Evidence map›Paper›PMID 35168191›Full record

ArticleOral oncology2022

The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm.

Leila J Mady, Khalil Baddour, Jacob C Hodges, Linda C Magaña, Hannah L Schwarzbach, Jeffrey D Borrebach, Marci L Nilsen, Jonas T Johnson, Daniel E Hall

Erratum issuedOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Oral oncology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.5field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 21 citations in OpenAlex.

  1. The use of frailty screening measures for predicting long-term survival outcomes in head and neck cancer: a systematic review.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
    Article
  2. Risk Analysis Index Outperforms the Modified Frailty Index in Predicting Outcomes in Thyroidectomy and Parathyroidectomy.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026
    Article
  3. Article
  4. Review
  5. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Leila J MadyDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: leila.mady@pennmedicine.upenn.edu.
Khalil BaddourDepartment of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jacob C HodgesWolff Center at UPMC, Pittsburgh, PA, USA.
Linda C MagañaDepartment of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Hannah L SchwarzbachDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Jeffrey D BorrebachWolff Center at UPMC, Pittsburgh, PA, USA.
Marci L NilsenDepartment of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Jonas T JohnsonDepartment of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Daniel E HallWolff Center at UPMC, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
University of Pittsburgh · USUniversity of Pennsylvania · US

Funding

Research Training in OtolaryngologyT32DC000066 · NIDCD · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI JOHNSON, JONAS T. · 2003 to 2017
$1.8M
NIDCD NIH HHS T32 DC000066
6 · The paper itself

Abstract

objectiveCompare survival of head and neck cancer (HNC) patients treated with surgical or non-surgical management according to frailty, quantify frailty with the Risk Analysis Index (RAI), a validated 14-item instrument. MATERIALS AND

methodsProspective cohort study of newly diagnosed HNC patients (≥18 years) who had frailty assessment from April 13, 2016 to September 30, 2016. Primary outcome was overall survival at 1- and 3-years. Cox proportional hazard models were utilized to examine mortality with predictor variables. Adjusted and unadjusted (Kaplan-Meier) survival curves stratified by either RAI scores or treatment modality were plotted. Kruskal-Wallis and likelihood ratio chi-square tests were used for comparing clinicodemographic variables.

resultsOf 165 patients, 54 (32.7%) were managed non-surgically, 49 (29.7%) were treated with definitive surgery only, and 62 (37.6%) were treated with multimodality (surgery + adjuvant) therapy. Among the full cohort and subgroup analysis of the frail/very frail (RAI ≥ 37), non-surgical patients had worse or similar 3-year survival than those treated with surgery +/- adjuvant therapy. Multivariable Cox proportional hazard models demonstrate that frail patients treated non-surgically experienced worse survival than their counterparts treated with surgery (HR = 2.50, p = 0.015, 95% CI: 1.19, 5.23) or multimodality therapy (HR = 3.91, p < 0.001, 95% CI: 1.94-7.89).

conclusionAcross all levels of frailty, long term survival of HNC patients treated without surgery is either worse than or like those treated with surgery. These findings (1) challenge current practices of steering patients "too frail for surgery" towards non-surgical, "non-invasive" therapy, and (2) suggest equipoise warranting randomized trials to clarify treatment of frail patients.

Indexed as

FrailtyHead and Neck NeoplasmsHumansProportional Hazards ModelsProspective StudiesRetrospective StudiesAdjuvant therapyFrailtyHead and neck cancerMorbidityMultimodalityPrognosisProportional hazard modelsRisk analysisSurvivalTreatment

Identifiers

PMID35168191
PMCPMC9642850
OpenAlexW4213184709

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.