Skip to main content

Advertisement

SpringerLink
Log in

Nutritional prehabilitation in head and neck cancer: a systematic review

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Prehabilitation affords an opportunity to support the management of malnutrition that is strongly associated with head and neck cancer. The purpose of this systematic review was to identify the components of nutritional prehabilitation interventions and their effects on nutritional and health outcomes in head and neck cancer patients.

Methods

A comprehensive search was completed within Medline (including PubMed), CINHAL, Cochrane database, EMBASE, PRoQUEST, clinical trials registries, and grey literature to identify studies involving a nutritional intervention pre-treatment in head and neck cancer patients receiving any form of curative therapy. Nutritional intervention was defined as a specified period pre-treatment and outcome measures had to include assessment of nutritional status or body composition. Quality of included studies was assessed using Cochrane risk of bias 2.

Results

From 557 identified studies, two met the inclusion criteria. Due to the low number of studies, a meta-analysis was not indicated. Both studies conducted a nutritional intervention using an “enriched formula” in malnourished patients prior to surgery. Neither study reported the intervention was effective for reducing weight loss, physical function, surgical complications, or length of stay versus the comparison.

Conclusion

There is limited nutritional prehabilitation research within head and neck cancer. An “enriched formula” provided in the prehabilitation period appears no more advantageous than routine standard nutritional formula in mitigating against the weight loss experienced in malnourished head and neck patient. Due to the malnutrition risks on diagnosis and the negative impact of poor nutritional status on clinical and functional outcomes, robust nutritional prehabilitation research is required to inform clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data generated or analysed during this study are included in this published article or within supplementary files.

Code availability

Not applicable as no software of coding was used.

References

  1. Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660

    Article  PubMed  Google Scholar 

  2. Cancer Research UK (2021) Early diagnosis hub data. In: Early Diagnosis Hub Data. https://crukcancerintelligence.shinyapps.io/EarlyDiagnosis. Accessed 18 March 2022

  3. Cancer Research UK (2020) cruk.org Together we will beat cancer. Cancer in the UK 2020: Socio-economic deprivation. https://www.cancerresearchuk.org/sites/default/files/cancer_inequalities_in_the_uk.pdf. Accessed 18 March 2022

  4. Matthews TW, Lampe HB, Dragosz K (1995) Nutritional status in head and neck cancer patients. The J otolaryngol 24:87–91

    CAS  PubMed  Google Scholar 

  5. Durham JS, Anderson DW, Prisman E et al (2020) The association between the Nutrition-Related index and morbidity following head and neck microsurgery. Laryngoscope 130:375–380. https://doi.org/10.1002/lary.27912

    Article  PubMed  Google Scholar 

  6. Cancer Research UK (2014) Cancer_by_Deprivation_in_England_1996_2011. http://www.ncin.org.uk/about_ncin/cancer_by_deprivation_in_england. Accessed 18 March 2022

  7. Langius JAE, Zandbergen MC, Eerenstein SEJ et al (2013) Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr 32:671–678. https://doi.org/10.1016/j.clnu.2013.06.012

    Article  PubMed  Google Scholar 

  8. Correia MITD, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22:235–239. https://doi.org/10.1016/s0261-5614(02)00215-7

    Article  PubMed  Google Scholar 

  9. Lim SL, Ong KCB, Chan YH et al (2012) Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 31:345–350. https://doi.org/10.1016/j.clnu.2011.11.001

    Article  PubMed  Google Scholar 

  10. Jager-Wittenaar H, Dijkstra PU, Dijkstra G et al (2017) High prevalence of cachexia in newly diagnosed head and neck cancer patients: an exploratory study. Nutrition 35:114–118. https://doi.org/10.1016/j.nut.2016.11.008

    Article  PubMed  Google Scholar 

  11. Martín Villares C, Domínguez Calvo J, San Román Carbajo J et al (2004) Heavy alcohol intake, malnutrition and head and neck cancer patients. Nutr Hosp 19:348–352

    PubMed  Google Scholar 

  12. Kawakita D, Matsuo K (2017) Alcohol and head and neck cancer. Cancer metastasis rev 36:425–434. https://doi.org/10.1007/s10555-017-9690-0

