P-84 Pre-treatment body mass composition affects survival in patients with head and neck cancer

Oral Oncology ◽  
2021 ◽  
Vol 118 ◽  
pp. 5-6
Author(s):  
Charbél Talani ◽  
Thorsteinn Astradsson ◽  
Lovisa Farnebo ◽  
Antti Mäkitie ◽  
Göran Laurell ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Mass Composition ◽  
Pre Treatment ◽  
Body Mass Composition

Correlation of body mass index with toxicity and survival in locoregionally advanced head and neck cancer patients treated with induction chemotherapy and concurrent chemoradiotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6074-6074
Author(s):  
A. K. Jain ◽  
J. K. Salama ◽  
K. M. Stenson ◽  
E. Blair ◽  
E. E. Cohen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Advanced Head ◽  
Pre Treatment ◽  
The Impact

6074 Background: Concurrent chemoradiotherapy (CRT) offers high functional organ preservation rates for locoregionally advanced head and neck cancer (LRAHNC) patients, but is associated with significant acute and chronic speech and swallowing toxicity. Recently, body mass index (BMI) has been suggested as a predictor of head and neck cancer patient outcome. In this analysis we sought to determine the impact of BMI on survival and toxicity outcomes in LRAHNC patients treated with CRT. Methods: 220 LRAHNC patients were treated on a multiinstitutional protocol consisting of induction carboplatin and paclitaxel followed by CRT. CRT was delivered for 4–5 cycles; each 14-day cycle consisted of 5 days concurrent paclitaxel, continuous infusion 5-FU, hydroxyurea, and 1.5 Gy twice daily radiation followed by 9 days without any treatment. Each patient's pre-treatment BMI was classified as overweight (BMI >= 25) or non-overweight (BMI < 25). As an independent variable, BMI was analyzed as a predictor of IndCT or CRT toxicity, locoregional control, and overall survival. BMI was analyzed as categorical variable, and also a continuous variable in a multivariate proportional hazards model. Results: There was no association between BMI and IndCT toxicity. During CRT overweight patients had significantly lower rates (24/103 vs 42/112) of grade 3 or higher neutropenia (p = 0.027), mucositis (p = 0.05), dermatitis (p = 0.028) and higher rates of anorexia (p = 0.05). Overweight patients had 12% long term PEG tube rate, compared to 34% of non-overweight patients (p < 0.001). On pooled survival analysis, patients with BMI > 25 had significantly better overall survival outcomes (mean 81.2 months, 95% CI 75.1–87.3 months) than patients with BMI < 25 (median 58.2 months; mean 56.5 months, 95% CI 49.6–63.3 months) (log-rank p < 0.001). Conclusions: Our data suggest patients with pre-treatment BMI > 25 experience lower rates of toxicity commonly associated with chemoradiation, and have a significantly better prognosis than patients with BMI < 25. Although the mechanism of BMI as an independent predictor of outcomes is unclear, we are continuing to explore mechanisms underlying this association. No significant financial relationships to disclose.

Associations between pretreatment body mass index and presence of post-treatment nutrition impact symptoms in head and neck cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17547-e17547
Author(s):  
Katherine G. Douglas ◽  
Sylvia L. Crowder ◽  
Laura S. Rozek ◽  
Gregory T. Wolf ◽  
Anna Arthur
Keyword(s):  
Body Mass Index ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Summary Score ◽  
Post Treatment ◽  
Disease Stage ◽  
Nutrition Impact Symptoms ◽  
Pre Treatment

