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Ray H, Sexton E, Frowen J, Gough K, Turnbull S, Abo S, Ftanou M, Loeliger J. Study protocol for a single-site feasibility study evaluating the adoption and fidelity of Prep-4-RT: prehabilitation for head and neck cancer patients undergoing radiotherapy. Pilot Feasibility Stud 2024; 10:106. [PMID: 39095879 PMCID: PMC11295311 DOI: 10.1186/s40814-024-01531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Prep-4-RT is a co-designed stepped-care multimodal prehabilitation program for people scheduled to receive radiotherapy for head and neck cancer (HNC). Prehabilitation, which occurs between diagnosis and treatment commencement, aims to improve a patient's health to reduce the incidence and severity of current and future impairments. HNC treatment can be distressing and has detrimental impacts on function and quality of life. HNC patients have increased social vulnerabilities including higher rates of socio-economic disadvantage and engagement in lifestyle habits which increase cancer risk. High levels of physical and psychological impacts of HNC treatment and increased social vulnerabilities of this population warrant investigation of optimal pathways of care, such as prehabilitation. This paper describes a research protocol to evaluate the feasibility of Prep-4-RT, which was designed to prepare HNC patients for the physical and psychological impacts of radiotherapy. METHODS AND ANALYSIS At least sixty adult HNC patients, scheduled to receive radiotherapy (with or without chemotherapy), will be recruited over a five-month period. All participants will receive access to Prep-4-RT self-management resources. Participants identified through screening as high-risk will also be offered individualised interventions with relevant allied health professionals prior to the commencement of radiotherapy (psychologists, dietitians, speech pathologists and physiotherapists). Participants will complete evaluation surveys assessing their experiences with Prep-4-RT resources and interventions. Clinicians will also complete program evaluation surveys. Primary feasibility outcomes include adoption (uptake and intention to try) and fidelity (adherence to the specialist prehabilitation pathway). Secondary feasibility outcomes include acceptability (patient and clinician) of and satisfaction (patient) with Prep-4-RT as well as operational costs. Feasibility outcome data will be analysed using exact binomial and one-sample t tests, as appropriate. ETHICS AND DISSEMINATION Ethics approval has been obtained at the Peter MacCallum Cancer Centre in Melbourne, Australia. Results will be presented at national conferences and published in peer-reviewed journal(s) so that it can be accessed by clinicians involved in the care of HNC patients receiving radiotherapy. If the model of care is found to be feasible and acceptable, the transferability and scalability to other cancer centres, or for other cancer types, may be investigated. REGISTRATION DETAILS ANZCTA (Australian New Zealand Clinical Trials Registry) ACTRN12623000770662.
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Affiliation(s)
- H Ray
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - E Sexton
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Turnbull
- Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Abo
- Physiotherapy & Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - M Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - J Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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Tang A, Dang S, Lao I, Pandya S, Solari MG, Maxwell J, Contrera KJ, Zevallos JP, Ferris R, Kim S, Sridharan S, Spector ME. Association of prealbumin with complications after total laryngectomy with free flap reconstruction. Am J Otolaryngol 2024; 45:104451. [PMID: 39137698 DOI: 10.1016/j.amjoto.2024.104451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Malnutrition is an important risk factor for patient surgical outcomes. This is especially true for head and neck cancer (HNC) patients receiving a total laryngectomy with free flap reconstruction (TLwFFR). Preoperative prealbumin and albumin values have both been used to indicate poor nutrition. This study aims to identify the prognostic value of preoperative prealbumin and albumin levels with wound healing complications in HNC patients after TLwFFR. METHODS A retrospective review was conducted in all HNC patients who underwent TLwFFR from 2016 to 2022 at a tertiary-care institution. Patients with either preoperative (within 1 month of surgery) prealbumin or albumin lab values were included. Low preoperative prealbumin (low prealbumin) levels and low preoperative albumin (low albumin) levels were defined as ≤20 mg/dL and <3.4 g/dL, respectively. Outcomes collected included all wound healing complications (infection, wound dehiscence, pharyngocutaneous fistula). The association between prealbumin and albumin with outcomes were analyzed using multivariable logistic regression. RESULTS A total of 83 patients met the inclusion criteria. The mean age at surgery was 61.6 ± 9.3. The overall wound healing complication rate was 33.7 %. There was an association between low prealbumin levels and any wound healing complication. On multivariate analysis, low prealbumin levels were associated with postoperative wound healing complications (OR, 4.7; CI 1.3-17.0. P = 0.02) after controlling for low albumin level, age, smoking, and preoperative radiation. CONCLUSIONS Low prealbumin levels were associated with wound healing complications in TLwFFR patients. Consideration of consistent prealbumin testing with nutritional intervention may reduce wound healing complications.
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Affiliation(s)
- Anthony Tang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Sophia Dang
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Isabella Lao
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Sumaarg Pandya
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Mario G Solari
- University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, United States of America
| | - Jessica Maxwell
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Kevin J Contrera
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Jose P Zevallos
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Robert Ferris
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Seungwon Kim
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Shaum Sridharan
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America
| | - Matthew E Spector
- University of Pittsburgh Medical Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, PA, United States of America.
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Britton B, Baker AL, Wolfenden L, Wratten C, Bauer J, Beck AK, McCarter K, Handley T, Carter GL. Five-Year Mortality Outcomes for Eating As Treatment (EAT), a Health Behavior Change Intervention to Improve Nutrition in Patients With Head and Neck Cancer: A Stepped-Wedge, Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 119:1166-1170. [PMID: 38320712 DOI: 10.1016/j.ijrobp.2024.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Malnutrition affects up to 80% of patients with head and neck cancer (HNC) and is associated with higher burden of disease, poorer treatment outcomes, and greater mortality. The Eating As Treatment (EAT) intervention is a behavioral intervention previously demonstrated to be effective in improving nutritional status, depression, and quality of life in patients with HNC. This article examines the effects of the EAT intervention on 5-year mortality among participants. METHODS AND MATERIALS A multicenter, stepped-wedge, randomized controlled trial was conducted in 5 Australian hospitals. Dietitians were trained to deliver EAT, a combination of motivational interviewing and cognitive behavior therapy strategies, to patients with HNC receiving radiation therapy. Secondary analyses of survival benefit on an intention-to-treat basis were performed. Differences in proportions of 5-year all-cause mortality between the control and EAT intervention arms were analyzed using multivariable logistic regression, and 5-year survival rates were analyzed using Cox proportional hazards regression. Analyses controlled for temporal effects (study duration), hospital site (clustering), and baseline nutritional status differences. RESULTS Overall, there were 64 deaths in the 5 years after enrollment, 36 (24%) among those assigned to the control condition and 28 (18%) among those assigned to EAT. Logistic regression showed statistically significant reduced odds in favor of EAT (odds ratio, 0.33; 95% CI, 0.11-0.96), with an absolute risk reduction of 17% (95% CI, 0.01-0.33) and a relative risk reduction of 55% (95% CI, 0.22-0.92), resulting in a number needed to treat of 6 (95% CI, 4-13). Survival analysis revealed that risk of death was significantly reduced by the EAT intervention (hazard ratio, 0.39; 0.16-0.96). CONCLUSIONS Participation in EAT provided a statistically and clinically meaningful survival benefit, likely via improved nutrition during radiation therapy. This survival benefit strengthens the finding of the main trial, showing that a behavioral intervention focused on nutrition could improve HNC outcomes. Replication studies using stepped-wedge designs for implementation into clinical practice may be warranted.
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Affiliation(s)
- Ben Britton
- Hunter New England Health Mental Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Amanda L Baker
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia; Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics & Food, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Alison K Beck
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kristen McCarter
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tonelle Handley
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gregory Leigh Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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McLay K, Stonewall N, Forbes L, Peters C. The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study. J Patient Rep Outcomes 2024; 8:71. [PMID: 38995461 PMCID: PMC11245459 DOI: 10.1186/s41687-024-00750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Cancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores. METHODS A single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman's correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses. RESULTS 2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%. CONCLUSION Malnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.
