The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial

Abstract Objective To analyze the impact of nutritional counseling on the development of hypothyroidism after (chemo)radiotherapy in head and neck cancer patients to propose a new normal tissue complication probability (NTCP) model. Materials and methods At baseline, at the end of (chemo)radiotherapy, and during follow-up, thyroid-stimulating hormone (TSH) with free thyroxin (fT3 and fT4), nutritional status, and nutrient intake were prospectively analyzed in 46 out of 220 screened patients. Patients received (chemo)radiotherapy within an intervention (individual nutritional counseling every 2 weeks during therapy) and a control group (no nutritional counseling). Results Overall median follow-up was 16.5 [IQR: 12; 22] months. Fourteen patients (30.4%) presented with hypothyroidism after 13.5 [8.8; 17] months. During (chemo)radiotherapy, nutritional status worsened in the entire cohort: body mass index (p < 0.001) and fat-free mass index (p < 0.001) decreased, calorie deficit (p = 0.02) increased, and the baseline protein intake dropped (p = 0.028). The baseline selenium intake (p = 0.002) increased until the end of therapy. Application of the NTCP models by Rønjom, Cella, and Boomsma et al. resulted in good performance of all three models, with an AUC ranging from 0.76 to 0.78. Our newly developed NTCP model was based on baseline TSH and baseline ferritin. Model performance was good, receiving an AUC of 0.76 (95% CI: 0.61–0.87), with a sensitivity of 57.1% and specificity of 96.9% calculated for a Youden index of 0.73 (p = 0.004; area = 0.5). Conclusion Baseline TSH and ferritin act as independent predictors for radiotherapy-associated hypothyroidism. The exclusion of such laboratory chemistry parameters in future NTCP models may result in poor model performance.

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Correction to: The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial

Strahlentherapie und Onkologie ◽

10.1007/s00066-021-01888-w ◽

2021 ◽

Author(s):

Anastassia Löser ◽

Kerstin Ramke ◽

Maximilian Grohmann ◽

Linda Krause ◽

Pia Roser ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Thyroid Disorders ◽

Nutritional Counseling ◽

Interventional Trial ◽

The Impact

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Effectiveness of Nutritional Counseling in Improving the Nutritional Status of Head and Neck Cancer Patients undergoing Concurrent Chemotherapy and Radiotherapy through continuous Guidance on Nutrition

Scholars Journal of Applied Medical Sciences ◽

10.36347/sjams.2020.v08i01.005 ◽

2020 ◽

Vol 08 (01) ◽

pp. 23-28

Author(s):

Manasij Mitra ◽

Maitraye Basu ◽

Babita Hazarika ◽

Swati Modak Das

Keyword(s):

Head And Neck Cancer ◽

Nutritional Status ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Concurrent Chemotherapy ◽

Nutritional Counseling

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SEVERE RADIODERMATITIS AND RISK FACTORS ASSOCIATED IN HEAD AND NECK CANCER PATIENTS

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2018-0343 ◽

2020 ◽

Vol 29 ◽

Author(s):

Aluane dos Santos Cardozo ◽

Fabiana Verdan Simões ◽

Valdete Oliveira Santos ◽

Luciana Fernandes Portela ◽

Rafael Celestino da Silva

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Interruption ◽

Treatment Technique ◽

Discontinuation Of Treatment ◽

Temporary Treatment ◽

The Impact

ABSTRACT Objective: To evaluate the association between sociodemographic, clinical, and treatment factors in the outcome of severe radiodermatitis in patients with head and neck cancer seen at the nursing consultation; and to analyze the impact of severe radiodermatitis cases on therapeutic follow-up. Method: A quantitative, documentary research conducted with medical records of 167 patients with head and neck cancer submitted to radiotherapy with curative indication followed in the nursing consultation in 2016. A structured form was used for data collection and analytical and descriptive statistics were used for its analysis. Results: Of the 99.4% patients who had radiodermatitis, 11.4% were severe cases. Severe radiodermatitis was associated with the type of equipment, treatment technique and presence of comorbidities. Of the patients who presented grade three, 53% had temporary discontinuation of treatment. Conclusion: Head and neck cancer patients who undergo radiotherapy with curative indication are at risk for severe radiodermatitis. Nursing consultation is important to minimize the severity of this event and the reduction of temporary treatment interruption due to this adverse reaction.

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Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00291-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Beatrice Martin ◽

Emanuele Cereda ◽

Riccardo Caccialanza ◽

Paolo Pedrazzoli ◽

Rosanna Tarricone ◽

...

