The Multidimensional Prognostic Index as a Measure of Frailty in Elderly Patients with Head and Neck Cancer

Abstract

Purpose The multidimensional prognostic index (MPI) is a prognostic model derived from the comprehensive geriatric assessment (CGA) which can predict 1-year mortality risk in elderly individuals. We hypothesized that the MPI also reflects the degree of frailty and thus will correlate with established measures of frailty. Therefore, the aim of this study is to explore whether the MPI-score is a measure of frailty in older head and neck cancer patients and is associated with several physical functioning measurements. Patients and Methods From November 2019 to July 2020, a prospective cohort study enrolled patients with head and neck cancer aged ≥70 years, and patients <70 years with an abnormal G8 score. The MPI-score ranged from 0 to 1 and was categorized in MPI-stage 1 (≤0.33, non-frail); MPI-stage 2 (0.34–0.66, mildly frail), and MPI-stage 3 (≥0.67, severe frail). Pearson’s correlation coefficient and multivariable linear regression were used to study the association between MPI-score and the physical functioning measurements handgrip strength, gait speed, and the timed up and go test (TUGT). Results A total of 163 patients were included. One hundred four (63.8%) patients were categorized as non-frail according MPI-stage 1, and 59 (36.2%) patients as mildly or severe frail (n=55 MPI-stage 2; n=4 MPI-stage 3, respectively). A higher MPI-score was significantly associated with lower hand grip strength (B −0.49 [95% CI −0.71; −0.28] p<0.001), lower gait speed (B −0.41 [95% CI −0.55; −0.25] p<0.001), and a slower TUGT (B 0.53 [95% CI 0.66; 0.85] p<0.001). Conclusion Almost one-third of the included patients with head and neck cancer was mild or severe frail. A higher MPI-score, indicating higher degree of frailty, was associated with worse physical performance by lower handgrip strength, gait speed, and a slower TUGT. Thus, the MPI reflects the degree of frailty.

Frailty in Non‐geriatric Patients With Head and Neck cancer

“…32 73.4% of the frail patients were either at risk for malnutrition or malnourished, which is almost double the percentages found in other studies. 31,33,34 For ADL and IADL dependence, our frail patient group appeared to be more dependent compared to other findings in HNC patients 35.6% versus 9.9%. 31,33 About half of the patient has MPI-stage 2 or MPI-stage 3, meaning moderate-to-severe frailty and subsequent higher 1-year mortality risk.…”

“…31,33,34 For ADL and IADL dependence, our frail patient group appeared to be more dependent compared to other findings in HNC patients 35.6% versus 9.9%. 31,33 About half of the patient has MPI-stage 2 or MPI-stage 3, meaning moderate-to-severe frailty and subsequent higher 1-year mortality risk. Surprisingly, looking at the MMSE score, only 7.7% scored <24, which is low compared to other studies.…”

“…Furthermore, we found that 20% and 2.6% scored below the 10th percentile of, respectively, handgrip strength, and gait speed. 31.6% of the frail patients suffered from orthostatic hypotension, which is high compared to other studies: 5% in HNC patients with a median age of 76 years 31 . In the general population, the prevalence of orthostatic hypotension is 6%, increasing to 30% >70 years 32 .…”

“…31.6% of the frail patients suffered from orthostatic hypotension, which is high compared to other studies: 5% in HNC patients with a median age of 76 years. 31 In the general population, the prevalence of orthostatic hypotension is 6%, increasing to 30% >70 years. 32 73.4% of the frail patients were either at risk for malnutrition or malnourished, which is almost double the percentages found in other studies.…”

Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care?

“…86 The reported incidence of frailty in older patients with head and neck cancer varies widely from 27.9% to 82.0%, depending on the patient population and the instruments used. [87][88][89][90][91][92][93] In patients not amenable to surgery, a Geriatric-8 score of 14 or less had a 91% sensitivity and 30% specificity for frailty assessed with CGA. 88 The investigators also used the ELAN geriatric evaluation, an adapted geriatric assessment that could be completed in 20 minutes by nongeriatricians with a better sensitivity (95%) and specificity (60%) than Geriatric-8.…”