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：皮肤鳞状细胞癌是第二大常见皮肤恶性肿瘤，多发于老年患者及头颈部区域（头颈部皮肤鳞状细胞癌，cutaneous squamous cell carcinoma of the head and neck，简称cSCCHN）。当前临床指南未将年龄、预期寿命及衰弱状态纳入考量范畴。
研究目的：本研究旨在评估衰弱状态与预期寿命对头颈部皮肤鳞状细胞癌（cSCCHN）患者的指南依从偏差、治疗结局及治疗后生活质量（Quality of Life, QoL）的影响。
方法：前瞻性纳入头颈部皮肤鳞状细胞癌（cSCCHN）患者。对患者开展老年综合评估，评估工具包括老年8项问卷（Geriatric 8, G8）、格罗宁根衰弱指数（Groningen Frailty Indicator）以及计时起立行走试验（Timed Up and Go test, TUG）。采用Lee指数预测患者的有限预期寿命，以成人共病评估-27（Adult Comorbidity Evaluation-27, ACE-27）作为共病评估指标。分别于3个时间点采用基底细胞与鳞状细胞癌生活质量问卷（Basal and Squamous cell carcinoma Quality of Life, BaSQoL）对患者的生活质量进行评估。
结果：共纳入77例头颈部皮肤鳞状细胞癌（cSCCHN）患者。衰弱患者的高危肿瘤占比显著更高。指南依从偏差发生率为7.8%，在衰弱（G8评分异常）、存在高危肿瘤（≥T2分期）、有限预期寿命或计时起立行走试验结果异常的患者中更为多见。本研究中，指南依从偏差并未显著升高疾病进展风险。未筛选出术后并发症的独立预测因素。总体队列中，各时间点的BaSQoL分项评分均处于极低水平，且随时间推移无显著变化。与非衰弱患者相比，衰弱患者在治疗后3个月时报告的肿瘤复发或新发肿瘤恐惧感更强，而在治疗后6个月时对他人皮肤的关注度更低。并发症发生率、性别及指南依从偏差均未对任何分项评分产生影响。
结论：衰弱状态与预期寿命评估可辅助临床医师与患者制定治疗决策。对于存在有限预期寿命的衰弱患者，可考虑采用低于指南推荐强度的治疗方案，本研究结果显示此类方案并未对头颈部皮肤鳞状细胞癌（cSCCHN）患者的短期治疗结局或生活质量造成负面影响。然而，该研究结论仍需通过更大样本量、更长随访周期的前瞻性研究予以验证。