Keyword(s):

Head And Neck Cancer ◽

Cost Effectiveness ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Nutritional Counseling ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

Abstract Objective There is limited evidence regarding the economic effects of nutrition support in cancer patients. This study aims at investigating the cost-effectiveness profile of systematic oral nutritional supplementation (ONS) in head and neck cancer (HNC) patients undergoing radiotherapy (RT) and receiving nutritional counseling. Methods A cost-effectiveness analysis based on a RCT was performed to estimate direct medical costs, life years gained (LYG) and Quality-Adjusted Life Years (QALY) for nutritional counseling with or without ONS at 5-month and 6-year follow up time. Value of information analysis was performed to value the expected gain from reducing uncertainty through further data collection. Results ONS with nutritional counseling produced higher QALY than nutritional counseling alone (0.291 ± 0.087 vs 0.288 ± 0.087), however the difference was not significant (0.0027, P = 0.84). Mean costs were €987.60 vs €996.09, respectively in the treatment and control group (-€8.96, P = 0.98). The Incremental Cost Effectiveness Ratio (ICER) was -€3,277/QALY, with 55.4% probabilities of being cost-effective at a cost-effectiveness threshold of €30,000/QALY. The Expected Incremental Benefit was €95.16 and the Population Expected Value of Perfect Information was €8.6 million, implying that additional research is likely to be worthwhile. At a median 6-year follow up, the treatment group had a significantly better survival rate when adjusting for late effect (P = 0.039). Conclusion Our findings provide the first evidence to inform decisions about funding and reimbursement of ONS in combination with nutritional counseling in HNC patients undergoing RT. ONS may improve quality of cancer care at no additional costs, however further research on the cost-effectiveness of nutritional supplementation is recommended. Trial Registration: ClinicalTrials.gov: NCT02055833. Registered 5th February 2014 https://clinicaltrials.gov/ct2/show/NCT02055833

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The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2006.09.021 ◽

2007 ◽

Vol 67 (3) ◽

pp. 660-669 ◽

Cited By ~ 137

Author(s):

Yun Li ◽

Jeremy M.G. Taylor ◽

Randall K. Ten Haken ◽

Avraham Eisbruch

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

The Impact

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Nutritional status and dietary quality index of head and neck cancer patients undergoing chemo radiotherapy

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.014 ◽

2020 ◽

Vol 8 (1) ◽

pp. 14-14

Author(s):

Shirin Fattahi ◽

Farshad Seyyednejad ◽

Sarvin Sanaie ◽

Tahereh Parhizkar ◽

Elnaz Faramarzi

Keyword(s):

Head And Neck Cancer ◽

Nutritional Status ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Quality Index ◽

Dietary Diversity ◽

Mini Nutritional Assessment ◽

Dietary Quality ◽

Quality Indices

Introduction: Considering the important role of early detection of malnutrition in patients with cancer and its negative effects on the outcome, as well as the lack of any published article (to the best of our knowledge) about the dietary quality index in head and neck cancer patients treated with chemoradio therapy, we decided to evaluate the nutritional status and dietary quality index in these patients. Methods: In this study, thirty-seven volunteer patients with head and neck cancer were recruited. Nutritional status of the patients was evaluated by Mini Nutritional Assessment (MNA) questionnaire. Dietary diversity score, dietary variety score, and diet quality index–international were calculated to assess the dietary quality of the patients. Results: Our findings indicated that about half of the patients were well nourished and 48.6%were at the risk of malnutrition. We did not find any significant differences between variousdietary quality indices and nutritional status of the patients. However, a significant reverse correlation was observed between dietary quality indices and nutritional status of the patients. Conclusion: According to our findings, the evaluation of nutritional status and the prediction of the patients at higher risks of chemoradio therapy-induced adverse events, may have a major role in the prevention of treatment gaps.

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Impact of Tracheal Tube on Swallowing in Post-Operative Head and Neck Cancer Patients: Scintigraphic Analysis

Dysphagia ◽

10.1007/s00455-020-10222-y ◽

2020 ◽

Author(s):

Jacopo Galli ◽

Maria Raffaella Marchese ◽

Tiziana Di Cesare ◽

Laura Tricarico ◽

Giovanni Almadori ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Tracheal Tube ◽

Transit Time ◽

Neck Cancer ◽

Retention Index ◽

Small Diameter ◽

Swallowing Rehabilitation ◽

The Impact

AbstractDysphagia is common in tracheostomized patients who underwent head and neck surgery for cancer treatment. The objective of this study was to evaluate, by means of oropharyngoesophageal scintigraphy (OPES), the impact of an occluded tracheal tube (TT) on swallowing in patients treated for head and neck cancer before hospital discharge, to provide further information to the benefit of out-patient care management. From October 2018 to November 2019, we enrolled 19 tracheostomized patients (6 females and 13 males; mean age 61 years) who underwent primary surgical resection of head and neck tumor and swallowing rehabilitation during hospitalization. All subjects underwent a double-standard OPES, one with occluded tracheal tube and the other without TT, with their tracheal stoma being closed directly by a plaster. For each study, we assessed and compared the following quantitative parameters: oral transit time (OTTsec), pharyngeal transit time (PTTsec), esophageal transit time (ETTsec), oral retention index (ORI%), pharyngeal retention index (PRI%), esophageal retention index (ERI%), and aspiration percentage (AP%). The mean values of OTT, PTT, ORI%, PRI%, and ERI% were abnormal during OPES both with TT and without TT and did not statistically differ between the two tests (p > 0.05). Aspiration was detected in 4 cases out of 19 (21.05%) cases during OPES with TT and in 4/19 (21.05%) cases without TT who showed a mean AP% of 11.4% and 11.5% respectively (p > 0.05). Patients with abnormal AP% (> 0%) during OPES with TT showed aspiration signs without TT. Our study showed that the mere presence of a closed tracheal tube does not impact significantly the oropharyngeal transit of bolus during swallowing. This result suggests the possibility to maintain a small-diameter occluded tracheal tube in place for the postsurgical management of head and neck cancer patients.

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