Abstract
Purpose
Non-metastatic stage IV oral cavity cancer patients undergoing concurrent chemoradiotherapy (CCRT) are at risk of malnutrition because of postoperative eating problems and CCRT-related complications. A high percentage of betel quid use, which is associated with metabolic disorders, is found in oral cavity cancer patients in Taiwan. The aim of this study is to evaluate the effect of an early and intensive nutritional support program, comprising individualized counseling, nasogastric tube feeding, and mandatory hospitalization, throughout the CCRT period for such cases in an area where betel quid use is prevalent.
Methods
We retrospectively analyzed 35 patients with nutritional support (NI) and 23 patients with no specifically designed nutrition program (NC).
Results
The NI group had better maintenance of body weight (p < 0.001) and higher serum albumin levels (p < 0.002) than the NC group. There was no difference in the total dose of radiation completed in the two groups; in contrast, the percentage of NI group patients who had radiation therapy (RT) breaks was lower and who completed planned chemotherapy was higher than in the NC group. Furthermore, more NC group patients suffered from sepsis during the treatment period, and fewer were alive 2 years after treatment.
Conclusions
An early and intensive nutrition support may be beneficial to minimizing body weight loss, offering better treatment tolerance and probable survival benefits for patients with non-metastatic stage IV oral cavity cancers undergoing CCRT in endemic betel quid chewing areas.
Similar content being viewed by others
References
Chen IH, Chang JT, Liao CT, Wang HM, Hsieh LL, Cheng AJ (2003) Prognostic significance of EGFR and Her-2 in oral cavity cancer in betel quid prevalent area cancer prognosis. Br J Cancer 89:681–686
Chen PH, Shieh TY, Ho PS, Tsai CC, Yang YH, Lin YC, Ko MS, Tsai PC, Chiang SL, Tu HP, Ko YC (2007) Prognostic factors associated with the survival of oral and pharyngeal carcinoma in Taiwan. BMC Cancer 7:101
Liu SA, Tsai WC, Wong YK, Lin JC, Poon CK, Chao SY, Hsiao YL, Chan MY, Cheng CS, Wang CC, Wang CP (2006) Nutritional factors and survival of patients with oral cancer. Head Neck 28:998–1007
Forastiere A, Koch W, Trotti A, Sidransky D (2001) Head and neck cancer. N Engl J Med 345:1890–1900
Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944
Kiyomoto D (2007) Head and neck cancer patients treated with chemo-radiotherapy require individualized oncology nutrition. J Am Diet Assoc 107:412–415
Guh JY, Chuang LY, Chen HC (2006) Betel-quid use is associated with the risk of the metabolic syndrome in adults. Am J Clin Nutr 83:1313–1320
Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, Harris J, Scrimger R, Parliament M, Baracos VE (2010) Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32:290–300
Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, Strome M, Carroll MA (2002) Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 20:1405–1410
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
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
Rubin P, Wasserman TH (1988) International clinical trials in radiation oncology. The late effects of toxicity scoring. Int J Radiat Oncol Biol Phys 14(Suppl 1):S29–S38
Brookes GB (1985) Nutritional status—a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg 93:69–74
Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR (1998) Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 338:1798–1804
Lavertu P, Adelstein DJ, Saxton JP, Secic M, Eliachar I, Strome M, Larto MA, Wood BG (1999) Aggressive concurrent chemoradiotherapy for squamous cell head and neck cancer: an 8-year single-institution experience. Arch Otolaryngol Head Neck Surg 125:142–148
Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT (1998) Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 124:589–592
Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD, Shofer JB, Fish BE, Knopp RH, Kahn SE (2004) Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 53:2087–2094
Ceriello A, Motz E (2004) Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Arterioscler Thromb Vasc Biol 24:816–823
Chang MC, Ho YS, Lee PH, Chan CP, Lee JJ, Hahn LJ, Wang YJ, Jeng JH (2001) Areca nut extract and arecoline induced the cell cycle arrest but not apoptosis of cultured oral KB epithelial cells: association of glutathione, reactive oxygen species and mitochondrial membrane potential. Carcinogenesis 22:1527–1535
Chu NS (2002) Neurological aspects of areca and betel chewing. Addict Biol 7:111–114
Huggett RJ, Burns J, Mackintosh AF, Mary DA (2004) Sympathetic neural activation in nondiabetic metabolic syndrome and its further augmentation by hypertension. Hypertension 44:847–852
Jeng JH, Chang MC, Hahn LJ (2001) Role of areca nut in betel quid-associated chemical carcinogenesis. Current awareness and future perspectives. Oral Oncol 37:477–492
Jeng JH, Wang YJ, Chiang BL, Lee PH, Chan CP, Ho YS, Wang TM, Lee JJ, Hahn LJ, Chang MC (2003) Roles of keratinocyte inflammation in oral cancer: regulating the prostaglandin E2, interleukin-6 and TNF-alpha production of oral epithelial cells by areca nut extract and arecoline. Carcinogenesis 24:1301–1315
Mannan N, Boucher BJ, Evans SJ (2000) Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London. Br J Nutr 83:267–275
Nguyen NP, Vos P, Vinh-Hung V, Borok TL, Dutta S, Karlsson U, Lee H, Martinez T, Jo BH, Nguyen LM, Nguyen N, Sallah S (2009) Altered glucose metabolism during chemoradiation for head and neck cancer. Anticancer Res 29:4683–4687
Nan DN, Fernandez-Ayala M, Vega Villegas ME, Garcia-Castano A, Rivera F, Lopez-Brea M, Gonzalez-Macias J (2003) Diabetes mellitus following cisplatin treatment. Acta Oncol (Stockholm) 42:75–78
Heymsfield SB, McManus CB (1985) Tissue components of weight loss in cancer patients. A new method of study and preliminary observations. Cancer 55:238–249
Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P (2001) Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91:1785–1790
Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, Baggio V, Lamon S, Babare R, Rosti G, Giometto M, Boscolo-Rizzo P, Kiwanuka E, Tessarin M, Caregaro L, Marchiori C (2010) Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 18:837–845
Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M (2009) Espen guidelines on parenteral nutrition. Non-surgical oncology. Clin Nutr (Edinb) 28:445–454
Huhmann MB, August DA (2008) Review of American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Guidelines for Nutrition Support in Cancer Patients: nutrition screening and assessment. Nutr Clin Pract 23:182–188
Conflict of interest
The authors declare that they have no competing interests and no financial relationship with other organizations sponsoring this research. All authors have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, CH., Wang, HM., Pang, YP. et al. Early nutritional support in non-metastatic stage IV oral cavity cancer patients undergoing adjuvant concurrent chemoradiotherapy: analysis of treatment tolerance and outcome in an area endemic for betel quid chewing. Support Care Cancer 20, 1169–1174 (2012). https://doi.org/10.1007/s00520-011-1192-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-011-1192-y