients with colorectal cancer: a meta-analysis. Aging Clin Exp Res. 2022; 34(7):1485-1494. DOI: 10.1007/s40520-021-02072-x. View

18.

Ostwal S, Singh R, Sanghavi P, Patel H, Anandi Q . Correlation between Symptom Burden and Perceived Distress in Advanced Head and Neck Cancer: A Prospective Observational Study. Indian J Palliat Care. 2021; 27(3):419-425. PMC: 8655637. DOI: 10.25259/IJPC_406_20. View

19.

Amit M, Hutcheson K, Zaveri J, Lewin J, Kupferman M, Hessel A . Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry. Oral Oncol. 2019; 91:13-20. DOI: 10.1016/j.oraloncology.2019.01.020. View

20.

Chow W, Rosenthal R, Merkow R, Ko C, Esnaola N . Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012; 215(4):453-66. DOI: 10.1016/j.jamcollsurg.2012.06.017. View