Role of frailty screening tools SCOPE-C and G8 in predicting surgical outcomes in older adults with head neck cancer in the Indian subcontinent: A prospective study.
TL;DR
Compared to the SCOPE-C screening tool, the G8 demonstrated statistically significant predictive value for both major surgical complications and readmissions; however, its low AUC indicates limited sensitivity and guarded clinical usefulness in predicting major postoperative complications.
Abstract
INTRODUCTION Frailty assessment has proved useful for evaluating the ability to withstand cancer treatments, but it remains understudied in low- and middle-income countries, where the average life expectancy is about two decades lower than in higher-income countries. This study aimed to establish frailty cutoffs to guide treatment decisions by determining optimal G8 (Geriatric 8) and SCOPE-C (SCreening of the Older Person with Cancer) scores to predict postoperative outcomes in older Indian adults with head and neck cancer.
Materials And Methods
In a tertiary care cancer facility in North India, patients ≥60 years with primary head and neck cancers undergoing curative surgery were included. This prospective observational study took place from January 2024 to March 2025. Pre-surgical frailty assessment was done by G8 and SCOPE-C. The main outcomes were major surgical complications and 30-day readmission.
Results
Of 115 patients included (mean age 66.9 years; 79.1% male), 22.6% developed major complications and 7.8% required readmission. On multivariable analysis, lower G8 (odds ratio [OR] 0.77, p = 0.007) and flap use (OR 3.21, p = 0.048) predicted major complications, while G8 alone predicted readmissions (OR 0.52, p = 0.001). Receiver operating characteristic analysis identified G8 cutoffs of ≤13 score for predicting complications (area under the curve [AUC] 0.636) and ≤ 11 for readmissions (AUC 0.839). Patients with G8 ≤ 11 had higher readmission rates (17% vs 1.5%; p = 0.003), and G8 ≤ 13 had more major complications (28.8% vs 11.9%; p = 0.04).
Discussion
Compared to the SCOPE-C screening tool, the G8 demonstrated statistically significant predictive value for both major surgical complications and readmissions; however, its low AUC indicates limited sensitivity and guarded clinical usefulness in predicting major postoperative complications.