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Affiliation(s)
- Katherine McLay
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Nicole Stonewall
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Christine Peters
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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LiYa L, XinSheng Z, Xiang H, Zhao L, Lu L, XiuMing L, Ye L, Jing C, KeMing Z, HongChi W, Jing X, Yang C, Xiu C, HongBo L, ShuQin Y, Fang L, YingHua L. A cross-sectional survey study on the correlation analysis of nutritional status and intestinal flora in patients with esophageal cancer. Front Nutr 2024; 11:1424039. [PMID: 39070256 PMCID: PMC11275563 DOI: 10.3389/fnut.2024.1424039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Objective This study aims to examine the nutritional status of individuals diagnosed with esophageal cancer and compare the nutritional indicators and intestinal flora between malnourished and non-malnourished patients. The findings aim to contribute to the early prevention of malnutrition and the development of interventions targeting the intestinal flora to treat esophageal cancer. Methods An 80-patient sample of hospitalized individuals with esophageal cancer was selected from the radiotherapy department of our hospital between July 2021 and July 2022 to evaluate NRS2002 scores and PG-SGA scores. This cross-sectional analysis aimed to examine the disparities in dietary nutrient intake, blood indicators, body composition, and fecal intestinal flora between malnourished and non-malnourished patients with esophageal cancer. Additionally, we randomly selected 40 cases to predict and analyze the relationship between intestinal flora and malnutrition. Results The incidence of nutritional risk and malnutrition in patients with esophageal cancer was 62.5% and 60%, respectively. The low intake of carbohydrates and dietary fiber in the malnutrition group was statistically significant compared to those in the non-malnutrition group (P < 0.05). The albumin (ALB) level was lower in the malnutrition group than in the non-malnutrition group, while the C-reactive protein (CRP) level was higher; these differences were also statistically significant (P < 0.05). The basal metabolic rate, phase angle, body cell mass, muscle mass, skeletal muscle index, and fat-free mass index in the malnutrition group all decreased compared to the non-malnutrition group. The extracellular water/total body water was higher than that in the non-malnutrition group, which was also statistically significant (P < 0.05). As shown by 16S rDNA sequencing of fecal intestinal flora, there was no significant difference in α and β diversity between the malnutrition and non-malnutrition groups; at the genus level, significant differences were observed for Selimonas, Clostridioides, Dielma, Lactobacillus, and [Eubacterium]_siraeum_group. However, Dielma, Sellimonas, and Clostridioides were significantly lower in the malnutrition group than in the non-malnutrition group, while Anaerococcus, Atopobium, Eubacterium_siraeum_group, and Lactobacillus were significantly higher in the malnutrition group. Correlation analysis between different genera and clinical indicators showed that Lactobacillus was positively correlated with ALB, dietary energy, intracellular water/total body water (ICW/TBW), phase angle (PA), muscle mass (MM), skeletal muscle mass (SMM), body cell mass (BCM), basal metabolic rate (BMR), appendicular skeletal muscle mass (ASMM), total body water (TBW), fat-free mass index (FFMI), skeletal muscle index (SMI), fat-free mass (FFM), Weight, body mass index (BMI) (r > 0, P < 0.05), but negatively correlated with PG-SGA score, NRS2002 score, and extracellular water/total body water (ECW/TBW) (r < 0, P < 0.05). Based on PG-SGA, there was only a low accuracy for identifying nutrient deficiency (most areas under curve (AUC) values fell within 0.5 to 0.7, or even lower), with Lachnoclostridium's AUC being 0.688 (CI = 0.518-0.858) and Lactobacillus_salivarius_g_Lactobacillus's AUC being 0.257 (CI = 0.098-0.416). A KEGG functional analysis based on 16S data indicated potential differences affecting glucose metabolism pathways and the synthesis or division of DNA, influencing the onset, development, and prognosis of esophageal cancer patients. Conclusion Esophageal cancer patients are more likely to be malnourished. The nutritional status of these patients is closely linked to the intake of carbohydrates and fiber, albumin levels, inflammation levels, and lean body mass. Furthermore, the patient's intestinal flora composition plays a significant role in their nutritional well-being. Consequently, modulating the intestinal flora holds promise as a potential therapeutic approach for addressing malnutrition in esophageal cancer patients. Clinical trial registration ChiCTR2100048141.
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Affiliation(s)
- Li LiYa
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang XinSheng
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Huang Xiang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Zhao
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu Lu
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lv XiuMing
- Department of Clinical Nutrition, Hebei Yanda Hospital, Langfang, China
| | - Li Ye
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Chen Jing
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhang KeMing
- Department of Nutrition, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wang HongChi
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xia Jing
- Department of Endocrinology, Jiangyin Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Cong Yang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Cui Xiu
- Department of Nutrition, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Long HongBo
- Department of Nutrition, Fangshan Hospital Beijing University of Chinese Medicine, Beijing, China
| | - You ShuQin
- Department of Endocrinology, Ili Kazakh Autonomous Prefecture, Huocheng County Hospital of Traditional Chinese Medicine, Yili, China
| | - Liu Fang
- Department of Radiation Oncology, Fifth Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Liu YingHua
- Department of Nutrition, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Löser A, Fabian A, Rühle A, Thieme A, Baehr A, Käsmann L, Zwaan I, Kahle B, Soror T, Kunte A, Seyedi N, Kebenko M, Seidel C, Dierks F, Krause L, Bruchhage KL, Rades D. Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project. Strahlenther Onkol 2024; 200:583-594. [PMID: 38381142 PMCID: PMC11186953 DOI: 10.1007/s00066-024-02206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Data on enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy vary considerably between German institutions. This survey aims to investigate the management of feeding tubes in an interdisciplinary context across Germany. MATERIALS AND METHODS Between December 2022 and May 2023, 70 participants (42 radiation oncologists, 12 medical oncologists, 14 head and neck surgeons, and 2 physicians covering several specialties) responded to our web-based survey. In addition to the type of institution (university hospital, private practice, etc.), their age, and professional experience (in years), participants were asked several questions on the indication and institutional policy for tube placement and management (prophylactic/reactive nasogastric or gastrostomy tube). All questions were mandatory single- or multiple-choice questions, while additional comments were possible by email. RESULTS Most participants were employed at a university hospital (n = 52; 74.3%) and came from a radiation oncology background (n = 42; 60%). Fifty-four contributors (77.1%) reported that no nutritional risk screening prior to chemoradiotherapy was routinely performed, and 71.4% (n = 50) stated that no standardized protocol was used at the institution to set the indication for tube placement. Generally, policies and methods of tube feeding vary considerably between the individual institutions and specialties. However, the majority (n = 56, 80%) recommended a prophylactic percutaneous enteral gastrostomy (PEG) tube to their patients before chemoradiotherapy. Still, there was no consistent trend regarding the approach for reactive tube feeding. CONCLUSION The policies and methods of tube feeding vary considerably between the individual institutions and specialties in Germany. In the era of individualized medicine, uniform protocols are difficult to establish. However, a baseline nutritional risk screening could simplify decision-making in clinical practice.
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Affiliation(s)
- Anastassia Löser
- Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein/Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Straße 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Alexander Thieme
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andrea Baehr
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lukas Käsmann
- Clinic and Polyclinic for Radiotherapy and Radiooncology, LMU Clinic, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Inga Zwaan
- Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Birte Kahle
- Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Tamer Soror
- Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ameya Kunte
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Niloufar Seyedi
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Maxim Kebenko
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Friederike Dierks
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl-Ludwig Bruchhage
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Dirk Rades
- Department of Radiotherapy, University Medical Center Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Surwiłło-Snarska A, Kapała A, Szostak-Węgierek D. Assessment of the Dietary Intake Changes in Patients with Head and Neck Cancer Treated with Radical Radiotherapy. Nutrients 2024; 16:2093. [PMID: 38999841 PMCID: PMC11243572 DOI: 10.3390/nu16132093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Patients during radiotherapy due to head and neck cancers experience a lot of side effects which may have a considerable impact on the patients' ability to meet individual daily energy demands by means of oral diet. METHODS The study included 104 head and neck cancer patients who qualified for radical radiotherapy. Radical treatment takes 6 weeks and every week the patients were assessed for dietary intake. The subjects were covered with the constant care of a dietician, received FSMP (food for special medical purposes), and, if necessary, enteral nutrition. RESULTS In the first week of treatment, the patients, from the kitchen diet alone, met 91.5% of the energy demand, while in the last week of treatment, only 40.9%. After introducing the FSMP or enteral nutrition, the patients met 120% of the demand in the first week of therapy and 95% in the last week, respectively. The patients who followed the dietary recommendations were characterized by significantly lower weight loss (3.07 kg) compared to non-adherent patients (5.56 kg). CONCLUSIONS The used therapy significantly contributed to decreasing nutritional intake in the subsequent weeks of treatment. On the other hand, incorporating FSMP in the diet and enteral nutrition with industrial diets significantly increased the fulfilled energy demand of patients.
