Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review

Deudekom, Floor J. van; Schimberg, Anouk S.; Kallenberg, Marije H.; Slingerland, Marije; Velden, Lily-Ann van der; Mooijaart, Simon P.

doi:10.1016/j.oraloncology.2016.11.013

Cited by 62 publications

(58 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although these studies represent a start to understanding frailty and outcomes in HNC surgery, there are limitations and gaps in the literature. A recent systematic review of longitudinal studies evaluating the association of functional or cognitive impairment, social environment, and/or frailty with adverse outcomes in patients with HNC failed to find any longitudinal studies assessing an association of frailty with adverse outcomes. Secondly, the median age of patients varied between studies, and many did not selectively include octogenarians and nonagenarians.…”

Section: Discussionmentioning

confidence: 99%

“…Frailty has been defined as a syndrome of age‐related loss of physical, cognitive, social, and psychological functioning as well as the inability of the body to compensate for increased stress, which leads to decreased physiologic reserve across multiple organ systems . There are two main constructs for conceptualizing frailty: 1) the phenotypic model, and 2) the deficit accumulation measure of frailty.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

Objective: Frailty has emerged as an important determinant of many health outcomes across various surgical specialties. We examined the published literature reporting on frailty as a predictor of perioperative outcomes in head and neck cancer (HNC) surgery.Study Design: Narrative review with limited electronic database search and cross-referencing of included studies. Methods: PubMed was searched from inception until June 2019 to capture studies evaluating an association between frailty and perioperative outcomes among patients undergoing HNC surgery. Primary outcomes included mortality and morbidity, whereas secondary outcomes included in-hospital cost, length of stay, readmission, and discharge disposition.Results: We identified nine series examining frailty as a predictor of outcomes in HNC. The majority of studies (77%) identified patients using a large population-based database such as the National Surgical Quality Improvement Project or National Inpatient Sample. Frailty measures applied in the HNC surgery literature include the modified frailty index, Groningen Frailty Indicator, and John Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Most studies demonstrated a significant association between frailty and perioperative outcomes, including mortality, perioperative complications, and Clavien-Dindo grade IV complications. Furthermore, frailty was associated with greater length of hospital stay, readmission rate, and likelihood of discharge to short-term or skilled nursing facilities.Conclusion: The current literature demonstrates the utility of frailty as a predictor of perioperative mortality and morbidity. Further research is needed to develop frailty screening measures in order to risk-stratify patients and optimize modifiable factors preoperatively.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…This difference was based on norms provided by the EORTC (http://groups.eortc.be/qol/manuals) with the threshold for statistical significance set at a p value of 0.05. Because of the severity of these patients’ pathology and the high risk of mortality of metastatic cancer combined with an aging population [6] and social isolation [20–24, 25], we assumed that a potential 20% of patients will be lost to follow-up. These calculations showed that 320 patients are needed (160 per group).…”

Section: Methodsmentioning

confidence: 99%

PREDOMOS study, impact of a social intervention program for socially isolated elderly cancer patients: study protocol for a randomized controlled trial

Crétel-Durand¹,

Nouguerède²,

Caer³

et al. 2017

Trials

View full text Add to dashboard Cite

BackgroundCancer incidence and social isolation increase along with advanced age, and social isolation potentiates the relative risk of death by cancer. Once spotted, social isolation can be averted with the intervention of a multidisciplinary team. Techniques of automation and remote assistance have already demonstrated their positive impact on falls prevention and quality of life (QoL), though little is known about their impact on socially isolated elderly patients supported for cancer.The primary objective of the PREDOMOS study is to evaluate the impact of establishing a Program of Social intervention associated with techniques of Domotic and Remote assistance (PS-DR) on the improvement of QoL of elderly isolated patients, treated for locally advanced or metastatic cancer. The secondary objectives include treatment failure, tolerance, survival, and autonomy.Methods/designThis trial is a multicenter, prospective, randomized, placebo-controlled, open-label, two-parallel group study. The setting is 10 French oncogeriatric centers. Inclusion criteria are patients aged at least 70 years with a social isolation risk and a histological diagnosis of cancer, locally advanced or metastatic disease. The groups are (1) the control group, receiving usual care; (2) the experimental group, receiving usual care associating with monthly social assistance, domotic, and remote assistance. Participants are randomized in a 1:1 allocation ratio. Evaluation times involve inclusion (randomization) and follow-up (12 months). The primary endpoint is QoL at 3 months (via European Organization for Research and Treatment of Cancer (EORTC) QLQ C30); secondary endpoints are social isolation, time to treatment failure, toxicity, dose response-intensity, survival, autonomy, and QoL at 6 months. For the sample size, 320 individuals are required to obtain 90% power to detect a 10-point difference (standard deviation 25) in QoL score between the two groups (20% loss to follow-up patients expected).DiscussionThe randomized controlled design is the most appropriate design to demonstrate the efficacy of a new experimental strategy (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study.Trial registrationClinicalTrials.gov, NCT02829762. Registered on 29 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1894-7) contains supplementary material, which is available to authorized users.

show abstract

“…Survivors report numerous unmet physical, functional, psychosocial, and financial needs and problems with subsequent cancers, fatigue, pain, lymphedema, neuropathies, balance problems, mobility issues, bladder and bowel problems, dysphonia and other communication difficulties, dysphagia, cardiopulmonary and other end‐organ function declines, sexual dysfunction, depression and anxiety, and cognitive problems, among others . These problems can lead to reduced work productivity, quality of life, and survival . A confluence of several factors is limiting the resources of both health care systems and patients to offer and participate in needed follow‐up care services.…”

Section: The Need For Personalized Pathways For Cancer Follow‐up Carementioning

confidence: 99%

“…[8][9][10][11][12][13][14] These problems can lead to reduced work productivity, 15 quality of life, 16,17 and survival. [18][19][20][21][22] A conf luence of several factors is limiting the resources of both health care systems and patients to offer and participate in needed follow-up care services. These factors include: the growing number of survivors, especially those older than 65 years, who require the management of multiple comorbid conditions in addition to their cancer-specific concerns 2 ; health care provider shortages in oncology, primary care, and nursing [23][24][25][26] ; scarce provider education or training in how to provide cancer follow-up care, especially for the primary care workforce 27 ; and the increasing costs of cancer care 28 and posttreatment survivorship care.…”

mentioning

confidence: 99%

Implementing personalized pathways for cancer follow‐up care in the United States: Proceedings from an American Cancer Society–American Society of Clinical Oncology summit

Alfano

Mayer

Bhatia

et al. 2019

CA A Cancer J Clinicians

View full text Add to dashboard Cite

A new approach to cancer follow‐up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow‐up care pathways, depending on the type(s) and level(s) of resources needed for patients’ long‐term care, is in use in the United Kingdom and other countries and has been shown to meet patients’ needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow‐up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow‐up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus‐based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients’ risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self‐managing their health, setting expectations with patients from diagnosis onward for the need for follow‐up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.

show abstract

Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review

Cited by 62 publications

References 64 publications

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

PREDOMOS study, impact of a social intervention program for socially isolated elderly cancer patients: study protocol for a randomized controlled trial

Implementing personalized pathways for cancer follow‐up care in the United States: Proceedings from an American Cancer Society–American Society of Clinical Oncology summit

Contact Info

Product

Resources

About