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Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status

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Abstract

Background

Nutritional counseling is frequently overlooked in cancer patients with normal nutritional status. This study aimed to evaluate the impact of nutritional counseling in head and neck cancer (HNC) patients with normal nutritional status prior to concurrent chemoradiotherapy (CCRT).

Methods

A total of 243 patients with pretreatment normal nutritional status and locally advanced HNC receiving concurrent chemoradiotherapy (CCRT) at three medical centers were enrolled. All patients were retrospectively allocated into the early (≤ 2 weeks, n = 105, 43.2%), late (> 2 weeks, n = 102, 42.0%), and no nutritional counseling groups (n = 36, 14.8%) according to the time interval between the date of CCRT initiation and the first date of nutritional counseling for comparison.

Results

The 1-year overall survival rates were 95.0%, 87.5%, and 81.3% in the early, late, and no nutritional counseling groups (p = 0.035), respectively. The median body weight changes at end of CCRT were − 4.8% (range, − 13.3 to 8.7%), − 5.6% (range, − 21.9 to 5.6%), and − 8.6% (range, − 20.3 to 2.4%) in patients in the early, late, and no nutritional counseling groups, respectively. The early termination of chemotherapy rates and the incompletion rates of planned radiotherapy were 1.9% and 1.9%, 2.9%, and 2.0%, 13.9%, and 19.4% in patients in the early, late, and no nutritional counseling groups, respectively.

Conclusions

Our findings strongly suggest that while some HNC patients may have pretreatment normal nutritional status, early nutritional counseling is nevertheless essential for the improvement of treatment tolerance and survival outcome.

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References

  1. Pressoir M, Desné S, Berchery D, Rossignol G, Poiree B, Meslier M (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102:966–971

    Article  CAS  Google Scholar 

  2. 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  Google Scholar 

  3. Jager-Wittenaar H, Dijkstra PU, Vissink A, Langendijk JA, van der Laan BF, Pruim J et al (2011) Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck 33:863–870

    Article  Google Scholar 

  4. Caillet P, Liuu E, Raynaud Simon A, Bonnefoy M, Guerin O, Berrut G et al (2017) Association between cachexia, chemotherapy and outcomes in older cancer patients: a systematic review. Clin Nutr 36:1473–1482

    Article  Google Scholar 

  5. Ryan AM, Power DG, Daly L, Cushen SJ, Ní Bhuachalla Ē, Prado CM (2016) Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proc Nutr Soc 75:199–211

    Article  Google Scholar 

  6. Citak E, Tulek Z, Uzel O (2019) Nutritional status in patients with head and neck cancer undergoing radiotherapy: a longitudinal study. Support Care Cancer 27:239–247

    Article  Google Scholar 

  7. Rosenthal D (2007) Consequences of mucositis-induced treatment breaks and dose reductions on head and neck cancer treatment outcomes. J Support Oncol 5:23–31

    CAS  PubMed  Google Scholar 

  8. Hsu WL, Yu KJ, Chiang CJ, Chen TC, Wang CP (2017) Head and neck cancer incidence trends in Taiwan, 1980–2014. Int J Head Neck Sci 1:180–189

    Google Scholar 

  9. Pauloski BR, Rademaker AW, Logemann JA, Newman L, MacCracken E, Gaziano J et al (2006) Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck 28:1069–1076

    Article  Google Scholar 

  10. Noronha V, Joshi A, Patil VM, Agarwal J, Ghosh-Laskar S, Budrukkar A et al (2018) Once-a-week versus once-every-3-weeks cisplatin chemoradiation for locally advanced head and neck cancer: a phase III randomized noninferiority trial. J Clin Oncol 36:1064–1072

    Article  CAS  Google Scholar 

  11. Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ et al (2019) Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 393:40–50

    Article  CAS  Google Scholar 

  12. Baxi SS, Schwitzer E, Jones LW (2016) A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation. Cancers Head Neck 1:9

    Article  Google Scholar 

  13. O’Neill CB, Baxi SS, Atoria CL, O’Neill JP, Henman MC, Sherman EJ et al (2015) Treatment-related toxicities in older adults with head and neck cancer: a population- based analysis. Cancer 121:2083–2089

    Article  Google Scholar 

  14. Couch M, Lai V, Cannon T, Guttridge D, Zanation A, George J et al (2007) Cancer cachexia syndrome in head and neck cancer patients: part I. Diagnosis, impact on quality of life and survival, and treatment. Head Neck 29:401–411

    Article  Google Scholar 

  15. Kono T, Sakamoto K, Shinden S, Ogawa K (2017) Pre-therapeutic nutritional assessment for predicting severe adverse events in patients with head and neck cancer treated by radiotherapy. Clin Nutr 36:1681–1685

    Article  Google Scholar 

  16. Langius JA, Zandbergen MC, Eerenstein SE, van Tulder MW, Leemans CR, Kramer MH 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

