1. An Introduction to a Head and Neck Cancer-Specific Frailty Index and Its Clinical Implications in Elderly Patients: A Prospective Observational Study Focusing on Respiratory and Swallowing Functions.
- Author
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Kwon, Minsu, Kim, Shin‐Ae, Roh, Jong‐Lyel, Lee, Sang‐Wook, Kim, Sung‐Bae, Choi, Seung‐Ho, Nam, Soon Yuhl, and Kim, Sang Yoon
- Subjects
GERIATRIC assessment ,DEGLUTITION ,DISEASES ,FISHER exact test ,FRAIL elderly ,LONGITUDINAL method ,HEAD tumors ,MORTALITY ,SCIENTIFIC observation ,NECK tumors ,QUESTIONNAIRES ,RESEARCH funding ,RESPIRATION ,PULMONARY function tests ,STATISTICS ,T-test (Statistics) ,PROPORTIONAL hazards models ,RECEIVER operating characteristic curves ,DATA analysis software ,KAPLAN-Meier estimator ,MANN Whitney U Test ,OLD age ,PROGNOSIS ,TUMOR treatment - Abstract
Introduction. Frailty refers to a decreased physiologic reserve in geriatric patients and its importance in terms of treatment planning and outcome prediction has been emphasized in oncologic practices for older patients with cancer. We investigated the clinical implications of a head and neck cancer (HNC)-specific frailty index suggested by prospective clinical and functional evaluations of HNC patients. Materials and Methods. We analyzed data on 165 elderly patients with HNC who were prospectively enrolled in our hospital from 2010 to 2013. Pretreatment functional evaluations were performed according to all comprehensive geriatric assessment (CGA) domains. We additionally evaluated the patients' respiratory and swallowing functions using pulmonary function tests, voice handicap index (VHI), MD Anderson Dysphagia Inventory (MDADI), and other associated tests. Factors affecting the 2-year morbidity and mortality were also analyzed. Results. Respiratory and swallowing problems were major causes of 2-year morbidity. Pretreatment performance status, VHI ≥8, MDADI,70, dental problems, and chemotherapy were significantly associated with early morbidity and mortality (all p < .05). CGA-assessed frailty was found in 72 patients (43.6%) and was significantly associated with 2-year mortality (p = .027) but not with morbidity (p = .716). The high-risk group according to our new HNC-specific frailty index that included functional evaluations of respiration and swallowing showed significantly higher 2-year morbidity (p = .043) and mortality (p < .001). Conclusion. Pretreatment functional disabilities related to respiration and swallowing were significantly associated with early morbidity and mortality. The suggested index would be more useful for assessing frailty in elderly HNC patients. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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