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 The Effectiveness and Safety of Metronomic Chemotherapy in Patients with Head and Neck Carcinoma: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xingli Li ◽  
Jianjian Wang ◽  
Ting Zhang ◽  
Jiabin Wang ◽  
Zhangcai Zheng ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Metronomic Chemotherapy ◽  
Head And Neck Carcinoma ◽  
Randomized Control Trials ◽  
Neck Carcinoma ◽  
Significant Difference ◽  
Randomized Control

Abstract Background: Head and neck carcinoma, usually begins in the squamous cells, not only seriously endangers the quality of life, but brings a heavy financial burden for families and countries. Metronomic chemotherapy, a frequent administration of chemotherapeutic agents at a non-toxic dose, gives an alternative low-cost and tolerated approach for patients. We conducted a systematic review to find the effectiveness and safety of metronomic chemotherapy for head and neck cancer.Methods: We searched seven databases and Clinical.gov from the inception to July 14, 2021. The patients diagnosed head and neck cancer and older than 18 were included. Metronomic chemotherapy was defined as intervention. Randomized and non-randomized trials were all included. Quality assessment of included randomized control trials was performed using the Cochrane Risk-of-Bias criteria, cohort studies using The Newcastle-Ottawa Scale (NOS), single arm trials using the checklist recommended by The Agency for Healthcare Research and Quality (AHRQ). Studies were synthetized using a narrative approach. The indicators used for meta-analysis was hazard ratio (HR).Results: 310 Literatures were potentially eligible from 7 databases, finally 13 records were included. Five studies were of high quality, while eight were of moderate quality. The overall effect of HR for death of five trials reported had no statistically significant (HR=0.89, 95%CI 0.71-1.10). Subgroup analysis by different design showed a statistically significant HR (0.73, 95%CI 0.60-0.90) in randomized control trials while no significant difference in subgroup of prospective study design (HR=1.23, 95%CI 0.72-2.10). As for HR for PFS, there was no significant difference in overall effect of four studies. HR for PFS was 0.84 (95%CI 0.55-1.31). Subgroup analysis of study design showed that randomized control trials produced a significant HR (0.54, 95%CI 0.45-0.64), while prospective studies did not (1.25, 95%CI 0.73, 2.14).Conclusions: Metronomic chemotherapy has been an optimistic option for treatment for advanced head and neck cancer, especially in low income and medical resource-restricted regions.

Which role plays specialized palliative care in patients with relapsed and/or metastatic head and neck cancer? A retrospective analysis in Southern Switzerland.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17503-e17503
Author(s):  
Vittoria G. Espeli ◽  
Claudia Gamondi ◽  
Tanja Fusi-Schmidhauser
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Unknown Primary ◽  
Early Palliative Care ◽  
Significant Difference ◽  
Specialized Palliative Care ◽  
The Impact

e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), with a median age of 66 years (range 43 – 86). Forty-two patients (67.7%) had a metastatic disease and the most common site of tumor was the oropharynx (35.5%), followed by oral cavity (32.3%), larynx (16.1%), hypopharynx (12.9%), and unknown primary (3.2%). Forty-eight patients (77.4%) were treated with systemic treatment (75% in the PC group and 80% in the non-PC group, p = 0.638). The median overall survival was 8.1 months for all patients, 8 months for the PC group and 8.7 months for the non-PC group, without significant difference (p = 0.440). Of the deceased patients, 70% of the PC group and 73.3% of the non-PC group received chemotherapy in the last three months of life. A greater percentage of patients in the PC group died at home, but without significant difference (39.2% vs. 19%, p = 0.134). Conclusions: only half of the patient had access to specialized PC. Whereas it did not seem to affect overall survival nor influence chemotherapy prescription, it seemed to favor home deaths. Further studies investigating the impact of early PC in recurrent and/or metastatic HNC are needed to improve access to PC and maximize benefits.

scholarly journals Hypothyroidism and risks of cerebrovascular complications among patients with head and neck cancer after radiotherapy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chi-Hung Liu ◽  
Joseph Tung-Chieh Chang ◽  
Tsong-Hai Lee ◽  
Pi-Yueh Chang ◽  
Chien-Hung Chang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cox Models ◽  
Cerebrovascular Complications ◽  
Significant Difference ◽  
The Impact ◽  
Cumulative Time ◽  
The Eu

Abstract Background Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear. Methods Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to > 50 % stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group. Results 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement. Conclusions Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

scholarly journals Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

2020 ◽  
Author(s):  
Chi-Hung Liu ◽  
Joseph Tung-Chieh Chang ◽  
Tsong-Hai Lee ◽  
Pi-Yueh Chang ◽  
Chien-Hung Chang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cox Models ◽  
Cerebrovascular Complications ◽  
Significant Difference ◽  
The Impact ◽  
Cumulative Time ◽  
The Eu

Abstract Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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 Appraisal of Beneficial Effects of Oral Supplementation with Folic Acid during Curative Chemo-Radiation for Head and Neck Cancer: An Observational Study

2019 ◽  
Vol 2 (2) ◽  
pp. 54-62
Author(s):  
Rao Suresh ◽  
◽  
Hegde Sanath ◽  
Rao Pratima ◽  
D’silva Prajna ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Folic Acid ◽  
Observational Study ◽  
Head And Neck ◽  
Neck Cancer ◽  
Radiation Treatment ◽  
Beneficial Effects ◽  
Curative Radiotherapy ◽  
Significant Difference

Background: In people undergoing curative radiation treatment to the head and neck region the local effects like mucositis, dysphasia, dermatitis, salivary dysfunction and systemic effects like anaemia and leucopoenia are major issues. Folic acid is always provided when a patient has anaemia and is also regularly used in the care of cancer patients. However, literature study indicates that the quantum of beneficial effects of folic acid supplementing to patients undergoing curative radiotherapy are lacking. In lieu of these observations the present study was conducted to ascertain the beneficial effect of folic acid supplementation to head and neck cancer (HNC) patients undergoing curative radiotherapy. Methods: This was an observational study and was carried out in HNC patients planned for curative radiotherapy. The folic acid levels were estimated at the start of the study. Patients who had folic acid less than 20 ng/ml were prescribed folic acid (5 mg TID) for the first two weeks. The incidence of mucositis, dysphasia, dermatitis, salivary dysfunction, anaemia and leucopoenia were analysed at the end of the study. For analysis we studied what is the effect in people who had folic acid less than and, above 5 ng/ml and analysed the results using the X2 analysis. Results: The results indicated that there was a significant difference (p = 0.03) was seen in the incidence of leukopenia in the volunteers who had less than 5 ng/ml of folic acid. A significant difference in the incidence of severe dermatitis (P = 0.04) and in weight loss (P = 0.02) was also observed. Conclusions: The study findings suggest that when compared to the patients who had folic acid less than 5 ng/ml, administering folic acid was beneficial in mitigating dermatitis, weight loss and leucopenia in people with folic acid above 5 ng/ml. More studies are required to ascertain the benefit of folic acid.

scholarly journals Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

2021 ◽  
Author(s):  
Chi-Hung Liu ◽  
Joseph Tung-Chieh Chang ◽  
Tsong-Hai Lee ◽  
Pi-Yueh Chang ◽  
Chien-Hung Chang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cox Models ◽  
Cerebrovascular Complications ◽  
Significant Difference ◽  
The Impact ◽  
Cumulative Time ◽  
The Eu

Abstract Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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.

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