Skip to main content
SpringerLink
Log in

Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up

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

Abstract

Purpose

Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

Methods

Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

Results

Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (−10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (−2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

Conclusions

Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

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
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Platteaux N, Dirix P, Dejaeger E, Nuyts S (2010) Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia 25:139–152

    Article  PubMed  Google Scholar 

  2. Argiris A, Karamouzis MV, Raben D, Ferris RL (2008) Head and neck cancer. Lancet 371:1695–1709

    Article  CAS  PubMed  Google Scholar 

  3. Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, Rademaker A, Logemann JA (2003) Swallowing dysfunction—preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol, Biol, Phys 57:1219–1230

    Article  Google Scholar 

  4. Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, Magnuson JS, Spencer SA, Bonner JA (2009) Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol, Biol, Phys 73:410–415

    Article  Google Scholar 

  5. Langendijk JA, Doornaert P, Rietveld DHF, Verdonck-de Leeuw IM, René Leemans C, Slotman BJ (2009) A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 90:189–195

    Article  PubMed  Google Scholar 

  6. Rosenthal DI, Lewin JS, Eisbruch A (2006) Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 24:2636–2643

    Article  PubMed  Google Scholar 

  7. Hughes PJ, Scott PMJ, Kew J, Cheung D, Leung SF, Ahuja AT, van Hasselt CA (2000) Dysphagia in treated nasopharyngeal cancer. Head Neck 22:393–397

    Article  CAS  PubMed  Google Scholar 

  8. Chang YC, Chen SY, Tak Lui L, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN (2003) Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 18:135–143

    Article  PubMed  Google Scholar 

  9. Zackrisson B, Nilsson P, Kjellén E, Johansson KA, Modig H, Brun E, Nyman J, Friesland S, Reizenstein J, Sjödin H (2011) Two-year results from a Swedish study on conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma—the ARTSCAN study. Radiother Oncol 100:41–48

    Article  PubMed  Google Scholar 

  10. Johansson KA, Nilsson P, Zackrisson B, Ohlson B, Kjellen E, Mercke C, Alvarez-Fonseca M, Billstrom A, Bjork-Eriksson T, Bjor O, Ekberg L, Friesland S, Karlsson M, Lagerlund M, Lundkvist L, Lofroth PO, Lofvander-Thapper K, Nilsson A, Nyman J, Persson E, Reizenstein J, Rosenbrand HO, Wiklund F, Wittgren L (2008) The quality assurance process for the ARTSCAN head and neck study—a practical interactive approach for QA in 3DCRT and IMRT. Radiother Oncol 87:290–299

    Article  PubMed  Google Scholar 

  11. Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, Chepeha DB, Hogikyan ND, Terrell JE (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol, Biol, Phys 53:23–28

    Article  Google Scholar 

  12. Nguyen N, Frank C, Moltz C, Vos P, Smith H, Bhamidipati P, Karlsson U, Nguyen P, Alfieri A, Nguyen L (2006) Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol 80:302–306

    Article  PubMed  Google Scholar 

  13. Nguyen N, Moltz C, Frank C, Vos P, Smith H, Karlsson U, Dutta S, Midyett F, Barloon J, Sallah S (2004) Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol 15:383–388

    Article  CAS  PubMed  Google Scholar 

  14. Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, MacCracken E, Gaziano J, Stachowiak L (2002) Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24:555–565

    Article  PubMed  Google Scholar 

  15. Chasen MR, Bhargava R (2009) A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer. Support Care Cancer 17:1345–1351

    Article  PubMed  Google Scholar 

  16. Jager-Wittenaar H, Dijkstra PU, Vissink A, van Oort RP, van der Laan BFAM, Roodenburg JLN (2011) Malnutrition in patients treated for oral or oropharyngeal cancer—prevalence and relationship with oral symptoms: an explorative study. Support Care Cancer 19:1675–1683

    Article  PubMed Central  PubMed  Google Scholar 

  17. Sobin LH, Fleming ID (1997) TNM classification of malignant tumors. Cancer 80:1803–1804

    Article  CAS  PubMed  Google Scholar 

  18. Palmer JB, Kuhlemeier KV, Tippett DC, Lynch C (1993) A protocol for the videofluorographic swallowing study. Dysphagia 8:209–214

    Article  CAS  PubMed  Google Scholar 

  19. Logemann JA (1998) Evaluation and treatment of swallowing disorders. PRO-ED, Incorporated

  20. Kondrup J, Allison S, Elia M, Vellas B, Plauth M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421

    Article  CAS  PubMed  Google Scholar 

  21. Vallén C, Hagell P, Westergren A (2011) Validity and user-friendliness of the minimal eating observation and nutrition form-version II (MEONF-II) for undernutrition risk screening. Food Nutr Res. doi:10.3402/fnr.v55i0.5801

    Google Scholar 

  22. Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM (2004) Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 130:1100–1103

