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. 2025 Jun;40(3):563-575.
doi: 10.1007/s00455-024-10754-7. Epub 2024 Aug 28.

Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer

Javier Hurtado-Oliva  1   2 , Hans Paul van der Laan  3 , Julius de Vries  4 , Roel J H M Steenbakkers  3 , Gyorgy B Halmos  4 , Inge Wegner  4
Affiliations

Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer

Javier Hurtado-Oliva et al. Dysphagia. 2025 Jun.

Abstract

In the rising and frail head and neck cancer (HNC) population, geriatric assessments are crucial. Frail HNC patients often experience dysphagia. The coexistence of dysphagia and frailty presents complex health challenges, however, there is limited evidence on the prognostic value of frailty on post-treatment dysphagia. This study explores the relationship between pre-treatment frailty status and post-treatment dysphagia in HNC patients. A retrospective data analysis from the OncoLifeS data-biobank at the University Medical Center Groningen of 242 patients diagnosed with HNC between 2014 and 2016. The study involved several physical, functional and psychological pre-treatment geriatric assessments, and frailty screening using the Groningen Frailty Indicator (GFI) and the Geriatric-8 screening tool (G8). Outcome measures were swallowing-related quality of life (HNSW-QoL) and toxicity-related dysphagia evaluations (CTCAE-D) at 3, 6, 12 and 24 months. Linear mixed-effects models assessed factors associated with HNSW-QoL and CTCAE-D. Frail patients consistently reported worse HNSW-QoL and CTCAE-D than non-frail patients over time, with symptoms increasing at 3 months, but gradually decreasing by 24 months. Frailty status (G8 or GFI) was a significant predictor for lower HNSW-QoL (β = 11.770 and 10.936, both p < 0.001), and lower CTCAE-D (β = 0.245, p = 0.058; β = 0.331, p = 0.019), respectively. In this study, frailty was found to be associated with a worse of swallowing-related quality of life, and with increased toxicity-related dysphagia. These findings provide insights for the identification of HNC patients at higher risk of post-treatment swallowing-related issues, and offer opportunities for optimizing their post-treatment swallowing outcomes.

Keywords: Dysphagia; Frailty; Geriatric assessment; Head and neck cancer; Toxicity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the OncoLifeS scientific committee, oncological data-biobank approved by the medical ethical committee of the UMCG and is registered in the Dutch Trial Register (registration number NL7839). All patients provided written informed consent for the participation in OncoLifeS. Conflict of interest: Javier Hurtado-Oliva declared receiving grant support from the Department of Human Capital Development, Chilean National Scholarship Program for Graduate Studies, of the National Agency of Research and Development (ANID), Government of Chili. Scholarship ID 72210512. Hans Paul van der Laan, Julius de Vries, Roel J.H.M. Steenbakkers, Gyorgy B. Halmos, and Inge Wegner, declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Influence of frailty status on swallowing-related quality of life over time. Legend: HNSW-QoL = EORTC QLQ - H&N35 Swallowing domain; GFI = Groningen Frailty Indicator; G8 = Geriatric Screening Tool. Higher scores means more impaired swallowing-related quality of life
Fig. 2
Fig. 2
Influence of frailty status on toxicity-related dysphagia over time. Legend: CTCAE-D = Common Terminology Criteria for Adverse Events - Dysphagia; GFI = Groningen Frailty Indicator; G8 = Geriatric Screening Tool. Higher scores means higher toxicity-related swallowing problems
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