Background <p>The distinction between frailty and ageing is becoming increasingly recognised, however, the clinical implication of this in head and neck cancers has not been fully explored. In this review we evaluate the prognostic value of frailty, assessed through established screening tools, in predicting the long-term survival outcomes among patients with head and neck cancer.</p> Methods <p>We performed a systematic review in accordance with the PRISMA guidelines. The search was conducted in Ovid MEDLINE, Ovid Embase, PubMed, Cochrane library and ClinicalTrials.gov databases.</p> Results <p>Five studies met the inclusion criteria for this review, encompassing 1131 patients. Of these four studies employed a retrospective design, while one was prospective. Three of the five studies demonstrated a significant correlation between frailty and long-term survival outcomes. In contrast, two of the five studies specifically examined long-term disease free survival (DFS), but neither found a significant association between frailty and long-term DFS.</p> Conclusion <p>Frailty is prevalent amongst patients with head and neck cancer and its assessment using validated screening tools may hold significant prognostic value. Currently, frailty assessment is most valuable as a guide in patient/treatment selection and enabling shared decision making. However, further research is needed to determine the most effective frailty screening tool and to clarify its specific role in this patient population.</p>