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383 The elderly head and neck cancer patient: sarcopenia and frailty INTRODUCTION Worldwide the annual incidence of head and neck cancer (HNC) accounts for more than 650,000 cases and 330,000 deaths. 1 Compared to patients with other malignancies, patients with HNC have a higher risk of severe malnutrition, mostly due to swallowing problems. 2 This could lead to sarcopenia. Sarcopenia is defined as a generalized and progressive loss of muscle function and skeletal muscle mass. 3 Previous studies showed that sarcopenia based on loss of skeletal muscle mass is present in 35.5–54.5% of patients with HNC and is related to adverse health outcomes. 4,5 For example, low skeletal muscle mass is associated with chemotherapy dose-limiting toxicity 6 , increased incidence of postoperative complications, and decreased survival in patients with HNC 7,8 . Patients with sarcopenia thus represent an important group that should be identified as they are at risk for complications of treatment and poor survival. Frailty is also associated with poor outcomes and higher risks of treatment complications. 9 Frailty is often mentioned as an age-related syndrome of physiological decline and vulnera - bility, leading to an increased risk of adverse health outcomes. 10 A comprehensive geriatric assessment (CGA) that evaluates physical, psychological, functional, and social capabilities, and limitations of geriatric patients is the gold standard assessment for diagnosing frailty. In geriatric oncology, a CGA is used to detect disabilities, and comorbid conditions that poten - tially contribute to an older adult patient’s vulnerabilities, which could predispose them to poor outcomes and treatment complications. 11 However, such assessments are time-consuming, leading many cancer specialists to seek a shorter screening tool that can separate fit older adults with cancer, who can receive standard cancer treatment, from vulnerable patients, who should subsequently receive a full assess- ment to guide tailoring of their treatment regimens. 12 One such tool is the Geriatrics 8 (G8) screening tool, which was developed specifically for older adults with cancer. Another poten - tial predictor of toxicity and poor outcomes is sarcopenia. 13 Zwart et al. found that sarcopenia as measured by skeletal muscle mass on screening CTs was a potential biomarker for frailty in patients with HNC. In their study low skeletal muscle mass, was independently associated with frailty screening based on the G8 questionnaire. 14 However, Williams et al. were unable to find an association between sarcopenia, based on skeletal muscle mass, and frailty diagnosed with the Carolina Frailty Index in older adult pa - tients with cancer. 15 Dunne et al., in their investigation of 100 older adults with cancer found no significant association between skeletal muscle mass, as measured at the level of the third lumbar vertebral body, and any components of the CGA. 16 Zwart et al. 11 and Dunne et al. 17 conducted only skeletal muscle mass measurements on CT of the third cervical or lumbar vertebrae to determine sarcopenia. According to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) sarcopenia is a combination of muscle function and skeletal muscle mass. 13 19