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Affiliation(s)
- Agnieszka Surwiłło-Snarska
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Aleksandra Kapała
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Department of Oncology Diagnostics, Cardio-Oncology and Palliative Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Dorota Szostak-Węgierek
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka 27, 01-445 Warsaw, Poland
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Mikhael M, Kansara B, Basta A, Hume E, Nguyen OT, Reblin M, Hong YR, Tabriz AA, Patel K, Magnuson JS, Turner K. Optimizing presurgical education for patients with head and neck cancer receiving laryngectomy and free flap surgery: A qualitative study. Head Neck 2024. [PMID: 38459809 PMCID: PMC11381573 DOI: 10.1002/hed.27729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND There has been limited study of oncology professionals' perspectives on optimizing delivery of presurgical education for individuals with head and neck cancer (HNC). Therefore, we assessed oncology professionals' perspectives about presurgical education for laryngectomy and free flap surgeries, which have a significant impact on patients' quality of life. METHODS Interviews were conducted with 27 oncology professionals from an NCI-designated Comprehensive Cancer Center and a community oncology setting. RESULTS Participants identified six recommendations to improve presurgical education: (1) establishing preoperative consultations with allied health professionals; (2) educating patients and providers on the concept of team-based care; (3) optimizing education through multimodal strategies; (4) connecting patients with other HNC surgical patients; (5) preparing caregivers for their role; and (6) educating patients on insurance navigation. CONCLUSIONS Study findings demonstrate gaps in the timing, content, and mode of delivery for presurgical education and suggest strategies for further evaluation in future studies.
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Affiliation(s)
- Marian Mikhael
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Bhargav Kansara
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ameer Basta
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Emma Hume
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Krupal Patel
- Department of Head and Neck Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jeffery Scott Magnuson
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Surgery, AdventHealth Orlando, Orlando, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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9
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Tristan Asensi M, Giangrandi I, Sartini L, Pagliai G, Dinu M, Lotti S, Colombini B, Sofi F. Quality of life and nutritional status of a group of post-operative head and neck cancer patients. NUTR HOSP 2023; 40:919-923. [PMID: 37732341 DOI: 10.20960/nh.04638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Introduction Introduction: scientific evidence on the appropriate nutritional support in the treatment of post-operative head and neck cancer (HNC) patients is still limited. Objectives: our aim was to evaluate nutritional status and quality of life in HNC patients in post-operative phase with different nutritional support. Methods: fifty-four HNC patients (26 with enteral nutrition [EN] via percutaneous endoscopic gastrostomy [PEG] and 28 with oral nutrition [ON]) were included. Nutritional status was evaluated with biochemical parameters and quality of life through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: ON patients reported significantly (p < 0.05) lower levels of hemoglobin, lymphocytes, iron, folic acid, and vitamin D than EN patients, with greater percentage of ON patients found to be below the reference limits for hemoglobin (21.4 % vs 19.4 %), and significantly for serum iron (17.9 % vs 0 %) and vitamin D (78.6 % vs 30.8 %). Furthermore, EN patients had a better quality of life (63.8 ± 17.6) than ON (55.4 ± 20.3), although ON patients reported less symptoms related to dyspnea (-5.8 %), loss of appetite (-11.3 %) and vomiting (-23.1 %). Conclusions: these results suggest that the use of EN in post-operative HNC patients could have a positive effect on the nutritional status and quality of life of these patients. However, further research is needed to optimize the nutritional support in these patients in order to avoid malnutrition and improve their well-being.
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Affiliation(s)
| | | | - Lorena Sartini
- Department of Health Professions. Dietary Production Line and Nutrition. Careggi University Hospital
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine. University of Florence
| | - Monica Dinu
- Department of Experimental and Clinical Medicine. University of Florence
| | - Sofia Lotti
- Department of Experimental and Clinical Medicine. University of Florence
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine. University of Florence
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine. University of Florence. Unit of Clinical Nutrition. Careggi University Hospital
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10
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Tao H, Wei Y, Shen Z, Liu Z. Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension. Front Oncol 2023; 13:1089275. [PMID: 37746267 PMCID: PMC10513504 DOI: 10.3389/fonc.2023.1089275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background We conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias. Methods The matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification. Results The median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT. Conclusion The results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.
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Affiliation(s)
| | - Yumei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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11
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Boesenecker SJ, Mathies V, Buentzel J, Huebner J. How can counselling by family physicians on nutrition and physical activity be improved: trends from a survey in Germany. J Cancer Res Clin Oncol 2023; 149:3335-3347. [PMID: 35932301 PMCID: PMC10314832 DOI: 10.1007/s00432-022-04233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Cancer and its therapy causes severe symptoms, most of which are amendable to nutrition and physical activity (PA). Counselling on nutrition and PA empowers patients to take part more actively in their treatment. Many cancer patients are yet in need of information on these topics. In this study, we investigate the perception of family physicians (FP) on nutrition and PA in cancer patient care and assess barriers and steps to improve their involvement in counselling on these topics. METHODS Based on qualitative content analysis of 5 semi-structured interviews with FP, a questionnaire was developed and completed by 61 German FP. RESULTS Most of the FP acknowledged the importance of nutrition and PA during (91.4%) and after (100%) cancer therapy. While many participants were involved in cancer patient care, 65.6% of FP viewed themselves as primary reference person to address these topics. However, a third (32.8%) of FP were unfamiliar with information thereof. Some were unsatisfied regarding timely updates on their patient's treatment course via discharge letters (25.0%) or phone calls (36.2%). FP would like to dedicate more consultation time addressing nutrition and PA than they currently do (p < 0.001). CONCLUSION Communication btween healthcare practitioners about mutual cancer patient's treatment must be improved, e.g. utilising electronic communication to quicken correspondence. Acquisition of information on nutrition and PA in cancer patient care needs to be facilitated for FP, approachable by compiling reliable information and their sources. Involvement of FP in structured treatment programs could benefit cancer patient care. TRIAL REGISTRATION NUMBER (May 7, 2021): 2021-2149-Bef.
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Affiliation(s)
- S J Boesenecker
- Clinic for Internal Medicine II, University Hospital, Bachstraße 18, 07743, Jena, Germany.
| | - V Mathies
- University Tumor Center, University Hospital, Jena, Germany
| | - J Buentzel
- Clinic for Otorhinolaryngology, Head Neck Surgery, Suedharz Klinikum, Nordhausen, Germany
| | - J Huebner
- Clinic for Internal Medicine II, University Hospital, Bachstraße 18, 07743, Jena, Germany
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12
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Eldridge RC, Qin ZS, Saba NF, Houser MC, Hayes DN, Miller AH, Bruner DW, Jones DP, Xiao C. Unsupervised Hierarchical Clustering of Head and Neck Cancer Patients by Pre-Treatment Plasma Metabolomics Creates Prognostic Metabolic Subtypes. Cancers (Basel) 2023; 15:3184. [PMID: 37370794 PMCID: PMC10296258 DOI: 10.3390/cancers15123184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
There is growing evidence that the metabolism is deeply intertwined with head and neck squamous cell carcinoma (HNSCC) progression and survival but little is known about circulating metabolite patterns and their clinical potential. We performed unsupervised hierarchical clustering of 209 HNSCC patients via pre-treatment plasma metabolomics to identify metabolic subtypes. We annotated the subtypes via pathway enrichment analysis and investigated their association with overall and progression-free survival. We stratified the survival analyses by smoking history. High-resolution metabolomics extracted 186 laboratory-confirmed metabolites. The optimal model created two patient clusters, of subtypes A and B, corresponding to 41% and 59% of the study population, respectively. Fatty acid biosynthesis, acetyl-CoA transport, arginine and proline, as well as the galactose metabolism pathways differentiated the subtypes. Relative to subtype B, subtype A patients experienced significantly worse overall and progression-free survival but only among ever-smokers. The estimated three-year overall survival was 61% for subtype A and 86% for subtype B; log-rank p = 0.001. The association with survival was independent of HPV status and other HNSCC risk factors (adjusted hazard ratio = 3.58, 95% CI: 1.46, 8.78). Our findings suggest that a non-invasive metabolomic biomarker would add crucial information to clinical risk stratification and raise translational research questions about testing such a biomarker in clinical trials.
