Clinical Significance of Frailty on Treatment Outcome in Nongeriatric Patients With Head and Neck Cancer and Esophageal Cancer Undergoing Curative-Intent Concurrent Chemoradiotherapy

Abstract

Background Whether the prevalence of frailty and its clinical significance are relevant to treatment outcomes in younger (aged < 65 years) cancer patients remains uncertain. This study aimed to evaluate the impact of frailty on treatment outcomes in younger cancer patients with head and neck and esophageal malignancy. Material and methods This multicenter prospective study recruited 502 patients with locally advanced head and neck and esophageal cancer during 2016–2017 in Taiwan, aged 20–64 years who received curative-intent concurrent chemoradiotherapy (CCRT) as first-line antitumor treatment. Baseline frailty assessment using geriatric assessment (GA) was performed for each patient within 7 days before CCRT initiation. Results Frailty was observed in 169 (33.7%) of 502 middle-aged patients. Frail patients had significantly higher incidences of chemotherapy incompletion (16.6% versus 3.3%, P < .001) and radiotherapy incompletion (16.6% versus 3.6%, P < .001) than fit patients. During CCRT, frail patients had a significantly higher percentage of hospitalizations (42.0% versus 24.6%, P < .001) and a trend toward a higher percentage of emergency room visits (37.9% versus 30.0%, P = .08) than fit patients. Frail patients more likely had a significantly higher incidence of grade ≥ 3 adverse events than fit patients during CCRT. The 1-year survival rate was 68.7% and 85.2% (hazard ratio 2.56, 95% confidence interval 1.80–3.63, P < .001) for frail and fit patients, respectively. Conclusions This study demonstrated the significance of pretreatment frailty on treatment tolerance, treatment-related toxicity, and survival outcome in younger patients with head and neck and esophageal cancer undergoing CCRT. While GA is commonly targeted toward the older population, frailty assessment by GA may also be utilized in younger patients for decision-making guidance and prognosis prediction.

“Age is just a number”; frailty as a marker of peri‐operative risk in head and neck surgery: Systematic review and meta‐analysis

“…The incidence of frailty among patients undergoing head and neck oncologic surgery within this meta‐analysis was 8.8% (15953/189059). These results are lower than those observed in previous oncological studies, including those within the field of head and neck care 21,55 . It is difficult to identify an explanation for this finding however, the inherent risks of selection biases must be considered, particularly as fitter (or “less‐frail”) patients have increased candidacy for surgery within the large retrospective studies included in this study.…”

“…These results are lower than those observed in previous oncological studies, including those within the field of head and neck care. 21,55 It is difficult to identify an explanation for this finding however, the inherent risks of selection biases must be considered, particularly as fitter (or "less-frail") patients have increased candidacy for surgery within the large retrospective studies included in this study. Other socioeconomic factors such as lower education level, smoking and lower income levels have also demonstrated an association with frailty.…”

“…17 The estimated incidence of frailty among nongeriatric patients with head and neck cancer undergoing chemoradiotherapy within a multicenter prospective study by Chou et al was 33.7%. 21 However, the incidence of frailty is known to increase with age, 22 and as such this figure looks certain to rise in accordance with the aging western population. 23 Nevertheless, it is important to highlight that a significant proportion of elderly patients are not frail.…”

Utilization and Impact of a Radiation Nursing Clinic to Address Acute Care Needs for Patients with Gynecologic Cancers

“…Within the head and neck cancer population, studies have shown that patients undergoing concurrent chemoradiotherapy experience a high symptom burden in addition to financial toxicity [ 15 ]. Increased age, baseline frailty, concurrent chemoradiotherapy, the presence of comorbidities, and low socioeconomic status have been identified as risk factors for acute care utilization, including emergency department visits and hospital admission [ 16 , 17 , 18 , 19 , 20 , 21 ]. These results are corroborated by studies in patients with glioblastoma, which also demonstrated an association between acute care utilization and age, Karnofsky Performance Status (KPS), and concurrent chemoradiotherapy [ 22 , 23 ].…”

Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group

“…As an illustration, among 502 patients aged 24 to 60 years who underwent concurrent chemoradiation for locally advanced head and neck cancer, 33.7% were frail. Those patients had a significantly higher rate of hospitalization, emergency room visits, and treatment incompletion compared to the fit ones [ 6 ]. Thus, it is not surprising that among older patients who are deemed fit enough to undergo concurrent chemoradiation for locally advanced disease, high rates of treatment discontinuation, grade 3–4 toxicity and poor survival have been reported [ 7 , 8 ].…”