    Article  Google Scholar 

  17. Talwar B, Donnelly R, Skelly R, Donaldson M (2016) Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130:S32–S40

    Article  CAS  Google Scholar 

  18. Isenring EA, Bauer JD, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107:404–412

    Article  CAS  Google Scholar 

  19. Bauer DJ, Ash S, Davidson LW, Hill MJ, Brown T, Isenring AE et al (2008) Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy of the Dietitians Association of Australia. Nutr Diet 65:S1–S20

    Google Scholar 

  20. 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  Google Scholar 

  21. Bossola M (2015) Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients 7:265–276

    Article  Google Scholar 

  22. Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A et al (2018) Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol 126:81–88

    Article  Google Scholar 

  23. Chou WC, Chang PH, Chen PT, Wang HM, Yeh KY, Lu CH et al (2020) Clinical significance of vulnerability assessment in patients with primary head and neck cancer undergoing definitive concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2020.01.004 [Epub ahead of print]

  24. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16:1582–1587

    Article  CAS  Google Scholar 

  25. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 56:M366–M372

    Article  CAS  Google Scholar 

  26. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349(22):2091–2098

    Article  CAS  Google Scholar 

  27. Taylor S, Murthy A, Vannetzel J, Colin P, Dray M, Caldarelli DD et al (1994) Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 12:385–395

    Article  Google Scholar 

  28. Huang PW, Lin CY, Hsieh CH, Hsu CL, Fan KH, Huang SF et al (2018) A phase II randomized trial comparing neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in advanced squamous cell carcinoma of the pharynx or larynx. Biom J 41:129–136

    Google Scholar 

  29. Lin MC, Shueng PW, Chang WK, Mu-Hsin Chang P, Feng HC, Yang MH et al (2018) Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan. Oral Oncol 81:16–21

    Article  Google Scholar 

  30. Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C et al (2004) Preliminary results of Radiation Therapy Oncology Group 97-03: a randomized phase II trial of concurrent radiation and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol 22:2856–2864

    Article  CAS  Google Scholar 

  31. Loong HH, Ma BB, Leung SF, Mo F, Hui EP, Kam MK et al (2012) Prognostic significance of the total dose of cisplatin administered during concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. Radiother Oncol 104:300–304

    Article  CAS  Google Scholar 

  32. Orell-Kotikangas H, Österlund P, Mäkitie O, Saarilahti K, Ravasco P, Schwab U et al (2017) Cachexia at diagnosis is associated with poor survival in head and neck cancer patients. Acta Otolaryngol 137:778–785

    Article  CAS  Google Scholar 

  33. Arribas L, Hurtós L, Taberna M, Peiró I, Vilajosana E, Lozano A et al (2017) Nutritional changes in patients with locally advanced head and neck cancer during treatment. Oral Oncol 71:67–74

    Article  CAS  Google Scholar 

  34. Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29:183–188

  35. Lønbro S, Petersen GB, Andersen JR, Johansen J (2016) Prediction of critical weight loss during radiation treatment in head and neck cancer patients is dependent on BMI. Support Care Cancer 2016(24):2101–2109

    Article  Google Scholar 

  36. Ravasco P (2011) Nutritional support in head and neck cancer: how and why? Anti-Cancer Drugs 22:639–646

    Article  CAS  Google Scholar 

  37. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A et al (2010) Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 18:837–845

    Article  Google Scholar 

  38. Beaver ME, Matheny KE, Roberts DB, Myers JN (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125:645–648

    Article  CAS  Google Scholar 

  39. Silander E, Nyman J, Hammerlid E (2013) An exploration of factors predicting malnutrition in patients with advanced head and neck cancer. Laryngoscope 123:2428–2434

    PubMed  Google Scholar 

  40. Prevost V, Joubert C, Heutte N, Babin E (2014) Assessment of nutritional status and quality of life in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 131:113–120

    Article  CAS  Google Scholar 

  41. Silander E, Jacobsson I, Berteus-Forslund H, Hammerlid E (2013) Energy intake and sources of nutritional support in patients with head and neck cancer-a randomised longitudinal study. Eur J Clin Nutr 67:47–52

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge the patients who participated in this study with the support from the Cancer Center of Chang Gung Memorial Hospital.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, No. 5, Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan

    Ya-Wen Ho, Chia-Yen Hung, Hung-Ming Wang, Yu-Shin Hung & Wen-Chi Chou

  2. School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Ya-Wen Ho

  3. Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Kun-Yun Yeh & Shun-Wen Hsueh

  4. Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    Chia-Yen Hung

  5. Department of Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan

    Chang-Hsien Lu

  6. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan

    Ngan-Ming Tsang

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  1. Ya-Wen Ho
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Ho, YW., Yeh, KY., Hsueh, SW. et al. Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status. Support Care Cancer 29, 2777–2785 (2021). https://doi.org/10.1007/s00520-020-05804-3

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  • DOI: https://doi.org/10.1007/s00520-020-05804-3

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