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Affiliation(s)
- Ronald C. Eldridge
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (M.C.H.); (D.W.B.); (C.X.)
| | - Zhaohui S. Qin
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Nabil F. Saba
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | - Madelyn C. Houser
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (M.C.H.); (D.W.B.); (C.X.)
| | - D. Neil Hayes
- Department of Medicine, UT/West Institute for Cancer Research, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Deborah W. Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (M.C.H.); (D.W.B.); (C.X.)
| | - Dean P. Jones
- Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Canhua Xiao
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (M.C.H.); (D.W.B.); (C.X.)
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13
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Vangelov B, Bauer J, Moses D, Smee R. The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography-defined sarcopenia evaluation in patients with head and neck cancer. Head Neck 2023; 45:1006-1016. [PMID: 36811256 DOI: 10.1002/hed.27320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)-defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC). METHODS Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated. RESULTS Scans of 111 patients (85% male) were evaluated. The predictive formula: L3-CSA (cm2 ) = 174.15 + [0.212 × T2-CSA (cm2 )] - [40.032 × sex] - [0.928 × age (years)] + [0.285 × weight (kg)] had good correlation r = 0.796, ICC = 0.882 (p < 0.001). SM index (SMI) mean difference (bias) was -3.6% (SD 10.2, 95% CI -8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ = 0.540, p < 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p = 0.003). CONCLUSIONS SM at T2 can be effectively used for CT-defined sarcopenia evaluation in HNC.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Robert Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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14
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Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions. Eur Arch Otorhinolaryngol 2023; 280:1893-1902. [PMID: 36484854 PMCID: PMC9988738 DOI: 10.1007/s00405-022-07728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC. METHODS In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors. RESULTS In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients. CONCLUSIONS Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
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15
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Leis C, Arthur AE, Chen X, Greene MW, Frugé AD. Systematic Review of Nutrition Interventions to Improve Short Term Outcomes in Head and Neck Cancer Patients. Cancers (Basel) 2023; 15:822. [PMID: 36765780 PMCID: PMC9913111 DOI: 10.3390/cancers15030822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023] Open
Abstract
Head and neck cancer (HNC) is associated with high rates of malnutrition. We conducted a systematic review and descriptive analysis to determine the effects of nutrition interventions on the nutrition status, quality of life (QOL), and treatment tolerance of HNC patients. PubMed, Web of Science, and Embase were searched to include all potentially relevant studies published between 2006-2022. Meta-analysis was not conducted due to heterogeneity of study designs and outcomes reported. Studies were categorized as nutrition interventions: (1) with oral nutrition supplements (ONS) and medical nutrition therapy (MNT) delivered by an RD; (2) with enteral nutrition (EN) support and MNT delivered by an RD; (3) with motivational interviewing and no ONS or EN; and (4) with ONS and no RD. Seven articles met inclusion criteria. Studies measured outcomes from immediately following treatment to 12 months post-treatment. Interventions resulted in benefits to lean mass/weight maintenance (three studies), QOL (two studies), nutrient intake adequacy (one study) and treatment tolerance (two studies). Nutrition counseling by a registered dietitian leads to improved nutrition status and QOL. Further research is needed to determine best practices related to timing of initiation, duration of nutrition intervention, as well as frequency of dietitian follow-up.
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Affiliation(s)
- Claire Leis
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Anna E. Arthur
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Xin Chen
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Michael W. Greene
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Andrew D. Frugé
- College of Nursing, Auburn University, Auburn, AL 36849, USA
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16
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Bagheri A, Asoudeh F, Rezaei S, Babaei M, Esmaillzadeh A. The Effect of Mediterranean Diet on Body Composition, Inflammatory Factors, and Nutritional Status in Patients with Cachexia Induced by Colorectal Cancer: A Randomized Clinical Trial. Integr Cancer Ther 2023; 22:15347354231195322. [PMID: 37621140 PMCID: PMC10467242 DOI: 10.1177/15347354231195322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Along with high calorie and high protein diet, a new comprehensive dietary approach is needed to control cachexia caused by cancer and its related outcomes. This study was done to evaluate the effect of a Mediterranean diet on body composition, nutritional status, and inflammatory markers among cancer cachexia patients. METHODS In this randomized clinical trial, 46 patients with colorectal cancer-induced cachexia were included. After randomization, 23 patients were allocated to the intervention group (Mediterranean diet) and 23 to the control group (nutritional counseling for weight gain and prevention of weight loss in cancer patients). The primary outcome including muscle health, nutritional status, and inflammatory markers along with secondary outcomes such as quality of life, and serum proteins were evaluated at the start and the eighth week of the study. Statistical analysis was performed according to the intention-to-treat concept. To compare changes in dependent variables between the 2 groups, analysis of covariance (ANCOVA) was performed. RESULTS After adjustment for the baseline values, age, sex, and supplements use, in the Mediterranean diet group mean of weight (P < .001), lean body mass (P = .001), fat mass (P = .002), and muscle strength (P < .001) were significantly increased compared to the control group. Regarding inflammatory markers, the mean serum level of tumor necrosis factor-alpha (TNF-α) (P < .001), high sensitive-C-reactive protein (hs-CRP) (P = .01) and Interleukin 6 (IL-6) (P < .001) were significantly improved in the Mediterranean diet group. Moreover, in the Mediterranean diet group, the score for global health status (P = .02) and physical performance score (P < .001) were significantly increased. CONCLUSION It appears that the implementation of the Mediterranean diet might be a strategy to improve nutritional status, quality of life, inflammatory markers, and body composition in patients with colorectal cancer cachexia. TRIAL REGISTRATION Iranian Registry of Clinical Trials (www.irct.ir); ID: IRCT20211027052884N1.
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Affiliation(s)
- Amir Bagheri
- Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saied Rezaei
- Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Esmaillzadeh
- Tehran University of Medical Sciences, Tehran, Iran
- Isfahan University of Medical Sciences, Isfahan, Iran
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17
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Bora H, Bhattacharyya M, Kalita AK, Medhi PP, Sarma G, Nath J, Kalita M, Ingtipi D, Sarma B. Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy - A Prospective Observational Study from North East India. Nutr Cancer 2022; 75:357-367. [PMID: 36052999 DOI: 10.1080/01635581.2022.2118323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Head and neck cancer (HNC) patients undergoing curative radiotherapy (RT) are at risk of malnutrition due to disease process as well as effects of therapy. Identifying the nutritional status of these patients at the earliest, helps to introduce adequate and timely interventions that can improve compliance and outcomes of treatment. Various tools for nutritional assessment in cancer patients have been proposed. In this prospective observational study we used the Subjective Global Assessment (SGA) questionnaire in a cohort of HNC patients receiving definitive RT at a regional cancer center of North East India. Recording of data was done at baseline, at two weekly intervals during treatment, at end of radiotherapy (EORT) and at follow-up upto 6 months. We observed that despite proper nutrition counseling, our patients suffered from malnutrition throughout their course of RT, which was at its peak by EORT but gradually improved over six months of follow-up. Pain on eating and swallowing were the most debilitating symptoms which caused significant decline of nutrient intake, body fat and muscle mass among patients together with deteriorating SGA ratings. Our results will hopefully help us design better strategies for nutrition management while delivering curative (chemo)radiotherapy for HNC patients of this region- which has one of the highest incidences of HNC in the world.
