Frailty and the Survival Outcomes of Patients With Laryngeal Squamous Cell Cancer

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ABSTRACT

Background

Frailty increases the risk of mortality in the head and neck cancer population. This study examines the association between frailty and survival outcomes in patients with laryngeal squamous cell cancer (LSCC).

Method

Retrospective data collection from patients in the West of Scotland diagnosed with LSCC between 2014 and 2020. The Modified Five Item Frailty Index (mFI‐5) measures frailty and categorizes patients according to their level of frailty. Statistical tests used were the Mann–Whitney U‐test or ANOVA for differences in means and survival analyses for overall survival time.

Results

There were 867 patients included. Seventy‐eight percent ( n = 676) of patients were deemed frail. Median survival for “not frail” patients was 78 months and “severely frail” was 23 months. The palliative treatment group had worse overall survival outcomes compared to curative (hazard ratio (HR) of 7.96, p < 0.001).

Conclusion

This study demonstrates frailty is common in patients with LSCC and leads to worse mortality and survival outcomes.

Related collections

Most cited references 41

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Frailty in Older Adults: Evidence for a Phenotype

L P Fried, C Tangen, J Walston … (2001)

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A global clinical measure of fitness and frailty in elderly people.

Kenneth Rockwood, Xiaowei Song, Chris MacKnight … (2005)

There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.

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Is Open Access

A standard procedure for creating a frailty index

Samuel Searle, Arnold Mitnitski, Evelyne A Gahbauer … (2008)

Background Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index. Methods This is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment. Results Procedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0–1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014–0.026) to 0.026 (0.020–0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality. Conclusion A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.

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Author and article information

Contributors

Cameron McCann: (View ORCID Profile)

Journal

Title: Head & Neck

Abbreviated Title: Head & Neck

Publisher: Wiley

ISSN (Print): 1043-3074

ISSN (Electronic): 1097-0347

Publication date Created: April 2025

Publication date (Electronic): November 22 2024

Publication date (Print): April 2025

Volume: 47

Issue: 4

Pages: 1079-1092

Affiliations

[1 ] Department of Otolaryngology/Head and Neck Surgery Glasgow Royal Infirmary Glasgow UK

[2 ] Department of Otolaryngology/Head and Neck Surgery Queen Elizabeth University Hospital Glasgow UK

[3 ] School of Cancer Sciences University of Glasgow Glasgow UK

[4 ] Cancer Research UK Scotland Institute Glasgow UK

[5 ] Glasgow Head and Neck Cancer (GLAHNC) Research Group Beastson Institute for Cancer Research Glasgow UK

[6 ] Academic Unit of Surgery University of Glasgow, Glasgow Royal Infirmary Glasgow UK

[7 ] Strathclyde Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow UK

Article

DOI: 10.1002/hed.27951

SO-VID: d2c730d3-33a6-42ff-b095-6f8a54ec0d10

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http://onlinelibrary.wiley.com/termsAndConditions#vor

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