    Article  CAS  PubMed  Google Scholar 

  13. Crowder SL, Douglas KG, Pepino Y et al (2018) Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surv 12:479–494. https://doi.org/10.1007/s11764-018-0687-7

    Article  Google Scholar 

  14. Schmidt KN, Olson K, Kubrak C et al (2013) Validation of the Head and Neck Patient Symptom Checklist as a nutrition impact symptom assessment tool for head and neck cancer patients. Support care cancer 21:27–34. https://doi.org/10.1007/s00520-012-1483-y

    Article  PubMed  Google Scholar 

  15. Lee S-C, Wang T-J, Chu P-Y (2019) Predictors of weight loss during and after radiotherapy in patients with head and neck cancer: a longitudinal study. Eur J Oncol Nurs 39:98–104. https://doi.org/10.1016/j.ejon.2019.02.004

    Article  PubMed  Google Scholar 

  16. Macmillan Cancer Support (2019) Principles and guidance for prehabilitation within the management and support of people with cancer. https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/1532-10061/prehabilitation-for-people-with-cancer-tcm9-353994. Accessed 18 March 2022

  17. Gillis C, Davies SJ, Carli F, Wischmeyer PE et al (2021) Current landscape of nutrition within prehabilitation oncology research. Front Nutr. https://doi.org/10.3389/fnut.2021.644723

    Article  PubMed  PubMed Central  Google Scholar 

  18. Skivington K, Matthews L, Simpson SA et al (2021) Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health technol assess 25:1–132. https://doi.org/10.3310/hta25570

    Article  PubMed  Google Scholar 

  19. Gillis C, Buhler K, Bresee L et al (2018) Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.05.012

    Article  PubMed  Google Scholar 

  20. Faithfull S, Turner L, Poole K et al (2019) Prehabilitation for adults diagnosed with cancer: a systematic review of long-term physical function, nutrition and patient-reported outcomes. Eur J Cancer Care 28:2020–2021. https://doi.org/10.1111/ecc.13023

    Article  Google Scholar 

  21. Ferreira V, Lawson C, Ekmekjian T et al (2021) Effects of preoperative nutrition and multimodal prehabilitation on functional capacity and postoperative complications in surgical lung cancer patients: a systematic review. Support Care Cancer. https://doi.org/10.1007/s00520-021-06161-5

    Article  PubMed  Google Scholar 

  22. Forbes CC, Swan F, Greenley SL et al (2020) Physical activity and nutrition interventions for older adults with cancer: a systematic review. J Cancer Surv 14:689–711. https://doi.org/10.1007/s11764-020-00883-x

    Article  Google Scholar 

  23. Gillis C, Loiselle S-E, Fiore JF et al (2016) Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer a pilot double-blinded randomized placebo-controlled trial. J Acad Nutr Diet 116:802–812. https://doi.org/10.1016/j.jand.2015.06.007

    Article  PubMed  Google Scholar 

  24. Li C, Carli F, Lee L et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27:1072–1082. https://doi.org/10.1007/s00464-012-2560-5

    Article  PubMed  Google Scholar 

  25. Liu Z, Qiu T, Pei L et al (2020) Two-week multimodal prehabilitation program improves perioperative functional capability in patients undergoing thoracoscopic lobectomy for lung cancer: a randomized controlled trial. Anesth Analg 131:840–849. https://doi.org/10.1213/ANE.0000000000004342

    Article  PubMed  Google Scholar 

  26. Aupérin A (2020) Epidemiology of head and neck cancers: an update. Curr Opin Oncol 32:178–186. https://doi.org/10.1097/CCO.0000000000000629

    Article  PubMed  Google Scholar 

  27. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668. https://doi.org/10.1002/hed.20221

    Article  PubMed  Google Scholar 

  28. Britton B, Baker AL, Wolfenden L et al (2019) Eating As Treatment (EAT): a stepped-wedge, randomized controlled trial of a health behavior change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiation therapy (TROG 12.03). Int J Radiation Oncol Biol Phys 103:353–362. https://doi.org/10.1016/j.ijrobp.2018.09.027

    Article  Google Scholar 

  29. van den Berg MGA, Rasmussen-Conrad EL, Wei KH et al (2021) Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. J Br Nutr. https://doi.org/10.1017/S0007114510001315