    Article  PubMed  Google Scholar 

  23. Teitelbaum D, Guenter P, Howell WH, Kochevar ME, Roth J, Seidner DL (2005) Definition of terms, style, and conventions used in ASPEN guidelines and standards. Nutr Clin Pract 20:281–285

    Article  PubMed  Google Scholar 

  24. Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29:893–900

    Article  PubMed  Google Scholar 

  25. Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:15–19

    Article  Google Scholar 

  26. Dechaphunkul T, Martin L, Alberda C, Olson K, Baracos V, Gramlich L (2013) Malnutrition assessment in patients with cancers of the head and neck: a call to action and consensus. Crit Rev Oncol Hematol 88:459–476

    Article  PubMed  Google Scholar 

  27. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr 92:799–808

    Article  CAS  PubMed  Google Scholar 

  28. Berg MG, Rütten H, Rasmussen–Conrad EL, Knuijt S, Takes RP, Herpen CM, Wanten GJ, Kaanders JH, Merkx MA (2013) Nutritional status, food intake, and dysphagia in long–term survivors with head and neck cancer treated with chemoradiotherapy: a cross–sectional study. Head Neck. doi:10.1002/hed.23265

    PubMed  Google Scholar 

  29. McQuestion M, Fitch M, Howell D (2011) The changed meaning of food: physical, social and emotional loss for patients having received radiation treatment for head and neck cancer. Eur J Oncol Nurs 15:145–151

    Article  PubMed  Google Scholar 

  30. Tiblom Ehrsson YT, Langius-Eklof A, Laurell G (2011) Nutritional surveillance and weight loss in head and neck cancer patients. Support Care Cancer 20:757–765

    Article  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. Ottosson S, Zackrisson B, Kjellén E, Nilsson P, Laurell G (2012) Weight loss in patients with head and neck cancer during and after conventional and accelerated radiotherapy. Acta Oncol 52:711–718

    Article  PubMed Central  PubMed  Google Scholar 

  33. Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E (2011) Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer—a randomized study. Head Neck 34:1–9

    Article  PubMed  Google Scholar 

  34. Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, Nguyen LM, Rose S, Dutta S, Sallah S (2006) Evolution of chronic dysphagia following treatment for head and neck cancer. Oral Oncol 42:374–380

    Article  PubMed  Google Scholar 

  35. Payakachat N, Ounpraseuth S, Suen JY (2012) Late complications and long–term quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck 35:819–825

    Article  PubMed  Google Scholar 

  36. Bodin I, Jäghagen EL, Isberg A (2004) Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer. Head Neck 26:923–929

    Article  PubMed  Google Scholar 

  37. Kuhlemeier K, Yates P, Palmer J (1998) Intra-and interrater variation in the evaluation of videofluorographic swallowing studies. Dysphagia 13:142–147

    Article  CAS  PubMed  Google Scholar 

  38. Lango MN, Egleston B, Fang C, Burtness B, Galloway T, Liu J, Mehra R, Ebersole B, Moran K, Ridge JA (2013) Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer. Cancer. doi:10.1002/cncr.28482

    PubMed  Google Scholar 

  39. Semenov YR, Starmer HM, Gourin CG (2012) The effect of pneumonia on short–term outcomes and cost of care after head and neck cancer surgery. Laryngoscope 122:1994–2004

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the Swedish Cancer Society, Laryngfonden (Sweden), Lions Cancer Research Foundation at Umeå University, and the Cancer Research Foundation of Northern Sweden. The study was made possible by the commitment from the staff at the participating centers in the ARTSCAN trial and the SALU study-Umeå University Hospital, Sunderby Hospital, Sundsvall Härnösand Hospital, Östersund Hospital, Lund University Hospital, and Malmö University Hospital. The authors acknowledge Ola Gärskog for help with the data collection and Ove Björ for statistical advice.

Conflict of interest statement

The authors have no conflict of interest to disclose and have full control of all primary data and agree to accept the journal to review the data if requested.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences, Otorhinolaryngology, Umeå University, 901 87, Umeå, Sweden

    Sandra Ottosson

  2. Department of Clinical Sciences, Otorhinolaryngology, Lund University, Lund, Sweden

    Ulrika Lindblom & Peter Wahlberg

  3. Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden

    Per Nilsson & Elisabeth Kjellén

  4. Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden

    Björn Zackrisson

  5. Department of Odontology, Oral and Maxillofacial Radiology, Umeå University, Umeå, Sweden

    Eva Levring Jäghagen

  6. Department of Surgical Sciences, Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden

    Göran Laurell

Authors
  1. Sandra Ottosson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrika Lindblom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Wahlberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Per Nilsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisabeth Kjellén
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Björn Zackrisson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eva Levring Jäghagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Göran Laurell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandra Ottosson.

Additional information

Eva Levring Jäghagen and Göran Laurell shared senior authorship

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ottosson, S., Lindblom, U., Wahlberg, P. et al. Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up. Support Care Cancer 22, 2361–2369 (2014). https://doi.org/10.1007/s00520-014-2211-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2211-6

Keywords

Search

Navigation