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Affiliation(s)
- Hima Bora
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | | | - Apurba Kumar Kalita
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Partha Pratim Medhi
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Gautam Sarma
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Manoj Kalita
- Department of Cancer Registry and Biostatistics, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Dimi Ingtipi
- Consultant Dietician, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Biswajit Sarma
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
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18
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Yeh KY, Wang CH, Ling HH, Peng CL, Chen ZS, Hsia S. Pretreatment Glasgow Prognostic Score Correlated with Serum Histidine Level and Three-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma and Optimal Performance Status. Nutrients 2022; 14:nu14173475. [PMID: 36079741 PMCID: PMC9458049 DOI: 10.3390/nu14173475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Few prospective cohort trials have investigted the effect of pretreatment nutritional and inflammatory status on the clinical outcome of patients with cancer and optimal performance status and assessed the interplay between nutrition, inflammation, body composition, and circulating metabolites before treatment. Here, 50 patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≤ 2 were prospectively recruited along with 43 healthy participants. Before concurrent chemoradiotherapy, compared with healthy controls, the cancer group showed lower levels of histidine, leucine, and phenylalanine and had low values in anthropometric and body composition measurements; however, the group displayed higher ornithine levels, more malnutrition, and severe inflammation. Pretreatment advanced Glasgow prognostic score (1 and 2) status was the sole prognostic factor for 3-year mortality rate and was associated with age and serum histidine levels in patients with cancer. Thus, even at the same tumor stage and ECOG PS, patients with LAHNSCC, poor nutrition, and high inflammation severity at baseline may have inferior survival outcomes than those with adequate nutrition and low inflammation severity. Assessment of pretreatment nutritional and inflammatory status should be included in the enrollment criteria in future studies.
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Affiliation(s)
- Kun-Yun Yeh
- Division of Hemato-Oncology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan
- Correspondence: ; Tel.: +886-2-2432-9292 (ext. 2360)
| | - Chao-Hung Wang
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Hang Huong Ling
- Division of Hemato-Oncology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan
| | - Chia-Lin Peng
- Taiwan Nutraceutical Association, Taipei 104483, Taiwan
| | | | - Simon Hsia
- Taiwan Nutraceutical Association, Taipei 104483, Taiwan
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Nutrition and physical activity in cancer patients: a survey on their information sources. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04282-w. [PMID: 35994117 DOI: 10.1007/s00432-022-04282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Many cancer patients suffer from problems concerning nutrition and physical activity (PA) during and after their treatment. Forwarding reliable health information could help to alleviate severe symptoms. The present study aimed to examine cancer patients' commonly used information sources on nutrition and PA. METHODS An anonymous questionnaire was developed and distributed to German cancer patients in different settings. In total, 90 questionnaires have been completed between October 2021 and March 2022. For analysis, descriptive statistics were used and associations between information sources and patients' lifestyle behaviour explored utilising Spearman's Rho, Mann-Whitney U, and Pearson's Chi Square tests. RESULTS The cancer patients received information on nutrition and PA most frequently from physicians (70.9%), family and friends (68%) and browsing the internet (61.3%). Half of the patients (51.1%) had questions concerning these topics during the time of their disease. The majority of those patients (81.8%) reported that their questions were answered. The topics were addressed primarily with outpatient oncologists (60.0%) and in rehabilitation clinics (53.3%). Just about half of the patients (55.3%) felt satisfactorily informed on nutrition and PA in their cancer disease, more so if they talked to their oncologist or family physician (Z = - 2.450, p = 0.014 and Z = - 3.425, p = 0.001 resp.). CONCLUSION Cancer patients receive information on nutrition and PA predominantly after their initial treatment. Since they might be missing significant information to alleviate severe symptoms during their treatment, the importance of nutrition and PA should be emphasised by clinicians early on in treatment. TRIAL REGISTRATION Trial Registration Number (May 7, 2021): 2021-2149-Bef.
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20
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Wang CH, Ling HH, Liu MH, Pan YP, Chang PH, Lin YC, Chou WC, Peng CL, Yeh KY. Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision. Cancers (Basel) 2022; 14:cancers14133112. [PMID: 35804884 PMCID: PMC9264877 DOI: 10.3390/cancers14133112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
We investigated risk factors for treatment interruption (TI) in patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC) following concurrent chemoradiotherapy (CCRT), under the provision of recommended calorie and protein intake; we also evaluated the associations between clinicopathological variables, calorie and protein supply, nutrition–inflammation biomarkers (NIBs), total body composition change (TBC), and a four-serum-amino-acid metabolite panel (histidine, leucine, ornithine, and phenylalanine) among these patients. Patients with LAHNSCC who completed the entire planned CCRT course and received at least 25 kcal/kg/day and 1 g of protein/kg/day during CCRT were prospectively recruited. Clinicopathological variables, anthropometric data, blood NIBs, CCRT-related factors, TBC data, and metabolite panels before and after treatment were collected; 44 patients with LAHNSCC were enrolled. Nine patients (20.4%) experienced TIs. Patients with TIs experienced greater reductions in hemoglobin, serum levels of albumin, uric acid, histidine, and appendicular skeletal mass, and suffered from more grade 3/4 toxicities than those with no TI. Neither increased daily calorie supply (≥30 kcal/kg/day) nor feeding tube placement was correlated with TI. Multivariate analysis showed that treatment-interval changes in serum albumin and histidine levels, but not treatment toxicity, were independently associated with TI. Thus, changes in serum levels of albumin and histidine over the treatment course could cause TI in patients with LAHNSCC following CCRT.
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Affiliation(s)
- Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan; (C.-H.W.); (M.-H.L.)
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
| | - Hang Huong Ling
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
| | - Min-Hui Liu
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan; (C.-H.W.); (M.-H.L.)
- Department of Nursing, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Yi-Ping Pan
- Department of Nutrition, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Pei-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
| | - Yu-Ching Lin
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333007, Taiwan
| | - Chia-Lin Peng
- Taiwan Nutraceutical Association, Taipei 104483, Taiwan;
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
- Correspondence: ; Tel.: +886-2-24329292 (ext. 2360); Fax: +886-2-2435342
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François C, Maud V, Frederique B, Alison J, Solem Laviec H, Audrey R. Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy. Support Care Cancer 2022; 30:6545-6553. [PMID: 35477810 DOI: 10.1007/s00520-022-07078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC). METHODS In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain. RESULTS OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836). CONCLUSION We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care.
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Affiliation(s)
- Cherifi François
- Medical Oncology Department, Centre François Baclesse, Caen, France.
