Journal of Cancer Survivorship

, Volume 12, Issue 4, pp 479–494 | Cite as

Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review

  • Sylvia L. Crowder
  • Katherine G. Douglas
  • M. Yanina Pepino
  • Kalika P. Sarma
  • Anna E. ArthurEmail author



It is estimated that more than 90% of head and neck cancer (HNC) survivors who underwent chemoradiotherapy experience one or more nutrition impact symptoms (NIS) in the months or years thereafter. Despite the high prevalence, there is limited research addressing long-term impact of NIS on outcomes such as nutrition and quality of life in HNC survivors treated with chemoradiotherapy.


To conduct a systematic review of the literature pertaining to the presence of nutrition impact symptoms and their associated outcomes in post-chemoradiotherapy head and neck cancer survivors.

Evidence review

A systematic review was conducted across three databases according to PRISMA guidelines and used to identify current literature regarding NIS in HNC survivors. A keyword search was conducted in PubMed, Scopus, and Web of Science from 2007 to 2017. Studies that met all of the following criteria were included in the review: (1) studies must include human subjects with a HNC diagnosis; (2) study participants must have received chemoradiotherapy; (3) study participants must have been post-treatment for a minimum of 3 months at the time of data collection; (4) full-text articles must have appeared in peer-reviewed journals; (5) papers must have been published in English; (6) studies must be quantitative in nature; (7) studies must have reported at least one NIS; and (8) studies must address at least one of the following outcomes: nutrition, functional status, or quality of life. Two independent reviewers assessed study quality using a predefined set of criteria.


A systematic search yielded 1119 papers, of which 15 met the inclusion criteria. The study reviewed existing evidence of NIS in a variety of HNC survivors ranging from 3 months to greater than 10 years post-chemoradiotherapy treatment. Eight hundred forty-nine study participants were included in the review. Of the 15 studies, 10 were designed as prospective cohort studies, 4 were cross-sectional studies, and 1 was a retrospective cohort study. Functional impairments as a result of chemoradiotherapy to the head and neck are prevalent in research and include dysphagia, xerostomia, trismus, salivary issues, mucositis, and oral pain.


NIS negatively influence HNC survivors beyond the acute phase of treatment. These symptoms are associated with decreased nutrition and quality of life. Interventions are necessary to improve survivors’ eating challenges beyond the completion of treatment. If practitioners do not follow patients long term, patients may suffer consequences of NIS including malnutrition risk, weight loss, and decreased food intake and quality of life.

Implications for Cancer Survivors

The prevalence and consequences of nutrition impact symptoms are substantial among head and neck cancer survivors beyond the acute phase of cancer treatment. Oncology clinicians should continuously monitor and manage these symptoms throughout the cancer continuum.


Head and neck cancer Nutrition impact symptoms Quality of life Nutrition Survivors 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interests.

Supplementary material

11764_2018_687_MOESM1_ESM.doc (62 kb)
ESM 1 (DOC 62 kb)


