(616) Effect of Frailty on Outcomes in Early-Stage HPV+ Oropharyngeal Squamous Cell Carcinoma

Introduction: Patients and providers often have perceptions that certain patients are too frail to receive surgery compared to radiation. Our objective was to determine the effect of accumulated health deficits on survival and functional outcomes of patients with early stage HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated primarily with either surgery or definitive radiotherapy (XRT) or chemoradiotherapy (CRT).

Methods: A retrospective case series was performed. All patients who received initial treatment for OPSCC at a single institution between 2019 and 2024 were reviewed. Those with cancers of stage III and above, follow-up duration of less than 4 months, p16-negative tumors, and those who underwent induction chemotherapy were excluded for a total of 194 patients. Clinical information including demographics, disease course, management, dysphagia, dysphonia, xerostomia and past medical history was collected. Frailty index was tabulated using the VA Frailty Index.

Results: Our population was 88% male, with mean age at diagnosis of 63 years. Frailty significantly reduced overall survival in a step-wise fashion – pre-frail patients had worse outcomes compared to healthy patients and frail patients experienced the worst outcomes overall (p = 0.017). Notably, frail and pre-frail patients had equivalent outcomes with both surgery and definitive XRT/CRT. Surgery was less associated with xerostomia (p = 0.047), but no differences between surgery or radiation were seen in speech and swallowing outcomes in either frail or pre-frail patients. Greater frailty scores were significantly associated with post-treatment dysphonia in both groups (p = 0.048).

Conclusions: Despite conceptions that certain patients are too frail for surgery, pre-frail and frail patients experienced similar survival outcomes with both surgery and definitive XRT/CRT, suggesting both are viable options for this population. Additionally, frailty may be an important metric in identifying patients who may benefit from early speech and swallow interventions due to increased association with dysphonia.