    Article  Google Scholar 

  30. Hoffman TC, Glasziou PP, Boutron I et al (2014) (Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J. https://doi.org/10.1136/bmj.g1687

    Article  Google Scholar 

  31. Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. Br Med J. https://doi.org/10.1136/bmj.l4898

    Article  Google Scholar 

  32. Campbell M, Mckenzie JE, Sowden A et al (2020) Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. Br Med J. https://doi.org/10.1136/bmj.l6890

    Article  Google Scholar 

  33. Flynn MB, Leightty FF (1987) Preoperative outpatient nutritional support of patients with squamous cancer of the upper aerodigestive tract. Am J Surg 154:359–362

    Article  CAS  PubMed  Google Scholar 

  34. Felekis D, Eleftheriadou A, Papadakos G et al (2010) Effect of perioperative immuno-enhanced enteral nutrition on inflammatory response, nutritional status, and outcomes in head and neck cancer patients undergoing major surgery. Nutr Cancer 62:1105–1112. https://doi.org/10.1080/01635581.2010.494336

    Article  CAS  PubMed  Google Scholar 

  35. Rabinovitch R, Grant B, Berkey BA et al (2006) Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90–03. Head Neck 28:287–296. https://doi.org/10.1002/hed.20335

    Article  PubMed  Google Scholar 

  36. Ho Y-W, Yeh K-Y, Hsueh S-W et al (2021) Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status. Support Care Cancer 29:2777–2785. https://doi.org/10.1007/s00520-020-05804-3

    Article  PubMed  Google Scholar 

  37. Jantharapattana K, Orapipatpong K (2019) Efficacy of EPA-enriched supplement compared with standard formula on body weight changes in malnourished patients with head and neck cancer undergone surgery: a randomized study. Head Neck 42:188–197. https://doi.org/10.1002/hed.25987

    Article  PubMed  Google Scholar 

  38. van Bokhorst-De Van Der Schueren MAE, Quak JJ, von Blomberg-Van Der Flier BME, et al (2001) Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients. Am J Clin Nutr 73:323–332. https://doi.org/10.1093/ajcn/73.2.323

    Article  Google Scholar 

  39. Jager-Wittenaar H, Ottery FD (2017) Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care 20:322–329. https://doi.org/10.1097/MCO.0000000000000389

    Article  PubMed  Google Scholar 

  40. Tisdale MJ, Beck SA (1991) Inhibition of tumour-induced lipolysis in vitro and cachexia and tumour growth in vivo by eicosapentaenoic acid. Biochem Pharmacol 41:103–107. https://doi.org/10.1016/0006-2952(91)90016-X

    Article  CAS  PubMed  Google Scholar 

  41. Ryan AM, Reynolds JV, Healy L et al (2009) Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following esophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann of Surg 249:355–363. https://doi.org/10.1097/SLA.0b013e31819a4789

    Article  Google Scholar 

  42. Barbul A (1990) Arginine and immune function. Nutrition 6:53–62

    CAS  PubMed  Google Scholar 

  43. Braga M, Vignali A, Gianotti L et al (1996) Immune and nutritional effects of early enteral nutrition after major abdominal operations. Eur J Surg 162:105–112

    CAS  PubMed  Google Scholar 

  44. Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452. https://doi.org/10.1038/sj.bjc.6601962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Gangadharan A, Choi SE, Hassan A et al (2017) Protein calorie malnutrition, nutritional intervention and personalized cancer care. Oncotarget 8:24009–24030. https://doi.org/10.18632/oncotarget.15103

    Article  PubMed  PubMed Central  Google Scholar 

  46. Arends J, Bachmann P, Baracos V et al (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11–48. https://doi.org/10.1016/j.clnu.2016.07.015

    Article  PubMed  Google Scholar 

  47. Head and Neck Guideline Steering Committee (2018). Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Clinical Oncological Society of Australia. https://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines Accessed 18 March 2022

  48. Talwar B, Donnelly R, Skelly R, Donaldson M (2021) Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130:32–40. https://doi.org/10.1017/S0022215116000402