  1. 1.
    Rettig EM, D'Souza G. Epidemiology of head and neck cancer. Surg Oncol Clin N Am. 2015;24(3):379–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Lewis A, Kang R, Levine A, Maghami E. The new face of head and neck cancer: the HPV epidemic. Oncology (Williston Park). 2015;29(9):616–26.Google Scholar
  3. 3.
    Institute, N.N.C. NCI dictionary of cancer terms . [cited 2017 September 8]; Available from:
  4. 4.
    Rosenthal D, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24(17):2636–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Patterson JM, McColl E, Wilson J, Carding P, Rapley T. Head and neck cancer patients’ perceptions of swallowing following chemoradiotherapy. Support Care Cancer. 2015;23(12):3531–8. Scholar
  6. 6.
    Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, et al. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29(3):365–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008;30(2):148–58.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gellrich NC, Handschel J, Holtmann H, Krüskemper G. Oral cancer malnutrition impacts weight and quality of life. Nutrients. 2015;7(4):2145–60.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12(Suppl 1):4–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Rosenthal DI, Mendoza TR, Chambers MS, Burkett VS, Garden AS, Hessell AC, et al. The M. D. Anderson symptom inventory-head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys. 2008;72(5):1355–61. Scholar
  11. 11.
    Pateman KA, Ford PJ, Batstone MD, Farah CS. Coping with an altered mouth and perceived supportive care needs following head and neck cancer treatment. Support Care Cancer. 2015;23(8):2365–73.CrossRefPubMedGoogle Scholar
  12. 12.
    Christianen ME, et al. Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol. 2015;117(1):139–44. Scholar
  13. 13.
    van der Laan HP, Christianen MEMC, Bijl HP, Schilstra C, Langendijk JA. The potential benefit of swallowing sparing intensity modulated radiotherapy to reduce swallowing dysfunction: an in silico planning comparative study. Radiother Oncol. 2012;103(1):76–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Myers, E., E. Hanna, and J. Myers, Cancer of the head and neck. 5th ed. 2017, Philadelphia: Wolters Kluwer. 847.Google Scholar
  15. 15.
    Seiwert TY, Salama JK, Vokes EE. The chemoradiation paradigm in head and neck cancer. Nat Clin Pract Oncol. 2007;4(3):156–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Moroney LB, Helios J, Ward EC, Crombie J, Wockner LF, Burns CL, et al. Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT+/-concurrent chemotherapy. Oral Oncol. 2017;64:1–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. Scholar
  18. 18.
    Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Kraaijenga SA, et al. Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 2015;51(8):787–94. Scholar
  20. 20.
    Verdonck-de Leeuw IM, Buffart LM, Heymans MW, Rietveld DH, Doornaert P, de Bree R, et al. The course of health-related quality of life in head and neck cancer patients treated with chemoradiation: a prospective cohort study. Radiother Oncol. 2014;110(3):422–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kraaijenga SA, et al. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol. 2015;272(11):3521–31.CrossRefPubMedGoogle Scholar
  22. 22.
    Rinkel RN, Verdonck-de Leeuw IM, Doornaert P, Buter J, de Bree R, Langendijk JA, et al. Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol. 2016;273(7):1849–55.CrossRefPubMedGoogle Scholar
  23. 23.
    van den Berg MGA, Rütten H, Rasmussen-Conrad EL, Knuijt S, Takes RP, van Herpen CML, et al. Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. 2014;36(1):60–5.CrossRefGoogle Scholar
  24. 24.
    Pauloski BR, Rademaker AW, Logemann JA, Lundy D, Bernstein M, McBreen C, et al. Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck. 2011;33(6):774–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Payakachat N, Ounpraseuth S, Suen JY. Late complications and long-term quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck. 2013;35(6):819–25.CrossRefPubMedGoogle Scholar
  26. 26.
    Pedersen A, Wilson J, McColl E, Carding P, Patterson J. Swallowing outcome measures in head and neck cancer—how do they compare? Oral Oncol. 2016;52:104–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Frowen, J., et al., Long-term swallowing after chemoradiotherapy: prospective study of functional and patient-reported changes over time. Head Neck, 2016 38 Suppl 1: p. E307–15.Google Scholar
  28. 28.
    Lee LY, Chen SC, Chen WC, Huang BS, Lin CY. Postradiation trismus and its impact on quality of life in patients with head and neck cancer. Oral Surgery Oral Medicine Oral Pathology Oral Radiology. 2015;119(2):187–95.CrossRefGoogle Scholar
  29. 29.
    Maurer J, Hipp M, Schäfer C, Kölbl O. Dysphagia impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol. 2011;187(11):744–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Nordgren M, Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Jannert M. Quality of life in oral carcinoma: a 5-year prospective study. Head Neck. 2008;30(4):461–70.CrossRefPubMedGoogle Scholar
  31. 31.
    Agarwal J, Dutta D, Palwe V, Gupta T, Laskar SG, Budrukkar A, et al. Prospective subjective evaluation of swallowing function and dietary pattern in head and neck cancers treated with concomitant chemo-radiation. J Cancer Res Ther. 2010;6(1):15–21.CrossRefPubMedGoogle Scholar
  32. 32.
    Chaukar DA, Walvekar RR, Das AK, Deshpande MS, Pai PS, Chaturvedi P, et al. Quality of life in head and neck cancer survivors: a cross-sectional survey. Am J Otolaryngol. 2009;30(3):176–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Howlader N, et al. SEER cancer statistics review. 2016 [cited 2017 April 7, ]; Available from:
  34. 34.
    Ganzer H, Touger-Decker R, Parrott JS, Murphy BA, Epstein JB, Huhmann MB. Symptom burden in head and neck cancer: impact upon oral energy and protein intake. Support Care Cancer. 2013;21(2):495–503.CrossRefPubMedGoogle Scholar
  35. 35.
    Wang HL, et al. Shoulder pain, functional status, and health-related quality of life after head and neck cancer surgery. Rehabil Res Pract. 2013;2013:601768.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Ganzer H, Rothpletz-Puglia P, Byham-Gray L, Murphy BA, Touger-Decker R. The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Support Care Cancer. 2015;23:3257–68.CrossRefPubMedGoogle Scholar
  37. 37.
    Kawecki A, Krajewski R. Follow-up in patients treated for head and neck cancer. Memo. 2014;7(2):87–91.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sylvia L. Crowder
    • 1
  • Katherine G. Douglas
    • 1
  • M. Yanina Pepino
    • 1
  • Kalika P. Sarma
    • 2
  • Anna E. Arthur
    • 1
    • 2
    Email author
  1. 1.Department of Food Science and Human NutritionUniversity of Illinois at Urbana-ChampaignUrbanaUSA
  2. 2.Carle Foundation HospitalUrbanaUSA

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