| | - Villemin Maud
- Medical Oncology Department, Centre François Baclesse, Caen, France.,Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France
| | - Bisiaux Frederique
- Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
| | - Johnson Alison
- Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France
| | - Heidi Solem Laviec
- Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
| | - Rambeau Audrey
- Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France.,Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
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22
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Bujan Rivera J, Kühl R, Zech U, Hendricks A, Luft T, Dreger P, Friedmann-Bette B, Betz TM, Wiskemann J. Impact of Resistance Exercise and Nutritional Endorsement on physical performance in patients with GvHD (IRENE-G study) - design and rational of a randomized controlled trial. BMC Cancer 2022; 22:440. [PMID: 35459108 PMCID: PMC9024288 DOI: 10.1186/s12885-022-09497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GvHD) remains a major complication and limitation to successful allogeneic hematopoietic stem cell transplantation. Treatment of GvHD is challenging due to its heterogeneous nature of presentation, with steroids remaining the established first-line treatment. Long-term doses of systemic corticosteroids have many well-known side-effects including muscle atrophy. Despite the fact that reports in non-cancer clinical populations treated with glucocorticoids demonstrated that resistance training can reverse atrophy and weakness, no RCT has evaluated the potential of resistance training on preventing the disease- and treatment-induced loss of skeletal muscle mass and function in GvHD patients yet. In this context, ensuring adequate nutrition is important as protein deprivation may accelerate the wasting process. As GvHD patients are commonly found to be malnourished, nutritional medical care should be considered when investigating the effect of exercise in GvHD patients. Therefore, the aim of the present "Impact of Resistance Exercise and Nutritional Endorsement on physical performance in patients with GvHD" - Study (IRENE-G) is to evaluate the effects of resistance exercise in combination with nutritional endorsement on physical, nutritional and patient-reported outcomes in GvHD patients. METHODS IRENE-G is a 24-week prospective interventional RCT. One hundred twelve participants will be randomly allocated (1:1) to one of two arms: resistance exercise and nutritional optimization (experimental) vs. nutritional optimization only (control). Participants in the experimental group will engage in a supervised, progressive moderate-to-high intensity resistance training that is consistent with exercise guidelines for cancer patients, while additionally receiving nutritional support/therapy. Subjects of the control group solely receive nutritional support/therapy based on individual needs. Participants will be assessed at baseline, at 8, 16, 24 weeks for physical performance and various physiological, nutritional and patient-reported outcomes. Follow-up will be 6 months after intervention completion. DISCUSSION To our knowledge, this will be the first RCT to assess and compare the effects of a resistance intervention supplemented by nutritional support/therapy against nutritional support only on various health-related outcomes in GvHD patients. The study will contribute to our understanding of the value of exercise and nutritional endorsement in counteracting the negative consequences of GvHD and its treatment. TRIAL REGISTRATION ClinicalTrials.gov : NCT05111834 . Registered 8 November 2021 - Retrospectively registered.
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Affiliation(s)
- Janina Bujan Rivera
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Rea Kühl
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Ulrike Zech
- Department of Internal Medicine I, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anne Hendricks
- Department of Internal Medicine I, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Internal Medicine VII, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Theresa-Maria Betz
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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Pretreatment nutritional status is associated with quality of life in patients with gastric cancer: a cross-sectional study from Iran. Support Care Cancer 2022; 30:3313-3319. [PMID: 34985562 DOI: 10.1007/s00520-021-06792-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In the present study, we evaluated the association of nutritional status and quality of life (QoL) in patients with gastric cancer (GC). MATERIALS AND METHODS In the present cross-sectional study, the study sample consisted of 299 patients with GC. The assessment of the nutritional status and QoL of patients was done after diagnosis and before initiation of any treatment. The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA). The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTCQLQ-C30) was used for the assessment of QoL score. Statistical significance was reported at the p < 0.05 level. RESULTS The mean age of participants was 67.39 ± 12.04 years and 65.5% of them were males. According to the PG-SGA, 28.5% of patients were in good nutritional condition. The patients with better nutrition status had significantly better global and functional categories scores (p < 0.001) except social functioning. Moreover, they had significantly lower scores in symptoms severity except for dyspnea, constipation, and diarrhea. The result of regression analysis indicated that after adjusting to confounders, nutrition status was significantly associated with global score and functional categories score except for social and emotional functioning scores. Moreover, in terms of symptom categories, there was a significant association between PG-SGA score and all symptoms except diarrhea and dyspnea. CONCLUSION The results of the present study showed the significant association between nutrition status and functioning and symptom categories of QoL in patients with GC.
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24
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Velasco RN, Catedral LIG, Chua AV, Hernandez ARB, King REC, Leones LMB, Mondragon KAM, Ting FIL, Callueng JMC, Tampo MMT, Sacdalan DL. The Impact of Malnutrition on the Quality of Life of Colorectal Cancer Patients in a Tertiary Hospital. Nutr Cancer 2022; 74:2937-2945. [DOI: 10.1080/01635581.2022.2044061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rogelio N. Velasco
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Lance Isidore G. Catedral
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Alfredo V. Chua
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Aylmer Rex B. Hernandez
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rich Ericson C. King
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Louis Mervyn B. Leones
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Karen Anjela M. Mondragon
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Frederic Ivan L. Ting
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Miguel C. Callueng
- Department of Radiology, University of the Philippines-Philippine General Hospital, Ermita, Manila, Philippines
| | - Mayou Martin T. Tampo
- Department of Surgery, University of the Philippines-Philippine General Hospital, Ermita, Manila, Philippines
| | - Dennis Lee Sacdalan
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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25
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Löser A, Avanesov M, Thieme A, Gargioni E, Baehr A, Hintelmann K, Tribius S, Krüll A, Petersen C. Nutritional Status Impacts Quality of Life in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy: Results from the Prospective HEADNUT Trial. Nutr Cancer 2022; 74:2887-2895. [PMID: 35209777 DOI: 10.1080/01635581.2022.2042571] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Malnutrition negatively impacts quality of life (QoL) in patients with head and neck cancer (HNC). This is the first prospective study to assess the impact of malnutrition (defined by the bioelectrical impedance analysis (BIA)-derived fat-free mass index) on QoL in patients with HNC undergoing (chemo)radiotherapy. Between October 2018 and October 2020, 58 HNC patients prospectively completed the QoL-questionnaires EORTC-QLQ-C30 and EORTC-QLQ-H&N35 at the beginning (tb) and at the end of (chemo)radiotherapy (te) as well as during follow-up (tf). At these time points, nutritional risk assessment (MUST, NRS-2002, Nutriscore), BIA measurement and laboratory testing was performed by a permanent study team. Differences between malnourished (n = 14) and well-nourished patients (n = 44) were observed in UICC classification (P < 0.001) and HPV status (P = 0.03). Well-nourished patients showed higher baseline hemoglobin (P = 0.025) and albumin (P = 0.005), but lower c-reactive protein levels (P < 0.001). At tb, mostly malnourished patients presented with worse QoL. Multivariable analysis showed that MUST, NRS-2002, HPV status, and UICC classification were related to QoL. Nutritional status has a crucial impact on QoL. The nutritional screening protocols MUST and NRS-2002 are suitable for identifying patients at risk and predicting QoL in patients with HNC undergoing (chemo)radiotherapy.
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Affiliation(s)
- Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, Centre for Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Thieme
- Department of Medicine & Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Elisabetta Gargioni
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Baehr
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany
| | - Katharina Hintelmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany
| | - Silke Tribius
- Asklepios Hospital St. Georg, Hermann Holthusen Institute for Radiation Oncology, Hamburg, Germany
| | - Andreas Krüll
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Siregar A, Chandra DN, Rinaldi I. Correlation of Patient Generated-subjective Global Assessment with Serum C-reactive Protein Level in Stage I–IV Head-and-neck Cancer. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aims to identify the correlation between patient generated-subjective global assessment (PG-SGA) with serum C-reactive protein (CRP) to be used to predict inflammation and prevent cachexia in head-and-neck cancer patients.
METHODS: This was a cross-sectional study using 51 patients with inclusion criteria of patients diagnosed with head-and-neck cancer irrespective of stage, age ≥18 years old, had not received treatments of radiotherapy, chemotherapy, and surgery. The statistical analysis performed was Kolmogorov–Smirnov normality test, bivariate analysis by Spearman test, and linear regression analysis.
RESULTS: As many as 64.7% of the patients had PG-SGA score ≥9 (average PG-SGA score 11.7 ± 6.2). The CRP median value was 6.4 (0.4–170.4) mg/L. There was a statistically significant positive but weak correlation between PG-SGA score with serum CRP (r = 0.372 and p = 0.007) and a significant linear relationship (r2 = 0.201).
CONCLUSIONS: Malnutrition risk assessment using PG-SGA showed a high prevalence of malnutrition risk in head-and-neck cancer patients. PG-SGA score is correlated with serum CRP level. Further studies are needed to confirm the result of this study.
