Aims
Head and neck cancer (HNC) increasingly affects older adults, with incidence highest among Australians aged 80 to 84 years. Dysphagia is a major complication in HNC. As more older adults are diagnosed with HNC, many present with sarcopenia and frailty, conditions that reduce physiological and swallowing muscle reserve. These conditions may worsen dysphagia beyond the direct effects of the tumour or its treatment. Understanding this interplay is essential for early identification of high‑risk patients and for implementing preventative strategies. A scoping review was conducted to examine associations between frailty or sarcopenia and dysphagia in adults with HNC, with implications for early identification and preventative care.
Methods
A systematic search of PubMed, MEDLINE, EMBASE, and CINAHL identified studies reporting frailty or sarcopenia in adults with HNC alongside dysphagia outcomes.
Results
Across 3,342 records screened, 17 studies met inclusion criteria (sarcopenia n = 12; frailty n = 5). Considerable heterogeneity was observed in the assessment of frailty, sarcopenia, and dysphagia. Sarcopenia was most commonly assessed using computed tomography‑derived muscle measures, while frailty assessments varied from brief screeners to multidimensional indices. Despite this variability, most studies reported significant associations between frailty or sarcopenia and dysphagia. Both conditions were associated with increased dysphagia severity, aspiration pneumonia, and prolonged feeding tube dependence.
Conclusions
Frailty and sarcopenia are early predictors of dysphagia in HNC and increasingly relevant within ageing cancer population. Routine screening may support targeted preventative strategies including prehabilitation, nutritional optimization, and early speech pathology involvement to support proactive dysphagia prevention.