Differences in clinical presentation and treatment decisions between frail and not-frail head and neck cancer patients.

PURPOSE: This study evaluated if patient presentation, treatment decisions and oncologic outcomes were different among frail vs. not-frail patients presenting with a new head and neck cancer. METHODS: A single-centre retrospective cohort study was conducted including consecutive patients presenting with a new mucosal head and neck SCC over a 1-year period. Frailty was calculated using the 5 item modified frailty index (5mFI). RESULTS: Two-hundred and thirty-two patients were included with 61 patients (26.3%) being frail using the 5mFI. Frail patients were older (70.6 years vs. 61.9 years; p < 0.001) and more likely to present with T3/4 disease (65.7% vs. 49.1%; p = 0.027). Frail patients were more likely to receive palliative intent treatment (16.4% vs. 4.7%; p = 0.003). Among patients managed with curative intent, there were differences in treatments received (p = 0.022). Three-year overall survival (OS) (76.7% vs.49.7%; p < 0.001) and 3-year disease free survival (DFS) (71.1% vs. 38.9%; p < 0.001) was significantly reduced among frail patients. CONCLUSION: Over one-quarter of patients with new mucosal SCCs were frail. Frail patients presented with more advanced primary tumours. Frailty was associated with significantly worse 3-year OS and DFS and was associated with differences in treatment intent. LEVEL OF EVIDENCE: III.