Frailty Status and Dependence in Head and Neck Cancer Patients Receiving Concurrent Chemoradiation

Frailty status and functional dependence has not been measured in head and neck cancer patients undergoing concurrent chemoradiation therapy. Additionally, it remains to be determined whether frailty status correlates with functional dependence in head and neck cancer patients. This study aimed to address the gaps in literature regarding the relationship between frailty status and functional performance within this group. By identifying functional needs, this research will strengthen the justification for rehabilitation services including occupational therapy.

This is an exploratory, prospective pre-post study. Participants were identified through convenience sampling from a group of head and neck cancer patients currently being seen by a radiation oncologist at the comprehensive cancer center. All of the patients who were at least 18 years of age and at the start of their radiation therapy were invited to participate. Exclusion criteria included those who were pregnant or nursing, and anyone who was not proficient in English. A one-on–one assessment was conducted by an occupational therapy student in the Head and Neck Clinic. Data was collected before and following radiation treatment with 35 participants. The interval of time between the collection of pre and post data was approximately seven weeks.

Frailty status among patients was determined using the Fried Frailty Index which was based on grip strength, reduction in body weight, physical activity, exhaustion, and gait speed (Fried et al., 2001). Grip strength was measured using a hand dynamometer, gait speed and body weight were recorded, while physical activity and exhaustion were self-reported. Patients who met three out of five criteria were considered “frail”. Those who met one or two of the criteria were considered to be “pre-frail”. Those who did not meet any, were considered “robust”. Functional dependence was determined through the Katz Activities of Daily Living (ADL) Assessment (Hartigan, 2007), and the Older Americans Resources and Services (OARS) instrumental iADL questionnaire (Fillenbaum, 2005). Each of these assessments were measured pre- and post-7 weeks of concurrent chemoradiation. Thirty five participants (21 males, 14 females; 66.1 ± 10.8 years of age) completed the study. Paired t-tests were used to determine changes in frailty status as well as functional dependence in participants following their seven week course of treatment. Spearman’s rho was used to identify the correlation between these two factors. All statistical analyses used SPSS 24.0, and for the primary analyses, the significance level was set at p=0.025.

Frailty status worsened over the course of treatment (p<0.001) primarily due to a reduction in body weight (p=0.010) and a decrease in physical activity (p<0.001). There were no changes in average grip strength (p=0.251), gait speed (p=0.147), and exhaustion (p=0.118). The ability to perform iADLs declined (p=0.004) with no change in ADLs (p=0.324). There was a moderate negative correlation between frailty status and iADL (r=-0.483, p=0.003). Overall, the results of this study identified an increased prevalence in frailty among head and neck cancer patients following radiation treatment. The strength of the correlation between frailty status and functional dependence suggests a relationship between these two factors.

The interpretation of this study’s data suggests that concurrent chemoradiation in head and neck cancer patients induces a frailty phenotype that negatively influences the patient’s ability perform iADLs. This conclusion reveals a need for rehabilitation services within this population, and supports the specific inclusion of occupational therapy services in order to address and reduce functional deficits.

References

Fillenbaum, G. (2005). Multidimensional functional assessment of older adults: The Duke Older American Resources and Services procedures. Lawrence Erlbaum Associates, Hillsdale, NJ. https://doi.org/10.4324/9780203771563

Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., . . . McBurnie, M. A., (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology: Series A, 56(3), 1-1. https://doiorg.gate.lib.buffalo.edu/10.1093/gerona/56.3.M146

Hartigan, I. (2007), A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. International Journal of Older People Nursing, 2, 204–212. DOI: 10.1111/j.1748-3743.2007.00074.x