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27
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Lin YC, Wang CH, Ling HH, Pan YP, Chang PH, Chou WC, Chen FP, Yeh KY. Inflammation Status and Body Composition Predict Two-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma under Provision of Recommended Energy Intake during Concurrent Chemoradiotherapy. Biomedicines 2022; 10:biomedicines10020388. [PMID: 35203597 PMCID: PMC8962429 DOI: 10.3390/biomedicines10020388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
Only few prospective cohort trials have evaluated the risk factors for the 2-year mortality rate between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC): oral cavity cancer with adjuvant concurrent chemoradiotherapy (CCRT) (OCC) and non-oral cavity cancer with primary CCRT (NOCC), under the recommended calorie intake and investigated the interplay among calorie supply, nutrition–inflammation biomarkers (NIBs), and total body composition change (TBC), as assessed using dual-energy X-ray absorptiometry (DXA). Patients with LAHNSCC who consumed at least 25 kcal/kg/day during CCRT were prospectively recruited. Clinicopathological variables, blood NIBs, CCRT-related factors, and TBC data before and after treatment were collected. Factor analysis was performed to reduce the number of anthropometric and DXA-derived measurements. Cox proportional hazards models were used for analysis. We enrolled 123 patients with LAHNSCC (69 with OCC and 54 with NOCC). The mean daily calorie intake correlated with the treatment interval changes in total body muscle and fat. Patients consuming ≥30 kcal/kg/day had lower pretreatment levels but exhibited fewer treatment interval changes in anthropometric and DXA measurements than patients consuming <30 kcal/kg/day. In the multivariate analysis of the 2-year mortality rate, the prognostic influence of the recommended calorie intake could not be confirmed, but different risk factors (performance status, pretreatment platelet-to-lymphocyte ratio, and treatment interval body muscle changes in patients with OCC; age, pretreatment neutrophil-to-lymphocyte ratio, and body fat storage in patients with NOCC) showed independent effects. Therefore, the inflammation status and body composition, but not the recommended calorie supply, contribute to the 2-year mortality rate for patients with LAHNSCC receiving CCRT.
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Affiliation(s)
- Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan;
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Cheng-Hsu Wang
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan; (C.-H.W.); (H.H.L.); (P.-H.C.)
| | - Hang Huong Ling
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan; (C.-H.W.); (H.H.L.); (P.-H.C.)
| | - Yi-Ping Pan
- Department of Nutrition, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Pei-Hung Chang
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan; (C.-H.W.); (H.H.L.); (P.-H.C.)
| | - Wen-Chi Chou
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Linkou & Chang Gung University, Taoyuan 333007, Taiwan;
| | - Fang-Ping Chen
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan
| | - Kun-Yun Yeh
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung & Chang Gung University, Taoyuan 333007, Taiwan; (C.-H.W.); (H.H.L.); (P.-H.C.)
- Correspondence: ; Tel.: +886-2-24329292 (ext. 2360); Fax: +886-2-2435342
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28
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Joyaux C, Cherifi F, Khan S, Rambeau A. Évaluation du handgrip préradiochimiothérapie des patients présentant un cancer des voies aérodigestives supérieures. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhang Z, Wan Z, Zhu Y, Wan H. Predictive validity of the GLIM criteria in treatment outcomes in cancer patients with radiotherapy. Clin Nutr 2022; 41:855-861. [DOI: 10.1016/j.clnu.2022.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/17/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022]
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30
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Lin X, Wang B, Zheng F, Fei Z, Chen C. Prognostic Relevance of Change in Body Mass Index in Patients With Nasopharyngeal Carcinoma Undergoing Volumetric Modulated Arc Therapy: A Retrospective Study. Cancer Control 2022; 29:10732748221126935. [PMID: 36075003 PMCID: PMC9468699 DOI: 10.1177/10732748221126935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the effect of pretreatment body mass index (BMI) and the extent of
change in BMI (ΔBMI) during the treatment course on the treatment outcomes
in patients with nasopharyngeal carcinoma (NPC) receiving volumetric
modulated arc therapy (VMAT). Methods Data pertaining to 498 consecutive NPC patients with stage I–IVA disease who
received VMAT between January 2010 and November 2011 at a single center were
retrospectively analyzed. Univariate Kaplan-Meier and multivariate Cox
regression analyses were used to evaluate the prognostic significance of
pretreatment BMI and ΔBMI. Receiver operating characteristic (ROC) curve
analysis was used to determine the optimal cut-off point of ΔBMI. Results The 5-year loco-regional failure-free (L-FFR), distant failure-free survival
(D-FFR), disease-free survival (DFS), and overall survival (OS) rates were
90.6%, 83.7%, 71.5% and 79.3%, respectively. The 5-year L-FFR, D-FFR, DFS,
OS rates for NPC patients with ΔBMI ≤1 kg/m2 vs ΔBMI
>1 kg/m2 were 92.3% vs 89.3% (P = .137),
90.9% vs 78.5% (P < .001), 80.4% vs 65.1%
(P < .001), and 88.0% vs 73.0% (P
< .001), respectively. ΔBMI >1 kg/m2 was an independent
predictor of D-FFR (P = .002), DFS (P =
.002), and OS (P = .001). Conclusions ΔBMI during treatment course may have a significant impact on the prognosis
of NPC patients receiving VMAT.
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Affiliation(s)
- Xiang Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 66552Fujian Cancer Hospital, Fuzhou, China
| | - Bingyi Wang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 66552Fujian Cancer Hospital, Fuzhou, China
| | - Fei Zheng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 66552Fujian Cancer Hospital, Fuzhou, China
| | - Zhaodong Fei
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 66552Fujian Cancer Hospital, Fuzhou, China
| | - Chuanben Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, 66552Fujian Cancer Hospital, Fuzhou, China
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Chitose H, Kuwana M, Miura T, Inoue M, Nagasu Y, Shimizu R, Hattori Y, Uehara Y, Kosugi K, Matsumoto Y. A Japanese Nationwide Survey of Nutritional Counseling for Cancer Patients and Risk Factors of Burnout among Registered Dietitians. Palliat Med Rep 2022; 3:211-219. [PMID: 36876291 PMCID: PMC9983137 DOI: 10.1089/pmr.2022.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Registered dietitians have played a key role in the nutritional management of cancer patients; however, no study has investigated the prevalence of burnout and associated factors among this population. The aim of this study was to investigate the following: (1) experiences, approaches, and perspectives during nutritional counseling, (2) the prevalence of burnout, and (3) burnout-associated factors among registered dietitians. Methods A nationwide survey with self-administered questionnaires was conducted for 1070 registered dietitians belonging to all 390 designated cancer hospitals in Japan. Nutrition counseling, the prevalence of burnout, and burnout-associated factors were analyzed. Results A total of 631 responses were analyzed. Half of the respondents recommended a consultation about treatment of symptoms or listened to their patients' distress and anxiety of death. Respondents with a severe level of burnout for emotional exhaustion, depersonalization, and personal accomplishment (PA) were 21.1%, 2.8%, and 71.9%, respectively. Burnout was associated with fewer years of clinical experience, more overtime hours, higher score of Patient Health Questionnaire-9, higher score of K-6, not so positive attitude about caring for dying patients, the approach of listening to the patients and family distress and anxiety about death, the uneasiness interacting with patients and families without an effective proposal, the difficulty of allocating staff without increasing medical costs, and the absence of feeling of a good contribution to patients and families. Conclusions The prevalence of burnout on PA was quite high. Registered dietitians who engaged in nutritional counseling for cancer patients and families might benefit from education to help protect against burnout.
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Affiliation(s)
- Haruka Chitose
- Nutrition Management Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Miki Kuwana
- Nutrition Management Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mihoko Inoue
- Nutrition Management Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuko Nagasu
- Nutrition Management Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ryogo Shimizu
- Nutrition Management Office, National Cancer Center Hospital East, Kashiwa, Japan.,Nutrition Management Office, Tochigi Medical Cancer, Utsunomiya, Japan
| | - Yukako Hattori
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cancer Therapeutic Center, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
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32
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[12th "Jesús Culebras" Lesson. Feeding and nutrition in patients with head and neck cancer - a permanent challenge]. NUTR HOSP 2021; 39:217-222. [PMID: 34881636 DOI: 10.20960/nh.03963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Head and neck cancer patients are a population at permanent nutritional risk. In addition to the presence of the tumour, the reason for this is the tumour's location, which affects all structures involved in the swallowing process. The side effects of the oncological treatments they must receive during the course of their illness-surgery, chemo-radiotherapy, etc.-only further burden an already precarious nutritional status. For all these reasons, it is essential that, from the diagnosis of their disease, a multidisciplinary team including specialists in dietetics and nutrition supervises them.
