Nutrition impact symptoms and weight loss in head and neck cancer during radiotherapy: a longitudinal study

2020 ◽  
pp. bmjspcare-2019-002077
Author(s):  
Sanli Jin ◽  
Qian Lu ◽  
Yan Sun ◽  
Shaowen Xiao ◽  
Baomin Zheng ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Post Treatment ◽  
Nutrition Impact Symptoms ◽  
The Mean ◽  
The Impact ◽  
Interference Score

ObjectivePatients with head and neck cancer (HNC) receiving radiotherapy (RT) are at high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NIS). This study aimed to describe the NIS through the Head and Neck patient Symptom Checklist and body weight over time and further explore the impact of NIS on WL in patients with HNC undergoing RT.MethodsThis was a prospective, longitudinal observational study. NIS and body weight of 117 participants were assessed at baseline, mid-treatment and post-treatment of RT. Generalised estimation equations (GEE) were used to conduct repeated measures analysis of NIS interference score and body weight at each time point and estimate the impact of NIS interference score on WL.ResultsAll participants experienced a substantial increase in the mean number of NIS during RT, with each patient having eight to nine NIS at mid-treatment and post-treatment. Marked increases were noted in almost each NIS score during RT. Compared with their baseline body weight, 97 (82.9%) and 111 (94.9%) participants experienced WL at mid-treatment and post-treatment, with the mean WL of 2.55±1.70 kg and 5.31±3.18 kg, respectively. NIS of dry mouth (β=−0.681, p=0.002, 95% CI −1.116 to −0.247), difficulty swallowing (β=−0.410, p=0.001, 95% CI −0.651 to −0.169) and taste change (β=−0.447, p=0.000, 95% CI −0.670 to −0.225) impacted WL significantly in GEE multivariate model.ConclusionsPatients with HNC experience a variety of NIS which have significant impact on WL during RT. Assessment of NIS, especially dry mouth, difficulty swallowing and taste change, should be given more considerable attention in the supportive care of patients with HNC.

scholarly journals Impact of Photobiomodulation for Oral Mucositis on Body Weight and Bmi of Patients with Head and Neck Cancer

2021 ◽  
Author(s):  
Amanda de Sousa Melo ◽  
Camila Lima Andrade ◽  
Juliana Borges de Lima Dantas ◽  
Alena Ribeiro Alves Peixoto Medrado ◽  
Gabriela Botelho Martins ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Oral Mucositis ◽  
Sham Group ◽  
Maximum Output Power ◽  
Maximum Output ◽  
The Impact

Abstract Purpose To evaluate the impact of photobiomodulation for oral mucositis on body weight and Body Mass Index (BMI) of patients with head and neck cancer. Methods Patients were divided into two distinct groups: Photobiomodulation - PBM (n = 17) and SHAM (n = 19). Participants in the PBM group received the low-power aluminum gallium arsenide (AsGaAl) laser device with maximum output power of 86.7 mW, wavelength of 660 nm (red) and laser applications at 33 different points of the oral mucosa, on alternate days. Patients in the SHAM group were found to be using the same procedure but with the device turned off. During the first and twenty-fourth session of radiotherapy, participants from both groups underwent an intraoral examination to assess the presence or absence of mucositis and its respective degree according to WHO scale, and were assessed by measuring weight and height and for BMI calculation. Results All patients presented significant differences on weight and BMI throughout the study. Patients in the PBM group had less weight loss (p<0.01) and reduced BMI loss (p<0.01) when compared to patients in the SHAM group. PBM did not prevent oral mucositis, however, it decreased its severity (p<0.01). Conclusion Photobiomodulation for oral mucositis reduces weight loss and prevented the reduction of BMI in patients who underwent radiochemotherapy treatment for head and neck cancer. Although it did not avoid the appearance of oral mucositis, PBM was able to reduce its degrees, preventing the progress of this condition. Retrospectively registered: https://data.mendeley.com//datasets/4kd7s49wk4/1

scholarly journals Exploration of risk factors for weight loss in head and neck cancer patients

2015 ◽  
Vol 14 (4) ◽  
pp. 343-352 ◽  
Author(s):  
Patrick Dawson ◽  
Amy Taylor ◽  
Chris Bragg
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Weight Loss ◽  
Body Weight ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Linear Regression Analysis ◽  
Relative Significance

