Comprehensive Geriatric Assessment and Quality of Life Aspects in Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC)

Abstract

To define frailty in older cancer patients, the aim of this study was to assess the geriatric status and quality of life (QoL) aspects in patients suffering from recurrent/metastatic head and neck squamous cell carcinoma (r/m HNSCC) under palliative treatment. A comprehensive geriatric assessment (CGA) was performed on 21 r/m HNSCC patients at two defined assessments, and the QoL aspects and the impact of descriptive data were evaluated. The Kolmogorov–Smirnov test, Spearman’s rho correlation, and two-way mixed ANOVA were used for statistical analysis. All patients were found to be “frail”. Pain, fatigue, and the burden of illness were the highest-rated symptoms. Oral function and orofacial appearance were highly impaired. A significant impact of descriptive data on the CGA and QoL results was found (all p ≤ 0.05). Thus, the CGA results revealed high frailty, severe comorbidities, and high impairments in QoL aspects. The CGA and QoL results were negatively affected by the primary HNSCC treatment approach, the need for prosthetic treatment, and worse oral functional capacity. Therefore, frailty in r/m HNSCC patients seems to be multidimensional. The evaluation of the CGA and QoL aspects in r/m HNSCC patients can be recommended to detect special needs, organize aftercare, and improve the support for frail and vulnerable cancer patients to create a multidisciplinary treatment approach.

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

“…This strong negative correlation between MIDOS 2 and G8 scores implies that the lower the G8 score, the higher the MIDOS 2 score, and vice versa. Previous studies were also able to show a link between the presence of frailty and increased levels of symptom burden in patients with other severe medical conditions such as chronic kidney disease [ 21 ], liver cirrhosis [ 22 ], and R/M HNSCC [ 16 ]. Furthermore, our data show a strong coherence between the presence of frailty and MIDOS 2 score in therapy-naive patients with newly diagnosed HNSCC, as, on the one hand, the presence of frailty can significantly be predicted by using the MIDOS 2 score and, on the other hand, both of these risk factors also correlate significantly with each other (OR 7.059 [95% CI 1.764–28.243]; p = 0.00296).…”

“…This tool represents the validated German version of the Edmonton Symptom Assessment System (ESAS) [ 14 ], which is validated for use in head and neck oncology itself [ 15 ], and measures symptoms on a self-reported basis. Recent studies were able to show the importance of symptom burden assessment, as increased levels of symptom burden in patients with recurrent or metastatic (R/M) HNSCC were found [ 16 ]. Symptom burden in HNSCC patients was also shown to be reduced depending on treatment response in patients with R/M HNSCC [ 17 ].…”