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.

Keywords:

• comprehensive geriatric assessment
• sarcopenia
• head and neck cancer
• multidimensional prognostic index
• elderly

Acknowledgments

We would like to thank all volunteers from the departments of Otorhinolaryngology and Oral and Maxillofacial surgery, and nurse consultants, former research students, and residents of the Division of Geriatrics at the Erasmus MC University Medical Center for their contribution to the study database.

Abbreviations

ADL, Activities of daily living; BCC, Basal cell carcinomas; CGA, Comprehensive Geriatric Assessment; COPD, Chronic Obstructive Pulmonary Disease; CIRS-CI, Cumulative Illness Rating Scale – Comorbidity Index; ESS, Exton-Smith Scale; IADL, Instrumental activities of daily living; IQR, median with the interquartile range; KATZ, Katz/s Activities of Daily Living; Lawton, Lawton’s Instrumental Activities of Daily Living; MMSE, Mini-Mental State Exam; MNA-SF, Mini nutritional Assessment-Short Form; MPI, Multidimensional Prognostic Index; NSTEMI, Non-ST-elevated myocardial infarction; SD, standard deviation; STEMI, ST-elevated myocardial infarction; TUGT, Timed-Up-and-Go-Test; WHO, World Health Organization.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author on request.

Ethics Approval and Informed Consent

This study was approved by the ethics committee of the Erasmus Medical Center [MEC 2019-0711].

Written informed consent to participate was obtained from all participants.

Author Contributions

All authors contributed to the study design, acquisition of data, and article preparation; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.