Association of Preoperative Functional Performance With Outcomes After Surgical Treatment of Head and Neck Cancer

Abstract

IMPORTANCE Patients with head and neck cancers have comorbidities and other constitutional symptoms known to be associated with adverse postoperative outcomes, but the role of functional performance is not well studied. OBJECTIVE To explore the addition of functional performance to other clinical factors for association with 3 patient outcomes: 30-day unplanned readmission (UR), 90-day medical complications, and overall survival (OS). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in a single tertiary care center with patients surgically treated for squamous cell cancer of the lip, oral cavity, pharynx, or larynx from January 2012 to December 2016. All analysis took place between January 2018 and November 2018. Data from 2 registries were analyzed, supplemented with medical record review. Logistic regression analysis was used to explore association of preoperative functional performance with outcomes. Conjunctive consolidation was used to create a useful clinical severity staging system, which included functional performance (estimated from metabolic equivalent [MET] score: <4, light-intensity activities; Ն4 at least moderate-intensity activities); overall comorbidity severity; preoperative weight loss; and TNM tumor staging. Logistic regression was used to assess the prognostic accuracy of the clinical severity staging system for 30-day UR and 90-day complications, and Cox proportional hazard regression for OS. EXPOSURES All patients underwent surgical treatment for head and neck cancer. MAIN OUTCOMES AND MEASURES The primary outcomes were 30-day UR and 90-day complications; the secondary outcome was OS. RESULTS For the 657 patients included, the mean (SD) age was 62.0 (11.3) years; 73% were men (n = 477), and 88% were white (n = 580). A total of 75 (11%) had a 30-day UR; 204 (31%) developed a 90-day complication; and 127 (19%) patients died during the observation period. Individually, poor functional performance (<4 METs), high comorbidity burden, preoperative weight loss, and advanced TNM stage were associated with all 3 outcomes; the increased risk for each outcome ranged from 1.5 to 3.0 times the reference range. Using these 4 variables in combination, the 4-category clinical severity staging system demonstrated a strong association between severity stage and all 3 adverse outcomes: 30-day UR (C statistic, 0.63), 90-day complications (C statistic, 0.63), and OS (C statistic, 0.68). CONCLUSIONS AND RELEVANCE Poor preoperative functional performance, high comorbidity burden, preoperative weight loss, and advanced tumor stage were all associated with worse patient outcomes after head and neck cancer surgery. The model incorporating all 4 of these factors developed in this study may facilitate patient-centered risk assessment and patient-physician shared preoperative decision making.

Comparison of surgical complications after curative surgery in patients with oral cavity squamous cell carcinoma and sarcopenia

“…Because the mass and strength of skeletal muscles are affected by many factors such as age, sex, underlying diseases, dietary habits and exercise, they can reflect the overall functional status of the body 27 . In general, the prognosis of surgical patients is also closely related to the functional status of the body 28 . Sarcopenia patients, as a special group, often exhibit low physical function, and they may have an increased risk of postsurgical complications 29 .…”

Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review

“…Within the field of otolaryngology, poor preoperative functional performance has been associated with a significantly higher rate of unplanned 30-day readmissions after HNC surgery. 37 Behavioral interventions incorporating consumer wearables could optimize preoperative mobilization as a means of prehabilitation. Of note, there is conflicting evidence surrounding the efficacy of prehabilitation: though several studies across various surgical fields suggest that prehabilitation may shorten hospital length of stay 38,39 and reduce the risk of postoperative complications, 40,41 others report that prehabilitation does not improve postoperative outcomes.…”

“…53 Nonetheless, the use of consumer wearables for assessment and promotion of physical activity among otolaryngology patients remains a clear avenue for future research. 37,54…”

“…These interventions tend to evaluate whether real‐time biofeedback provided by consumer wearables, whether alone or in combination with other behavioral incentives, promotes increased physical activity and decreased sedentary behavior. Within the field of otolaryngology, poor preoperative functional performance has been associated with a significantly higher rate of unplanned 30‐day readmissions after HNC surgery 37 . Behavioral interventions incorporating consumer wearables could optimize preoperative mobilization as a means of prehabilitation.…”

“…The success of these interventions rests on their ability to incentivize sustained patient engagement with prescribed behaviors, a notoriously difficult feat 53 . Nonetheless, the use of consumer wearables for assessment and promotion of physical activity among otolaryngology patients remains a clear avenue for future research 37,54 …”