e17547 Background: The objective of this study was to determine if pre-treatment body mass index (BMI) is associated with the presence of self-reported, nutrition impact symptoms (NIS) 1-year post-treatment in head and neck cancer (HNC) survivors. We hypothesize that higher pre-treatment BMI may be associated with fewer reported NIS post treatment. Methods: This was a longitudinal study of 430 HNC survivors recruited from the University of Michigan Head and Neck Specialized Program of Research Excellence (HN-SPORE) study. Participants completed a pre-treatment health questionnaire which included self-reported height and weight. NIS were assessed at 1-year post-treatment using a Likert scale ranging from 1 (not at all) vs 5 (extremely) bothered by symptoms. Eight individual NIS were assessed (trismus, xerostomia, bothered chewing, dysphagia liquids, dysphagia solids, taste changes, mucositis, and shoulder or neck pain). Individual symptoms were summed to create a symptom summary score. Self-reported pre-treatment height and weight were used to calculate BMI in kg/m2. BMI was categorized as 1) underweight, 2) normal weight, 3) overweight and 4) obese. Pearson partial correlations between pre-treatment BMI status and individual post-treatment NIS and post-treatment NIS summary score were examined. Covariates included age, sex, tumor site, disease stage, smoking, alcohol consumption, and HPV status. Results: BMI was significantly inversely associated with bothered chewing, dysphagia liquids, dysphagia solids, taste alterations, and shoulder pain (p < 0.05). BMI was also significantly inversely correlated with the overall symptom summary score. Conclusions: Higher pre-treatment BMI may be associated with reduced risk of post-diagnosis symptom burden in HNC survivors. Funding: NIH/NCI P50CA097248; Hatch project 1011487; Carle-Illinois Cancer Scholars for Translational and Applied Research Fellowship.

Effect of Body Mass Index on Chemoradiation Outcomes in Head and Neck Cancer

2008 ◽  
Vol 118 (7) ◽  
pp. 1180-1185 ◽  
Author(s):  
Theodore R. McRackan ◽  
John M. Watkins ◽  
Amy E. Herrin ◽  
Elizabeth M. Garrett-Mayer ◽  
Anand K. Sharma ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer

scholarly journals A Bayesian Sensitivity Analysis to Partition Body Mass Index Into Components of Body Composition: An Application to Head and Neck Cancer Survival

2019 ◽  
Vol 188 (11) ◽  
pp. 2031-2039
Author(s):  
Patrick T Bradshaw ◽  
Jose P Zevallos ◽  
Kathy Wisniewski ◽  
Andrew F Olshan
Keyword(s):  
Body Mass Index ◽  
Sensitivity Analysis ◽  
Body Composition ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Hazard Ratio ◽  
Unit Increase ◽  
The Relationship

Abstract Previous studies have suggested a “J-shaped” relationship between body mass index (BMI, calculated as weight (kg)/height (m)2) and survival among head and neck cancer (HNC) patients. However, BMI is a vague measure of body composition. To provide greater resolution, we used Bayesian sensitivity analysis, informed by external data, to model the relationship between predicted fat mass index (FMI, adipose tissue (kg)/height (m)2), lean mass index (LMI, lean tissue (kg)/height (m)2), and survival. We estimated posterior median hazard ratios and 95% credible intervals for the BMI-mortality relationship in a Bayesian framework using data from 1,180 adults in North Carolina with HNC diagnosed between 2002 and 2006. Risk factors were assessed by interview shortly after diagnosis and vital status through 2013 via the National Death Index. The relationship between BMI and all-cause mortality was convex, with a nadir at 28.6, with greater risk observed throughout the normal weight range. The sensitivity analysis indicated that this was consistent with opposing increases in risk with FMI (per unit increase, hazard ratio = 1.04 (1.00, 1.08)) and decreases with LMI (per unit increase, hazard ratio = 0.90 (0.85, 0.95)). Patterns were similar for HNC-specific mortality but associations were stronger. Measures of body composition, rather than BMI, should be considered in relation to mortality risk.

scholarly journals Changes in immune parameters between pre-treatment and recurrence after (chemo) radiation therapy in patients with head and neck cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takeharu Ono ◽  
Koichi Azuma ◽  
Akihiko Kawahara ◽  
Tatsuyuki Kakuma ◽  
Fumihiko Sato ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Immune Parameters ◽  
Pre Treatment

Clinical analysis for pre-treatment sarcopenia assessments in elderly head and neck cancer patients

