Heirman, A.N. (Anne Nadine) (2019) ‘Frailty screening as a predictor of treatment outcomes in elderly patients with cutaneous head and neck malignancies’. thesis, Medicine.
Full text available on request.Abstract
Objective: Defining the treatment for elderly patients with cutaneous head and neck malignancies (HNcM) is difficult because chronological age is most often used as an important factor in decision making instead of biological age. This present study has been set up to find predictors of treatment outcome (postoperative complication and survival) in HNcM patients and determine the value of geriatric screening. Methods: In this retrospective cohort study, a prospectively gathered database is utilized. Patients, diagnosed and/or treated in the UMCG for HNcM between October 2014 and November 2018 were included. In addition to patient, tumor and treatment characteristics, the Groningen Frailty Indicator (GFI) and the Geriatric 8 (G8) were used for frailty screening, together with multiple geriatric measuring tools (ACE-27, MMSE, GDS-15, history of delirium, history of falls, IADL, Katz-ADL, TUG). Outcome variables were postoperative complications (measured by the Clavien-Dindo system) and survival. Statistical analysis was performed with uni- and multivariate logistic regression and cox regression. Results: Of the 197 included patients, 151 were primary treated with surgery. The mean age was 78.9 years. Frailty based on the G8 (OR: 3.17, p = 0.01) and extensive (locoregional) surgery (OR: 3.60, p = <0.001) were found to be independent predictors of postoperative complications. The multivariate analysis for overall survival indicated smoking (HR: 4.54, p = 0.02), immunosuppression (HR: 3.97, p = 0.002) and an MMSE ≤ 24 (HR: 3.13, p = 0.01) as significant predictors. No frailty, disease- or treatment-related variables seemed to be significantly associated with survival. Conclusions: Frailty screening, using the G8 seems to be of value in predicting postoperative complications; however, its poor specificity seems to be a limitation. Age and comorbidities are not predictive for treatment outcome and therefore should not be used as a determining factor in choosing a proper treatment in these patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Halmos, Dr. G.B. and Department of Otorhinolaryngology and Head and Neck Surgery |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2370 |
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