AbstractIntroductionHead and neck cancer patients receiving radiotherapy can experience a number of toxicities, including weight loss and malnutrition, which can impact upon the quality of treatment. The purpose of this retrospective cohort study is to evaluate weight loss and identify predictive factors for this patient group.Materials and methodsA total of 40 patients treated with radiotherapy since 2012 at the study centre were selected for analysis. Data were collected from patient records. The association between potential risk factors and weight loss was investigated.ResultsMean weight loss was 5 kg (6%). In all, 24 patients lost >5% starting body weight. Age, T-stage, N-stage, chemotherapy and starting body weight were individually associated with significant differences in weight loss. On multiple linear regression analysis age and nodal status were predictive.ConclusionYounger patients and those with nodal disease were most at risk of weight loss. Other studies have identified the same risk factors along with several other variables. The relative significance of each along with a number of other potential factors is yet to be fully understood. Further research is required to help identify patients most at risk of weight loss; and assess interventions aimed at preventing weight loss and malnutrition.

scholarly journals The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features

2020 ◽  
Vol 3 ◽  
Author(s):  
Marelle Rukes ◽  
Alexander Jones ◽  
Leah Novinger ◽  
Kyle Davis ◽  
Vincent Campiti ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Head And Neck Carcinoma ◽  
Depth Of Invasion ◽  
Skeletal Muscle Index ◽  
Pathologic Features ◽  
Significant Difference ◽  
The Impact

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients.     Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05.      Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension.     Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes. 

scholarly journals Dysphagia, voice problems, and pain in head and neck cancer patients

2021 ◽  
Author(s):  
Veit Zebralla ◽  
Gunnar Wichmann ◽  
Markus Pirlich ◽  
Carola Hammermüller ◽  
Thomas Berger ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Assessment Tool ◽  
Emotional Quality ◽  
Eortc Qlq C30 ◽  
Important Symptom ◽  
The Mean ◽  
Eortc Qlq ◽  
The Impact

Abstract Purpose Head and neck cancer (HNC) and its treatment can leave devastating side effects with a relevant impact on physical and emotional quality of life (QoL) of HNC patients. The objectives were to examine the amount of dysphagia, voice problems, and pain in HNC patients, the impact of sociodemographic, behavioral, and clinical factors on these symptoms, the psychometric properties of the EAT-10, and the relationship between these symptoms and QoL variables. Methods HNC patients attending for regular follow-up from 07/2013 to 09/2019 completed questionnaires (Eating Assessment Tool-10 (EAT-10); questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems, pain, fatigue, and QoL collected with the software OncoFunction. Associations between prognostic factors and symptoms were tested with analyses of variance (ANOVAs). Associations between the symptom scales and QoL variables were expressed with Pearson correlations. Results Of 689 patients, 54.9% suffered from dysphagia, the EAT-10 proved to be a reliable measure. The mean voice score was 37.6 (± 33.9) [range 0–100], the mean pain score 1.98 (± 2.24) [range 0–10]. Trimodality treatment was associated with the highest dysphagia scores. Dysphagia, voice problems, and pain significantly correlated with each other, the highest association was found for dysphagia and pain (r = 0.51). QoL was strongly correlated with dysphagia and pain (r = − 0.39 and r = − 0.40, respectively), while the association with voice problems was weaker (r = − 0.28). Conclusion Dysphagia is an important symptom in HNC patients greatly affecting patients’ QoL and significantly correlating with voice problems and pain.

scholarly journals Changes in Nutrition Impact Symptoms, Nutritional and Functional Status during Head and Neck Cancer Treatment

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1225
Author(s):  
May Kay Neoh ◽  
Zalina Abu Zaid ◽  
Zulfitri Azuan Mat Daud ◽  
Nor Baizura Md. Yusop ◽  
Zuriati Ibrahim ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Functional Status ◽  
Head And Neck ◽  
Neck Cancer ◽  
Protein Intake ◽  
Nutritional Parameters ◽  
Taste Changes ◽  
Oral Nutritional Supplements ◽  
Nutrition Impact Symptoms

Background: The purpose of this study is to evaluate changes in nutrition impact symptoms (NIS) and nutritional and functional status that occur throughout radiotherapy in head and neck cancer (HNC) patients. Methods: A prospective observational study of HNC inpatients who underwent radiotherapy with or without chemotherapy were recruited to participate. Fifty patients were followed for the periods before, in the middle and at the end of radiotherapy. Nutritional parameters were collected throughout radiotherapy. Results: According to Patient-Generated Subjective Global Assessment (PG-SGA), there was an increase from a baseline of 56% malnourished HNC patients to 100% malnourished with mean weight loss of 4.53 ± 0.41kg (7.39%) at the end of radiotherapy. Nutritional parameters such as muscle mass, fat mass, body mass index, dietary energy and protein intake decrease significantly (p < 0.0001) while NIS score, energy and protein intake from oral nutritional supplements (ONS) increased significantly (p < 0.0001). Hand grip strength did not differ significantly. All HNC patients experienced taste changes and dry mouth that required ONS at the end of treatment. ONS compliance affected the percentage of weight loss (p = 0.013). Conclusions: The intensive nutritional care time point was the middle of RT. The PG-SGA and NIS checklist are useful for monitoring nutrition for HNC patients.

