Influence of Frailty and Life Expectancy on Guideline Adherence and Outcomes in Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Prospective Pilot Study

Abstract

<b><i>Background:</i></b> Cutaneous squamous cell carcinoma is the second most common malignancy of the skin, often occurring in older patients and in the head and neck area (cSCCHN). Age, life expectancy, and frailty are not taken into consideration by current guidelines. <b><i>Objectives:</i></b> The objective of this study was to evaluate the influence of frailty and life expectancy on guideline deviation, treatment outcomes, and quality of life (QoL) after treatment in patients with cSCCHN. <b><i>Methods:</i></b> Patients with cSCCHN were prospectively included. A geriatric assessment was performed, including the Geriatric 8 (G8), Groningen Frailty Indicator, and Timed Up and Go test (TUG). The Lee index was used to predict a limited life expectancy, and the Adult Comorbidity Evaluation-27 was used as a comorbidity index. QoL was assessed by the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire at three time points. <b><i>Results:</i></b> Seventy-seven patients with cSCCHN were included. Frail patients had significantly more high-risk tumours. Guideline deviation occurred in 7.8% and was more common in patients who were frail (G8), with high-risk tumours (≥T2), with a limited life expectancy or an increased TUG. Guideline deviation did not lead more often to progression of disease in our study. No predictors for post-operative complications were found. BaSQoL subscores were very low at each time point and did not change significantly with time in the total group. Frail patients reported more fear of recurrence or new tumours 3 months after treatment, and less concern about other people’s skin 6 months after treatment, compared to non-frail patients. Complication rate, gender, or guideline deviation did not affect any subscale scores. <b><i>Conclusions:</i></b> Assessment of frailty and life expectancy can guide physicians and patients in treatment decisions. Deviation from guidelines towards less aggressive treatment schedules can be considered in frail patients with a limited life expectancy, since it did not negatively affect short-term outcomes or QoL in patients with cSCCHN in our study. However, these results should be confirmed by other, larger prospective studies with a longer follow-up period.

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

“…This is higher than in previous studies on HNC patients, which have mainly included patients without recurrence/metastatic disease [21,23,68]. Although there is disagreement about whether comorbidities affect the treatment approach in HNC/HNSCC patients, previous findings have demonstrated that mortality and the prognosis of HNC and HNSCC patients are negatively influenced by existing comorbidities [69][70][71][72]. In our patients, severe comorbidities were highly prevalent.…”

“…In our patients, severe comorbidities were highly prevalent. This may be explained by their higher age when developing recurrence/metastatic cancer disease, the presence of tumor disease, the development of metastasis, and adverse side effects of the primary cancer therapy compared to other studies [69][70][71][72]. Noteworthy, the ineligibility for salvage surgery or (re-)irradiation is oftentimes based on prevalent comorbidities and frailty.…”

Wound Care Adherence in Mohs Micrographic Surgery: A Prospective Cohort Study

“…Besides low wound care adherence, frailty is often a predictor for poor outcomes in dermatology. 17,18 The only significant associations between adherence and the independent variables in the model were age (p 5 .005), help with wound care (p 5 .03), and frailty (p 5 .04).…”

“…Besides low wound care adherence, frailty is often a predictor for poor outcomes in dermatology. 17,18…”

“…Frailty likely decreased adherence because frail patients often must simultaneously manage other comorbidities. 17,18 Frail MMS patients may not have the physical ability to effectively perform their wound care instructions compared with robust patients. MMS has been long-established as a safe and welltolerated procedure.…”