151751-Najiba-Chargi

403 The elderly head and neck cancer patient: skeletal muscle mass and frailty INTRODUCTION Head and neck cancer (HNC) is among the most frequent malignant tumors in the world with an annual incidence of more than 650,000 cases and 330,000 deaths. 1 Of these patients, more than 60%have an age at diagnosis of 60 years or more. 2 With the global aging of the worldwide population, it is to be expected that the incidence of HNCs will increase. Besides advanced age, the significant amount of pre-existent comorbidities in HNCs patients are additional negative prognostic factors that reduce overall survival. 3 Treatment of HNCs is often complex and requires, based on tumor-specific and patient-specific characteristics, surgery with or without adjuvant (chemo)radiotherapy or radiotherapy with or without chemotherapy with salvage surgery in reserve for residual or recurrent loco regional disease. 4 These treatments are effective, but have significant risk of toxicities, complications, and even mortality. 5 Treatment could also decrease quality of life, for instance speech prob- lems, fatigue or trouble with social eating caused by dry mouth, and swallowing problems. 6,7 Due to the growing incidence of both HNCs worldwide and the global aging of the population it is of great importance to identify key predictive and prognostic factors for treatment out- comes in older patients with HNC. This knowledge can be useful for clinicians and patients in (shared) decision making weighing suitability of treatment, prognosis, and expected quality of life. Although this knowledge is also important in younger HNC patients, it is even more warranted in older HNC patients due to their vulnerability, decreased physical and mental compensation mechanisms compared to younger patients. This vulnerability is also being referred to as frailty. A comprehensive geriatric assessment (CGA) is the most appropriate way to detect frailty. 8 A CGA is a multidisciplinary, multidimensional, and systematic assessment, and consists of validated scales to identify impairments in the four geriatric domains: somatic, functional, nutritional, and psychosocial 9 . Frailty is associated with poor treatment outcomes and health ‐ related quality of life. 7 Because performing CGA is time consuming and not all patients will benefit from a CGA, screening methods have been developed to identify those at risk for adverse health outcomes and who may benefit from a CGA. However, the available frailty screening methods may have insufficient discriminative power to select patients for further assessment. 10 Sarcopenia also frequently observed in older patients is suggested as a more reliable, inex- pensive and easy alternative for frailty screening questionnaires in HNC patients 11 . However, there is much discussion on different definitions of frailty and sarcopenia. 12 By the European Working Group on Sarcopenia in Older People (EWGSOP) sarcopenia is described as a general - ized and progressive loss of muscle function (MF) and skeletal muscle mass (SMM), caused by adverse muscle changes that accrue across a lifetime. 13 Sarcopenia itself is also related with 20