Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma

Abstract

Background The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status (PS) on head and neck squamous cell carcinoma (HNSCC) survival. Methods Six hundred patients with HNSCC were prospectively recruited. Comorbidity and PS were measured using the Charlson Comorbidity Index (CCI) and the Eastern Cooperative Oncology Group (ECOG) Scale. Outcomes were overall survival (OS) and cancer‐specific survival (CSS). Results A total of 48.3% of the patients had at least 1 comorbidity, and 42.3% had impaired PS at baseline. There was no correlation between CCI and ECOG (Spearman's ρ = 0.033; p = .42). In multivariate analysis, CCI score was significantly associated with OS (p = .01). ECOG was not associated with OS, but seems to act as an effect modifier in the association between comorbidity and OS. CCI and ECOG were not associated with CSS. Conclusion CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC, but a significant association with CSS was not observed. © 2015 Wiley Periodicals, Inc. Head Neck 38: 736–742, 2016

Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

“…The head and neck oncology population has been assessed with other indices, including the Kaplan‐Feinstein score comorbidity index, CCI, and Adult Comorbidity Evaluation‐27 demonstrating decreased survival rates and increased complications with increasing index scores. We found when comparing the modified frailty index score to the CCI directly, only the modified frailty index score was associated with increasing Clavien‐Dindo classification IV complication rates in patients who underwent flap reconstructions.…”

Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

“…Higher comorbidity scores have been shown to be adversely associated with overall survival (OS), choice of treatment modality, and treatment outcomes in head and neck cancer . People with head and neck cancer tend to have a higher comorbidity burden compared to the general population . This may partially be attributable to their engagement in adverse health behaviors such as smoking and high alcohol intake that increase the risk of the development of comorbid conditions as well as head and neck cancer.…”

“…Previous studies have examined the impact of comorbidities on outcomes in head and neck cancer . However, no prospective study has been able to adjust for HPV status, behavioral, and social variables in their study populations while stratifying for head and neck cancer subsite in the same model.…”

Adjuvant chemoradiation does not improve survival in elderly patients with high‐risk resected head and neck cancer

“…However, a limitation of the CDS in patient registries is that it is often a reflection of the number of comorbidities and not necessarily the severity of the comorbidities. Similarly, there is no information in the NCDB on each patient's performance status or smoking history, both of which are important prognostic factors for patients with HNSCC . Recent single‐institution data have demonstrated that elderly patients with HNSCC receiving definitive CRT or RT alone received less toxic concurrent chemotherapy but experienced higher rates of hospitalization, lower rates of feeding gastrostomy tube removal, and a higher rate of death within 3 months of treatment initiation .…”