Supplementary Material for: Influence of Frailty and Life Expectancy on Guideline Adherence and Outcomes in Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Prospective Pilot Study

Background: Cutaneous squamous cell carcinoma is the second most common malignancy of the skin, often occurring in older patients and in the head and neck area (cSCCHN). Age, life expectancy, and frailty are not taken into consideration by current guidelines. Objectives: The objective of this study was to evaluate the influence of frailty and life expectancy on guideline deviation, treatment outcomes, and quality of life (QoL) after treatment in patients with cSCCHN. Methods: Patients with cSCCHN were prospectively included. A geriatric assessment was performed, including the Geriatric 8 (G8), Groningen Frailty Indicator, and Timed Up and Go test (TUG). The Lee index was used to predict a limited life expectancy, and the Adult Comorbidity Evaluation-27 was used as a comorbidity index. QoL was assessed by the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire at three time points. Results: Seventy-seven patients with cSCCHN were included. Frail patients had significantly more high-risk tumours. Guideline deviation occurred in 7.8% and was more common in patients who were frail (G8), with high-risk tumours (≥T2), with a limited life expectancy or an increased TUG. Guideline deviation did not lead more often to progression of disease in our study. No predictors for post-operative complications were found. BaSQoL subscores were very low at each time point and did not change significantly with time in the total group. Frail patients reported more fear of recurrence or new tumours 3 months after treatment, and less concern about other people’s skin 6 months after treatment, compared to non-frail patients. Complication rate, gender, or guideline deviation did not affect any subscale scores. Conclusions: Assessment of frailty and life expectancy can guide physicians and patients in treatment decisions. Deviation from guidelines towards less aggressive treatment schedules can be considered in frail patients with a limited life expectancy, since it did not negatively affect short-term outcomes or QoL in patients with cSCCHN in our study. However, these results should be confirmed by other, larger prospective studies with a longer follow-up period.

背景：鳞状细胞癌是皮肤的第二大恶性肿瘤，常见于老年患者以及头颈部区域（cSCCHN）。当前指南未考虑年龄、预期寿命及易损性。目标：本研究的目的是评估易损性和预期寿命对指南偏差、治疗结果及治疗后生活质量（QoL）的影响。方法：前瞻性地纳入了cSCCHN患者。进行了包括Geriatric 8（G8）、格罗宁根易损性指标和Timed Up and Go测试（TUG）在内的老年评估。使用Lee指数预测有限寿命，并以成人合并症评估-27作为合并症指标。通过Basal和鳞状细胞癌生活质量（BaSQoL）问卷在三个时间点评估生活质量。结果：共纳入77例cSCCHN患者。易损患者具有显著更多的高风险肿瘤。指南偏差发生在7.8%的患者中，且在易损（G8）、高风险肿瘤（≥T2）、有限寿命或TUG增加的患者中更为常见。在本研究中，指南偏差并未导致疾病进展的频率增加。未发现术后并发症的预测因子。BaSQoL亚组得分在每个时间点都非常低，且在总体组中随时间推移没有显著变化。与非易损患者相比，易损患者在治疗3个月后报告了更多对复发或新肿瘤的恐惧，而在治疗6个月后对他人皮肤的关心减少。并发症发生率、性别或指南偏差不影响任何亚组得分。结论：评估易损性和预期寿命可以指导医生和患者在治疗决策中。在本研究中，由于未对cSCCHN患者的短期结果或生活质量产生负面影响，因此可以考虑在预期寿命有限且易损的患者中偏离指南，采取较为保守的治疗方案。然而，这些结果应由其他更大规模、随访期更长的前瞻性研究予以证实。