Hurtado-Oliva Javier, van der Laan Hans Paul, de Vries Julius, Steenbakkers Roel J H M, Halmos Gyorgy B, Wegner Inge
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1 , PO box 30.001, Groningen, 9700RB, the Netherlands.
Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Dysphagia. 2024 Aug 28. doi: 10.1007/s00455-024-10754-7.
In the rising and frail head and neck cancer (HNC) population, geriatric assessments are crucial. Frail HNC patients often experience dysphagia. The coexistence of dysphagia and frailty presents complex health challenges, however, there is limited evidence on the prognostic value of frailty on post-treatment dysphagia. This study explores the relationship between pre-treatment frailty status and post-treatment dysphagia in HNC patients. A retrospective data analysis from the OncoLifeS data-biobank at the University Medical Center Groningen of 242 patients diagnosed with HNC between 2014 and 2016. The study involved several physical, functional and psychological pre-treatment geriatric assessments, and frailty screening using the Groningen Frailty Indicator (GFI) and the Geriatric-8 screening tool (G8). Outcome measures were swallowing-related quality of life (HNSW-QoL) and toxicity-related dysphagia evaluations (CTCAE-D) at 3, 6, 12 and 24 months. Linear mixed-effects models assessed factors associated with HNSW-QoL and CTCAE-D. Frail patients consistently reported worse HNSW-QoL and CTCAE-D than non-frail patients over time, with symptoms increasing at 3 months, but gradually decreasing by 24 months. Frailty status (G8 or GFI) was a significant predictor for lower HNSW-QoL (β = 11.770 and 10.936, both p < 0.001), and lower CTCAE-D (β = 0.245, p = 0.058; β = 0.331, p = 0.019), respectively. In this study, frailty was found to be associated with a worse of swallowing-related quality of life, and with increased toxicity-related dysphagia. These findings provide insights for the identification of HNC patients at higher risk of post-treatment swallowing-related issues, and offer opportunities for optimizing their post-treatment swallowing outcomes.
在日益增多的体弱头颈癌（HNC）患者群体中，老年评估至关重要。体弱的HNC患者常出现吞咽困难。吞咽困难和身体虚弱并存带来了复杂的健康挑战，然而，关于身体虚弱对治疗后吞咽困难的预后价值的证据有限。本研究探讨HNC患者治疗前身体虚弱状态与治疗后吞咽困难之间的关系。对格罗宁根大学医学中心OncoLifeS数据生物样本库中2014年至2016年间诊断为HNC的242例患者进行回顾性数据分析。该研究涉及多项治疗前的身体、功能和心理老年评估，以及使用格罗宁根虚弱指标（GFI）和老年8项筛查工具（G8）进行虚弱筛查。结局指标为3、6、12和24个月时与吞咽相关的生活质量（HNSW-QoL）和与毒性相关的吞咽困难评估（CTCAE-D）。线性混合效应模型评估与HNSW-QoL和CTCAE-D相关的因素。随着时间的推移，虚弱患者始终报告的HNSW-QoL和CTCAE-D比非虚弱患者更差，症状在3个月时增加，但到24个月时逐渐减少。虚弱状态（G8或GFI）分别是较低的HNSW-QoL（β = 11.770和10.936，均p < 0.001）和较低的CTCAE-D（β = 0.245，p = 0.058；β = 0.331，p = 0.019）的显著预测因素。在本研究中，发现身体虚弱与较差的吞咽相关生活质量以及与毒性相关的吞咽困难增加有关。这些发现为识别治疗后吞咽相关问题风险较高的HNC患者提供了见解，并为优化其治疗后吞咽结局提供了机会。