Weight loss during concomitant chemo-radiation therapy for squamous cell head and neck cancer: Possible role of transient hyperthyroidism

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16531-16531
Author(s):  
B. Mehrotra ◽  
A. Caramalis ◽  
S. Nissel-Horowitz ◽  
N. Radhakrishnan ◽  
J. Marsh ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Thyroid Function ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Post Treatment ◽  
Reduce Weight Loss ◽  
Tsh Levels

16531 Background: Concomitant Chemoradiotherapy (CRT) is a standard treatment modality for locally advanced squamous cell head and neck cancer (HNC). This treament is often associated with significant weight loss which is commonly attributed to nutritional depletion secondary to mucositis, pain and inadequate oral intake. We undertook an evaluation of thyroid function as measured by Thyroid Stimulating Hormone (TSH) levels during CRT to evaluate the possible role of a thyroid hormone flare during treatment that may account for part of this weight loss. Methods: Institutional Review Board approval was obtained to conduct this retrospective analyses. Patients treated at our institution during the past six months who were treated with CRT for HNC and had recorded TSH levels at baseline (when available), mid treatment (week 4 to 6 of CRT), and post CRT (6 to 9 weeks later), at least 5% weight loss during treatment, and feeding tube requirement data available were identified. Age, Gender, Stage and Primary site of disease, Radiation dose and fields, chemotherapy regimen, were recorded. Results: Twelve patients were identified. Mid treatment TSH levels were suppressed below normal reference range (0.49–4.67 mIU/L) in 7of 12 pts (58%). A decline in TSH levels was noted in all 8 of 8 pts (100%) that had recorded pre-CRT TSH levels and mid treatment levels. Improvement of TSH levels was noted in all 9 of 9 patients that had mid treatment and post treatment TSH levels recorded, although in three of these nine patients TSH levels remained below normal range. Four of twelve pts required PEG placements for nutritional support. Conclusions: Transient suppression of TSH levels suggesting a thyroid flare is frequently observed early during CRT for HNC and appears to improve by 6–9 weeks post treatment. This may contribute to weight loss in this nutritionally challanged population. Further studies evaluating more specialised thyroid function testing to exclude sick euthyroid states and other etiologies for suppressed TSH levels are warranted. In addtion, therapeutic methods to abbrogate this flare may reduce weight loss during aggressive CRT treatment protocols. No significant financial relationships to disclose.

scholarly journals Can Bioelectrical Impedance Analysis and BMI Be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 557 ◽  
Author(s):  
Maria Mantzorou ◽  
Maria Tolia ◽  
Antigoni Poultsidi ◽  
Eleni Pavlidou ◽  
Sousana K. Papadopoulou ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Electrical Properties ◽  
Nutritional Status ◽  
Head And Neck ◽  
Disease Progression ◽  
Neck Cancer ◽  
Prognostic Role ◽  
The Impact

Background: Malnutrition can significantly affect disease progression and patient survival. The efficiency of weight loss and bioimpedance analysis (BIA)-derived measures in the evaluation of malnutrition, and disease progression and prognosis in patients with head and neck cancer (HNC) are an important area of research. Method: The PubMed database was thoroughly searched, using relative keywords in order to identify clinical trials that investigated the role of BIA-derived measures and weight loss on the disease progression and prognosis of patients with HNC. Twenty-seven studies met the criteria. More specifically, six studies examined the prognostic role of the tissue electrical properties in HNC patients; five examined the role of the tissue electrical properties on identifying malnutrition; four studies looked at the changes in the tissue electrical properties of HNC patients; and 12 examined the prognostic role of weight loss on survival and/or treatment outcomes. Results: Several studies have investigated the role of nutritional status tools on prognosis in HNC patients. Current studies investigating the potential of BIA-derived raw data have shown that phase angle (PA) and capacitance of the cell membrane may be considered prognostic factors of survival. Weight loss may be a prognostic factor for treatment toxicity and survival, despite some conflicting evidence. Conclusions: Further studies are recommended to clarify the role of BIA-derived measures on patients’ nutritional status and the impact of PA on clinical outcomes as well as the prognostic role of weight loss.

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