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A comparison of the MNA-SF, MUST, and NRS-2002 nutritional tools in predicting treatment incompletion of concurrent chemoradiotherapy in patients with head and neck cancer

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Abstract

Background

Concurrent chemoradiotherapy (CCRT) treatment incompletion is a known negative prognosticator for patients with head and neck cancer (HNC). Malnutrition is a common phenomenon which leads to treatment interruption in patients with HNC. We aimed to compare the performance of three nutritional tools in predicting treatment incompletion in patients with HNC undergoing definitive CCRT.

Material and methods

Three nutritional assessment tools, Mini Nutritional Assessment-Short Form (MNA-SF), Malnutritional Universal Screening Tool (MUST), and Nutritional Risk Screening 2002 (NRS-2002), were prospectively assessed prior to CCRT for HNC patients. Patients were stratified into either normal nutrition or malnourished groups using different nutrition tools. Treatment incompletion and treatment-related toxicities associated with CCRT were recorded.

Results

A total of 461 patients were included in the study; malnourished rates ranged from 31.0 to 51.0%. The CCRT incompletion rates were 4.9–6.3% and 14.5–18.2% for normal nutrition patients and malnourished patients, respectively. The tools had significant correlations with each other (Pearson correlation 0.801–0.837, p<0.001 for all) and accurately predicted the incompletion of CCRT. MNA-SF had the highest performance in predicting treatment-related toxicity, including emergency room visits, need for hospitalization, any grade III or higher hematological adverse events, and critical body weight loss, compared to the other tools.

Conclusions

MNA-SF, MUST, and NRS2002 were all shown to be competent tools for prediction of treatment incompletion and treatment-related toxicity in HNC patients undergoing CCRT. We suggest implementing nutritional assessment prior to treatment to improve the rate of treatment completion and to reduce treatment-related toxicity in HNC patients.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    PubMed  Google Scholar 

  2. Lai YC, Tang PL, Chu CH, Kuo TJ (2018) Effects of income and residential area on survival of patients with head and neck cancers following radiotherapy: working age individuals in Taiwan. PeerJ 6:e5591

    Article  Google Scholar 

  3. Dhull AK, Atri R, Dhankhar R, Chauhan AK, Kaushal V (2018) Major risk factors in head and neck cancer: a retrospective analysis of 12-year experiences. World J Oncol 9:80–84

    Article  Google Scholar 

  4. Thomas K, Martin T, Gao A, Ahn C, Wilhelm H, Schwartz DL (2017) Interruptions of head and neck radiotherapy across insured and indigent patient populations. J Oncol Pract 13:e319–e328

    Article  Google Scholar 

  5. Patel UA, Thakkar KH, Holloway N (2008) Patient compliance to radiation for advanced head and neck cancer at a tertiary care county hospital. Laryngoscope 118:428–432

    Article  Google Scholar 

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

    CAS  Google Scholar 

  7. Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, Kim H, Silverman C, Raben A, Galloway TJ, Fortin A, Gore E, Westra WH, Chung CH, Jordan RC, Gillison ML, List M, le QT (2014) Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J Clin Oncol 32:3858–3866

    Article  CAS  Google Scholar 

  8. Lazarev S, Gupta V, Ghiassi-Nejad Z, Miles B, Scarborough B, Misiukiewicz KJ, Reckson B, Sheu RD, Bakst RL (2018) Premature discontinuation of curative radiation therapy: insights from head and neck irradiation. Adv Radiat Oncol 3:62–69

    Article  Google Scholar 

  9. Sharma A, Madan R, Kumar R, Sagar P, Kamal VK, Thakar A, Sharma A, Mohanti BK (2014) Compliance to therapy-elderly head and neck carcinoma patients. Can Geriatr J 17:83–87

    Article  Google Scholar 

  10. 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 

  11. 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 

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

    Article  Google Scholar 

  13. Yanni A, Dequanter D, Lechien JR, Loeb I, Rodriguez A, Javadian R, van Gossum M (2019) Malnutrition in head and neck cancer patients: impacts and indications of a prophylactic percutaneous endoscopic gastrostomy. Eur Ann Otorhinolaryngol Head Neck Dis 136:S27–S33

    Article  CAS  Google Scholar 

  14. Taylor SG, Murthy AK, Vannetzel JM, 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 

  15. Huang PW, Lin CY, Hsieh CH, Hsu CL, Fan KH, Huang SF, Liao CT, Ng SK, Yen TC, Chang JTC, Wang HM (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 

  16. Garden AS, Harris J, Vokes EE, Forastiere AA, Ridge JA, Jones C, Horwitz EM, Glisson BS, Nabell L, Cooper JS, Demas W, Gore E (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 

  17. 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 

  18. 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 

  19. 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  Google Scholar 

  20. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336

    Article  Google Scholar 

  21. Dronkers EA, Mes SW, Wieringa MH, van der Schroeff MP, Baatenburg de Jong RJ (2015) Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician. BMC Cancer 15:515

    Article  Google Scholar 

  22. 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

    Article  CAS  Google Scholar 

  23. Yeh SA (2010) Radiotherapy for head and neck cancer. Semin Plast Surg 24:127–136

    Article  Google Scholar 

  24. Riley P, Glenny AM, Worthington HV, Littlewood A, Clarkson JE, McCabe MG. (2015) Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev CD011552. https://doi.org/10.1002/14651858

  25. Knight TG, Deal AM, Dusetzina SB, Muss HB, Choi SK, Bensen JT et al (2018) Financial toxicity in adults with cancer: adverse outcomes and noncompliance. J Oncol Pract. https://doi.org/10.1200/JOP.18.00120

  26. Dodd MJ, Miaskowski C (2000) The PRO-SELF Program: a self-care intervention program for patients receiving cancer treatment. Semin Oncol Nurs 16:300–308 discussion 308-16

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge Miss Vengi Ho and the support from the Cancer Center of Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Availability of data

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Not applicable

Author information

Authors and Affiliations

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

    Shun-Wen Hsueh, Kun-Yun Yeh & Pei-Hung Chang

  2. Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Cheng-Chou Lai

  3. Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chia-Yen Hung, Yu-Shin Hung & Wen-Chi Chou

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

    Chia-Yen Hung

  5. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Yu-Ching Lin

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

    Chang-Hsien Lu

  7. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Ngan-Ming Tsang

  8. Department of Hematology and Oncology, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan

    Wen-Chi Chou

Authors
  1. Shun-Wen Hsueh
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Contributions

Conception and design of study: HSW, LCC, YKY, CHL, and WCC; Acquisition of data: TNM, SWH, HYS, and CPH; Analysis and interpretation of data: HCY, LYC, WCC, and TNM; Drafting of the manuscript: HSW, LCC, HCY, HYS, LCH, and WCC.

Corresponding author

Correspondence to Wen-Chi Chou.

Ethics declarations

Ethics approval

This study was approved by the institutional review board of Chang Gung Memorial Hospital in August 2017 (ethic code: 1608080002) and has been conducted in compliance with the Helsinki Declaration (1996).

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All patients provided written informed consent prior to inclusion.

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Not applicable.

Competing interest

The authors declare no competing interests.

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Hsueh, SW., Lai, CC., Hung, CY. et al. A comparison of the MNA-SF, MUST, and NRS-2002 nutritional tools in predicting treatment incompletion of concurrent chemoradiotherapy in patients with head and neck cancer. Support Care Cancer 29, 5455–5462 (2021). https://doi.org/10.1007/s00520-021-06140-w

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