Toukeibu Gan ◽  
2020 ◽  
Vol 46 (3) ◽  
pp. 284-290
Author(s):  
Mutsukazu Kitano ◽  
Ryohei Fujiwara ◽  
Sena Horiguchi ◽  
Misako Nishihara ◽  
Ko Shiraishi ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Clinical Analysis ◽  
Pre Treatment

scholarly journals Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S13-S22 ◽  
Author(s):  
A Robson ◽  
J Sturman ◽  
P Williamson ◽  
P Conboy ◽  
S Penney ◽  
...  
Keyword(s):  
Heart Failure ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Enzyme Inhibitors ◽  
Bleeding Risk ◽  
Neck Surgery ◽  
Converting Enzyme Inhibitors ◽  
Pre Treatment ◽  
Clean Contaminated

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer.Recommendations• Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R)• Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R)• Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R)• Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G)• Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G)• Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G)• Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R)• Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G)• Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R)• Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R)• Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin II antagonists should be continued including on the day of surgery. (R)• Angotensin-converting enzyme inhibitors and angiotensin II antagonists should be withheld on the day of surgery unless they are for the treatment of heart failure. (R)• Post-operative care in a critical care area should be considered for patients with heart failure or significant diastolic dysfunction. (R)• Patients with respiratory disease should have their peri-operative respiratory failure risk assessed and critical care booked accordingly. (G)• Patients with severe lung disease should be assessed for right heart disease pre-operatively. (G)• Patients with pulmonary hypertension and right heart failure will be at extraordinarily high risk and should have the need for surgery re-evaluated. (G)• Perioperative glucose readings should be kept within 4–12 mmol/l. (R)• Patients with a high HbA1C facing urgent surgery should have their diabetes management assessed by a diabetes specialist. (G)• Insulin-dependent diabetic patients must not omit insulin for more than one missed meal and will therefore require an insulin replacement regime. (R)• Patients taking more than 5 mg of prednisolone daily should have steroid replacement in the peri-operative period. (R)• Consider proton pump therapy for patients taking steroids in the peri-operative phase if they fit higher risk criteria. (R)• Surgery within three months of stroke carries high risk of further stroke and should be delayed if possible. (R)• Patients with rheumatoid arthritis should have flexion/extension views assessed by a senior radiologist pre-operatively. (R)• Patients at risk of post-operative cognitive dysfunction and delirium should be highlighted at pre-operative assessment. (G)• Patients with Parkinson's disease (PD) must have enteral access so drugs can be given intra-operatively. Liaison with a specialist in PD is essential. (R)• Intravenous iron should be considered for anaemia in the urgent head and neck cancer patient. (G)• Preoperative blood transfusion should be avoided where possible. (R)• Where pre-operative transfusion is essential it should be completed 24–48 hours pre-operatively. (R)• An accurate alcohol intake assessment should be completed for all patients. (G)• Patients considered to have a high level of alcohol dependency should be considered for active in-patient withdrawal at least 48 hours pre-operatively in liaison with relevant specialists. (R)• Parenteral B vitamins should be given routinely on admission to alcohol-dependent patients. (R)• Smoking cessation, commenced preferably six weeks before surgery, decreases the incidence of post-operative complications. (R)• Antibiotics are necessary for clean-contaminated head and neck surgery, but unnecessary for clean surgery. (R)• Antibiotics should be administered up to 60 minutes before skin incision, as close to the time of incision as possible. (R)• Antibiotic regimes longer than 24 hours have no additional benefit in clean-contaminated head and neck surgery. (R)• Repeat intra-operative antibiotic dosing should be considered for longer surgeries or where there is major blood loss. (R)• Local antibiotic policies should be developed and adhered to due to local resistance patterns. (G)• Individual assessment for venous thromboembolism (VTE) risk and bleeding risk should occur on admission and be reassessed throughout the patients' stay. (G)• Mechanical prophylaxis for VTE is recommended for all patients with one or more risk factors for VTE. (R)• Patients with additional risk factors of VTE and low bleeding risk should have low molecular weight heparin at prophylactic dose or unfractionated heparin if they have severe renal impairment. (R)

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