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Screening for frailty and malnutrition in a multidisciplinary head and neck cancer program
Eden R Brauer1, Stephanie Lazaro1, Denice R Economou2
1School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, California, USA; Multidisciplinary Head and Neck Cancer Program, University of California, Los Angeles (UCLA), Los Angeles, California, USA.
Introduction:
Frailty and malnutrition are strong predictors of adverse outcomes in patients with head and neck cancer, yet remain underassessed in routine clinical care. This project aimed to develop, implement, and evaluate a standardized screening process for frailty and malnutrition in a multidisciplinary head and neck cancer program to identify high-risk patients and inform treatment planning.
Materials And Methods:
Through a quality improvement initiative, a multidisciplinary team integrated the Risk Analysis Index for Cancer (RAI-C) for frailty and Malnutrition Screening Tool (MST) into routine intake for new referrals of patients with head and neck cancer. Implementation was evaluated across three domains: feasibility, measured through completion rates, acceptability, assessed using clinician feedback via a survey, and impact on patient outcomes, using survival analysis.
Results:
Among 585 eligible patients, 488 (83.4%) were successfully screened. The cohort (mean age 63.1 years, 64% male) demonstrated high frailty prevalence with 57.2% categorized as frail (RAI-C score ≥ 37) and 14.3% at risk for malnutrition (MST score ≥ 2). In multivariable analysis adjusted for tumor site, treatment intensity, and comorbidities, frail patients had a more than 3-fold increased mortality risk compared to non-frail patients (adjusted HR 3.07, 95% CI 1.50-6.30, p = 0.002). Similarly, malnourished patients showed a 2.8-fold increased mortality risk compared to non-malnourished patients (adjusted HR 2.77, 95% CI 1.52-5.03, p < 0.001). Clinician feedback (n = 14) emphasized the value of screening in promoting "whole person" treatment planning, with suggestions for developing standardized pathways for interventions based on screening results.
Discussion:
Implementing frailty and malnutrition screening in multidisciplinary head and neck cancer care is feasible, acceptable to clinicians, and identifies patients at significantly higher mortality risk. The strong association between screening results and survival validates these tools' clinical utility and supports their integration into routine practice. Future directions include developing a structured prehabilitation program targeted to modifiable risk factors identified through screening to potentially improve outcomes in this vulnerable population.
