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Original Investigation
From the American Head and Neck Society
October 21, 2021

Association of Deficits Identified by Geriatric Assessment With Deterioration of Health-Related Quality of Life in Patients Treated for Head and Neck Cancer

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 2Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 3Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 4Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 5Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 6Department of Otorhinolaryngology–Head and Neck Surgery, Haaglanden Medical Center, The Hague, the Netherlands
JAMA Otolaryngol Head Neck Surg. Published online October 21, 2021. doi:10.1001/jamaoto.2021.2837
Key Points

Question  Are pretreatment geriatric deficits associated with quality of life after treatment for head and neck cancer?

Findings  In this cohort study including 283 patients, items of geriatric assessment within all domains (physical, functional, psychological, social) were associated with decline of quality of life after treatment. The accumulation of domains with geriatric deficits was a major significant factor for deterioration at both short- and long-term follow-up after treatment.

Meaning  Deficits in individual and accumulated geriatric domains are associated with decline in quality of life; this knowledge may aid decision-making, indicate interventions, and reduce loss of quality of life.

Abstract

Importance  Accumulation of geriatric deficits, leading to an increased frailty state, makes patients susceptible for decline in health-related quality of life (HRQOL) after treatment for head and neck cancer (HNC).

Objective  To assess the association of single and accumulated geriatric deficits with HRQOL decline in patients after treatment for HNC.

Design, Setting, and Participants  Between October 2014 and May 2016, patients at a tertiary referral center were included in the Oncological Life Study (OncoLifeS), a prospective data biobank, and followed up for 2 years. A consecutive series of 369 patients with HNC underwent geriatric assessment at baseline; a cohort of 283 patients remained eligible for analysis, and after 2 years, 189 patients remained in the study. Analysis was performed between March and November 2020.

Interventions or Exposures  Geriatric assessment included scoring of the Adult Comorbidity Evaluation 27, polypharmacy, Malnutrition Universal Screening Tool, Activities of Daily Living, Instrumental Activities of Daily Living (IADL), Timed Up & Go, Mini-Mental State Examination, 15-item Geriatric Depression Scale, marital status, and living situation.

Main Outcomes and Measures  The primary outcome measure was the Global Health Status/Quality of Life (GHS/QOL) scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Differences between patients were evaluated using linear mixed models at 3 months after treatment (main effects, β [95% CI]) and declining course per year during follow-up (interaction × time, β [95% CI]), adjusted for baseline GHS/QOL scores, and age, sex, stage, and treatment modality.

Results  Among the 283 patients eligible for analysis, the mean (SD) age was 68.3 (10.9) years, and 193 (68.2%) were male. Severe comorbidity (β = −7.00 [−12.43 to 1.56]), risk of malnutrition (β = −6.18 [−11.55 to −0.81]), and IADL restrictions (β = −10.48 [−16.39 to −4.57]) were associated with increased GHS/QOL decline at 3 months after treatment. Severe comorbidity (β = −4.90 [−9.70 to −0.10]), IADL restrictions (β = −5.36 [−10.50 to −0.22]), restricted mobility (β = −6.78 [−12.81 to −0.75]), signs of depression (β = −7.08 [−13.10 to −1.06]), and living with assistance or in a nursing home (β = −8.74 [−15.75 to −1.73]) were associated with further GHS/QOL decline during follow-up. Accumulation of domains with geriatric deficits was a major significant factor for GHS/QOL decline at 3 months after treatment (per deficient domain β = −3.17 [−5.04 to −1.30]) and deterioration during follow-up (per domain per year β = −2.74 [−4.28 to −1.20]).

Conclusions and Relevance  In this prospective cohort study, geriatric deficits were significantly associated with HRQOL decline after treatment for HNC. Therefore, geriatric assessment may aid decision-making, indicate interventions, and reduce loss of HRQOL.

Trial Registration  trialregister.nl Identifier: NL7839

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