title: Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review.
abstract: Older head and neck cancer patients are at increased risk for adverse health outcomes, but little is known about which geriatric assessment associates with poor outcome. The aim is to study the association of functional or cognitive impairment, social environment and frailty with adverse health outcomes in patients with head and neck cancer.
  
  
  
  Four libraries were searched for studies reporting on an association of functional or cognitive impairment, social environment and frailty with adverse outcomes in head and neck cancer patients.
  
  
  
  Of 4158 identified citations, 31 articles were included. The mean age was ⩾60years in twelve studies (39%). Geriatric conditions were prevalent: between 40 and 50% of the included participants were functional impaired, around 50% had depressive symptoms, and around 40% did not have a partner. Functional impairment was assessed in 18 studies, two studies reported on a cognitive test, eight studies examined mood and social status was depicted by 14 studies. None of the included studies addressed frailty or objectively measured physical capacity such as hand grip strength, gait speed or balance tests. In 64% of the reported associations, a decline in functional or cognitive impairment, mood or social environment was associated with adverse outcomes.
  
  
  
  Functional and cognitive impairment, depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes. In the future, these measurements may guide decision-making and customize treatments, but more research is needed to further improve and firmly establish clinical usability.
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands. Electronic address: F.J.A.van_Deudekom@lumc.nl.
authors.forename: Floor J
authors.initials: FJ
authors.lastname: van Deudekom
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, The Netherlands.
authors.forename: Anouk S
authors.initials: AS
authors.lastname: Schimberg
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands; Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Marije H
authors.initials: MH
authors.lastname: Kallenberg
authors.affiliation: Department of Medical Oncology, Leiden University Medical Centre, The Netherlands.
authors.forename: Marije
authors.initials: M
authors.lastname: Slingerland
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, The Netherlands; Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Lily-Ann
authors.initials: LA
authors.lastname: van der Velden
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands; Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Mooijaart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology*; D016330:Frail Elderly; D006258:Head and Neck Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D012931:Social Environment
keywords: Cognitive impairment; Frailty; Functional impairment; Head and neck cancer; Mood; Social environment; Systematic review