    Article  Google Scholar 

  49. Giles KH, Kubrak C, Baracos VE et al (2016) Recommended European Society of Parenteral and Enteral Nutrition protein and energy intakes and weight loss in patients with head and neck cancer. Head Neck 38:1248–1257. https://doi.org/10.1002/hed.24427

    Article  PubMed  Google Scholar 

  50. Jager-Wittenaar H, Dijkstra PU, Vissink A et al (2011) Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck 33:863–870. https://doi.org/10.1002/hed.21546

    Article  PubMed  Google Scholar 

  51. Prado CM, Purcell SA, Laviano A (2020) Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle 11:366–380. https://doi.org/10.1002/jcsm.12525

    Article  PubMed  PubMed Central  Google Scholar 

  52. Mehanna H, Nankivell PC, Moledina J, Travis J (2009) Refeeding syndrome–awareness, prevention and management. Head Neck Oncol 1:4. https://doi.org/10.1186/1758-3284-1-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Rasmussen SO, Kristensen MB, Wessel I, Andersen JR (2016) Incidence and risk factors of refeeding syndrome in head and neck cancer patients—an observational study. Nutr Cancer 68:1320–1329. https://doi.org/10.1080/01635581.2016.1225103

    Article  PubMed  Google Scholar 

  54. Gillis C, Hasil L, Kasvis P et al (2021) Nutrition care process model approach to surgical prehabilitation in oncology. Front Nutr. https://doi.org/10.3389/fnut.2021.644706

    Article  PubMed  PubMed Central  Google Scholar 

  55. Urquiza M, Fernandez N, Arrinda I et al (2020) Nutritional status is associated with function, physical performance and falls in older adults admitted to geriatric rehabilitation: a retrospective cohort study. Nutrients 12:1–14. https://doi.org/10.3390/nu12092855

    Article  CAS  Google Scholar 

  56. Gillis C, Fenton TR, Gramlich L et al (2021) Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications. Eur J Surg Oncol 47:874–881. https://doi.org/10.1016/j.ejso.2020.09.041

    Article  PubMed  Google Scholar 

  57. Moore J, Scoggins CR, Philips P et al (2021) Implementation of prehabilitation for major abdominal surgery and head and neck surgery: a simplified seven-day protocol. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04740-1

    Article  PubMed  Google Scholar 

  58. Bye A, Sandmael JA, Stene GB et al (2020) Exercise and nutrition interventions in patients with head and neck cancer during curative treatment: a systematic review and meta-analysis. Nutrients 12:3233. https://doi.org/10.3390/nu12113233

    Article  PubMed Central  Google Scholar 

  59. Capozzi LC, Nishimura KC, McNeely ML et al (2016) The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med 50:325–338. https://doi.org/10.1136/bjsports-2015-094684

    Article  PubMed  Google Scholar 

Download references

Funding

This report is an independent research supported by the National Institute for Health Research HEE/NIHR ICA Programme Pre-doctoral Clinical Academic Fellowship, Miss Linda Cantwell, NIHR301203.

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, Mersey Care NHS Foundation Trust, Whiston Health Centre, Liverpool, L35 3SX, UK

    Linda A. Cantwell

  2. School of Health Sciences, University of Liverpool, Liverpool Head and Neck Centre, Liverpool, UK

    Linda A. Cantwell & Joanne M. Patterson

  3. Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK

    Emer Fahy

  4. University of Southampton, Southampton, UK

    Emily R. Walters

Authors
  1. Linda A. Cantwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emer Fahy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily R. Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joanne M. Patterson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The initial conception was from Linda Cantwell. All authors then contributed to study design. Material preparation, data collection, and analysis were performed by Linda Cantwell, Emer Fahy, and Emily Walters. The first draft of the manuscript was written by Linda Cantwell and all authors commented on previous versions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Linda A. Cantwell.

Ethics declarations

Ethical approval

This is a systematic review. No ethical approval required.

Consent to participate

Not applicable as there were no human subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Disclaimer

The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 158 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cantwell, L.A., Fahy, E., Walters, E.R. et al. Nutritional prehabilitation in head and neck cancer: a systematic review. Support Care Cancer 30, 8831–8843 (2022). https://doi.org/10.1007/s00520-022-07239-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-022-07239-4

Keywords

Search

Navigation