Frailty und ihre Bedeutung in der Kopf-Hals-Onkologie

Die Therapie älterer Patienten mit Kopf-Hals-Tumoren ist aufgrund vorbestehender Komorbiditäten häufig eine Herausforderung. Erschwerend hinzu kommt ein Mangel an qualitativ hochwertiger Evidenz zur Therapie dieser Patientengruppe, da sie in der Regel von randomisiert-kontrollierten klinischen Studien ausgeschlossen wird. Dieser Beitrag möchte den Begriff Frailty als komplexes Syndrom erläutern und seine Bedeutung in der Kopf-Hals-Onkologie darstellen.

Abstract

Since treatment of elderly patients with head and neck cancer is often challenging due to preexisting comorbidities, continuous efforts are required to raise awareness for frailty, which is a multidimensional state of diminished physiologic reserve resulting in decreased resiliency and increased vulnerability to stressors. Frailty is a predictor of poor clinical outcomes in head and neck cancer patients, but until now there is no standardization of frailty assessment. Pretherapeutic frailty assessment among head and neck cancer patients should be incorporated into routine multidisciplinary management to predict adverse outcomes and tailor a personalized treatment. This article would like to explain the complex syndrome frailty and its importance for head and neck oncology.

Schlüsselwörter

Gebrechlichkeit - Frailty - Kopf-Hals-Onkologie - geriatrisches Assessment

• Literatur

• 1 Goel AN, Lee JT, Gurrola JG. et al. The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery. Laryngoscope 2020; 130: 290-296
• 2 Goldstein DP, Sklar MC, de Almeida JR. et al. Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery. Laryngoscope 2020; 130: E340-E345
• 3 Clegg A, Young J, Iliffe S. et al. Frailty in elderly people. Lancet 2013; 381: 752-762
• 4 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults. Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
• 5 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722-727
• 6 Chow WB, Rosenthal RA, Merkow RP. et al. Optimal preoperative assessment of the geriatric surgical patient. A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215: 453-466
• 7 Ghignone F, van Leeuwen BL, Montroni I. et al. The assessment and management of older cancer patients. A SIOG surgical task force survey on surgeonsʼ attitudes. Eur J Surg Oncol 2016; 42: 297-302
• 8 Bellera CA, Rainfray M, Mathoulin-Pélissier S. et al. Screening older cancer patients. First evaluation of the G-8 geriatric screening tool. Ann Oncol 2012; 23: 2166-2172
• 9 Dubruille S, Libert Y, Roos M. et al. Identification of clinical parameters predictive of one-year survival using two geriatric tools in clinically fit older patients with hematological malignancies. Major impact of cognition. J Geriatr Oncol 2015; 6: 362-369
• 10 Braun T, Grüneberg C, Thiel C. Deutsche Übersetzung, interkulturelle Adaptation und diagnostische Testgenauigkeit von drei Frailty Screening Fragebögen. PRISMA-7, FRAIL Skala und Groningen Frailty Indicator. Z Gerontol Geriatr 2018; 51: 282-292
• 11 Ellis G, Gardner M, Tsiachristas A. et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2017; 9: CD006211
• 12 Saum KU, Dieffenbach AK, Müller H. et al. Frailty prevalence and 10-year survival in community-dwelling older adults. Results from the ESTHER cohort study. Eur J Epidemiol 2014; 29: 171-179
• 13 Pabst G, Zimmermann AK, Huth C. et al. Association of low 25-hydroxyvitamin D levels with the frailty syndrome in an aged population. Results from the KORA-age Augsburg study. J Nutr Health Aging 2015; 19: 258-264
• 14 Gößwald A, Lange M, Kamtsiuris P. et al. DEGS. Studie zur Gesundheit Erwachsener in Deutschland. Bundesweite Quer- und Längsschnittstudie im Rahmen des Gesundheitsmonitorings des Robert Koch-Instituts. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 775-780
• 15 Dapp U, Fertmann R, Anders J. et al. Die Longitudinal-Urban-Cohort-Ageing-Studie (LUCAS). Z Gerontol Geriatr 2011; 44 (Suppl. 02) 55-72
• 16 Handforth C, Clegg A, Young C. et al. The prevalence and outcomes of frailty in older cancer patients. A systematic review. Ann Oncol 2015; 26: 1091-1101
• 17 Ethun CG, Bilen MA, Jani AB. et al. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 2017; 67: 362-377
• 18 Koll TT, Rosko AE. Frailty in Hematologic Malignancy. Curr Hematol Malig Rep 2018; 13: 143-154
• 19 Bras L, Driessen DAJJ, de Vries J. et al. Patients with head and neck cancer. Are they frailer than patients with other solid malignancies?. Eur J Cancer Care (Engl) 2020; 29: e13170
• 20 Thomas CM, Sklar MC, Su J. et al. Evaluation of older age and frailty as factors associated with depression and postoperative decision regret in patients undergoing major head and neck surgery. JAMA Otolaryngol Head Neck Surg 2019; 145: 1170-1178
• 21 Fancy T, Huang AT, Kass JI. et al. Complications, mortality, and functional decline in patients 80 years or older undergoing major head and neck ablation and reconstruction. JAMA Otolaryngol Head Neck Surg 2019; 145: 1150-1157
• 22 Kwon M, Kim SA, Roh JL. et al. 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. Oncologist 2016; 21: 1091-1098
• 23 de Vries J, Bras L, Sidorenkov G. et al. Frailty is associated with decline in health-related quality of life of patients treated for head and neck cancer. Oral Oncol 2020; 111: 105020
• 24 Han SH, Cho D, Mohammad R. et al. Use of the comprehensive geriatric assessment for the prediction of postoperative complications in elderly patients with head and neck cancer. Head Neck 2021;
• 25 Bakas AT, Sewnaik A, van Straaten J. et al. The Multidimensional Prognostic Index as a measure of frailty in elderly patients with head and neck cancer. Clin Interv Aging 2021; 16: 1679-1689
• 26 Bras L, de Vries J, Festen S. et al. Frailty and restrictions in geriatric domains are associated with surgical complications but not with radiation-induced acute toxicity in head and neck cancer patients: A prospective study. Oral Oncol 2021; 118: 105329