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33
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Kok A, van der Lugt C, Leermakers-Vermeer MJ, de Roos NM, Speksnijder CM, de Bree R. Nutritional interventions in patients with head and neck cancer undergoing chemoradiotherapy: Current practice at the Dutch Head and Neck Oncology centres. Eur J Cancer Care (Engl) 2021; 31:e13518. [PMID: 34637563 PMCID: PMC9285387 DOI: 10.1111/ecc.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 05/10/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Objective To assess variations in nutritional interventions during chemoradiotherapy (CRT) among the Dutch Head and Neck Oncology centres (HNOCs). Methods An online questionnaire about nutritional interventions and dietetic practices was sent to 14 oncology dietitians of the HNOCs. Results The response rate was 93%. The number of scheduled dietetic consultations varied from two to seven during CRT. Most centres (77%) reported using a gastrostomy for tube feeding in the majority of patients. Gastrostomies were placed prophylactically upon indication (39%) or in all patients (15%), reactive (15%), or both (31%). For calculating energy requirements, 54% of the dietitians used the Food and Agriculture Organization/World Health Organization and United Nations University (FAO/WHO/UNU) formula and 77% uses 1.2–1.5 g/kg body weight for calculating protein requirements. Almost half of the centres (46%) reported to remove the gastrostomy between 8 and 12 weeks after CR. Most centres (92%) reported to end dietary treatment within 6 months after CRT. Conclusion This study shows substantial variation in dietetic practice, especially in the use of a gastrostomy for tube feeding, between the HNOCs. There is a need for concise dietetic guidelines.
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Affiliation(s)
- Annemieke Kok
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carlijn van der Lugt
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Marja J Leermakers-Vermeer
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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de Oliveira Faria S, Hurwitz G, Kim J, Liberty J, Orchard K, Liu G, Barbera L, Howell D. Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review. J Clin Med 2021; 10:jcm10184162. [PMID: 34575271 PMCID: PMC8470145 DOI: 10.3390/jcm10184162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence: ; Tel.: +55-11-3061-8278
| | - Gillian Hurwitz
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jaemin Kim
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jacqueline Liberty
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Kimberly Orchard
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
- Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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35
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The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology. Nutrients 2021; 13:nu13082493. [PMID: 34444653 PMCID: PMC8399582 DOI: 10.3390/nu13082493] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/31/2022] Open
Abstract
Body composition is a key component for maintaining good general health and longevity. It can be influenced by a variety of factors, including genetics, environment, and lifestyle choices. The assessment of body composition is an essential tool for nutrition specialists to effectively evaluate nutritional status and monitor progression during dietary interventions. As humans age, there is a natural increase in fat mass coupled with a gradual decline in lean mass, specifically in bone and muscle mass. Individuals with a high body fat percentage are at a greater risk of cardiovascular diseases, type 2 diabetes, several types of cancer, and early mortality. Significant decreases in bone mineral density signify osteopenia and osteoporosis, while reductions in skeletal muscle mass increase the risk of developing sarcopenia. Moreover, undernutrition exacerbates the effects of many medical conditions and is important to address. Though weight tracking and calculation of BMI are used commonly by clinicians and dietitians, these measures do not provide insight on the relative contributions of fat mass and fat-free mass or the changes in these compartments that may reflect disease risk. Therefore, it is important that healthcare professionals have a critical understanding of body composition assessment and the strengths and limitations of the methods available.
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36
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Silva NMF, Carvalho IRDA, Lopes LP, Menezes TM, Guandalini VR, Capuzzo RDC. Evolution of Nutritional Status in Patients with Advanced Head and Neck Cancer Undergoing Surgical Treatment or Organ Preservation Protocol. Nutr Cancer 2021; 74:852-859. [PMID: 34080516 DOI: 10.1080/01635581.2021.1931367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We sought to evaluate the evolution of the nutritional status of patients with advanced cancer of the upper aerodigestive tract undergoing surgical treatment (SURG) or organ preservation protocol (OP). Evaluations were conducted at the beginning and end of treatment, including weight, body composition and Patient-Generated Subjective Global Assessment (PG-SGA). Each group was comprised of 29 patients. Initially, malnutrition rates were 65.5% and 51.7% in the SURG and OP groups, respectively. At the end, the values went to 55.1% in SURG and 79.3% in OP. In the OP, there was a reduction in weight (P = 0.001), fat mass (P = 0.006), fat free mass (P = 0.002), and muscle mass (P = 0.005) and an increase in scores of the PG-SGA (P = 0.008). The same was not observed in SURG, except for the weight decrease (P = 0.025). Malnutrition was prevalent in both treatment groups and patients in OP were at greater risk of nutritional decline.
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37
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Miura T, Elgersma R, Okizaki A, Inoue MK, Amano K, Mori M, Chitose H, Matsumoto Y, Jager-Wittenaar H, Ottery FD. A Japanese translation, cultural adaptation, and linguistic and content validity confirmation of the Scored Patient-Generated Subjective Global Assessment. Support Care Cancer 2021; 29:7329-7338. [PMID: 34050400 DOI: 10.1007/s00520-021-06310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The Scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a globally recognized and used nutritional screening, assessment, monitoring, and triaging tool. The aim of this study was to translate and culturally adapt the original English PG-SGA for the Japanese speaking populations and to assess its linguistic validity (i.e., comprehensibility, difficulty) and content validity, as perceived by Japanese patients and healthcare professionals. METHODS In accordance with methodology used in previous Dutch, Thai, German, and Norwegian PG-SGA studies, we followed the ten steps of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Principles of Good Practice for Translation and Cultural Adaptation for Patient-Reported Outcome Measures. The study enrolled 50 patients and 50 healthcare professionals (HCPs) to evaluate the comprehensibility and difficulty of the translated and culturally adapted PG-SGA. The HCPs also evaluated the content validity of the translation. We evaluated each item and quantified scale indices for content validity (item content validity index (I-CVI), scale content validity index (S-CVI)), comprehensibility (item comprehensibility index (I-CI), scale comprehensibility index (S-CI)), and difficulty (item difficulty index (I-DI), scale difficulty index (S-DI)). RESULTS Patients evaluated the comprehensibility and difficulty of the patient component as excellent (S-CI = 0.97, S-DI = 0.96). The professionals rated the Japanese version of both components of the PG-SGA as very relevant (S-CVI = 0.94). The professionals evaluated the comprehensibility of the professional component as being acceptable (S-CI = 0.88) but difficult (S-DI = 0.69), based predominantly on items related to physical examination (I-DI = 0.33-0.67). CONCLUSION The PG-SGA was systematically translated and culturally adapted for the Japanese setting according to the ISPOR process. The Japanese version of the PG-SGA was perceived as comprehensive, easy to use, and relevant. Perceived difficulty in professional components, specifically in the context of metabolic demand and physical examination, will require appropriate training for professionals in order to optimize implementation.
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Affiliation(s)
- Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Rikako Elgersma
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Ayumi Okizaki
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | | | - Koji Amano
- Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Haruka Chitose
- Division of Nutrition, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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38
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Kapała A, Surwiłło-Snarska A, Jodkiewicz M, Kawecki A. Nutritional Care in Patients with Head and Neck Cancer during Chemoradiotherapy (CRT) and Bioradiotherapy (BRT) Provides Better Compliance with the Treatment Plan. Cancers (Basel) 2021; 13:cancers13112532. [PMID: 34064057 PMCID: PMC8196687 DOI: 10.3390/cancers13112532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The nutritional status of patients with head and neck cancer (HNC) during concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy, BRT) inevitably deteriorates during treatment. Malnutrition is responsible for increased treatment-related toxicity, an increased incidence of infectious complications, the risk of postponing or discontinuing therapy, reduced drug doses (platinum derivatives or cetuximab), deteriorating quality of life (QoL), worse outcome, and increased treatment costs. A nutritional care programme, which included prophylactic dietary counselling and early enteral nutrition, reduced the incidence of complications and prevented drug dose reduction and the deterioration of patients’ anthropometric and laboratory parameters. The study confirmed that nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit. Abstract The treatment of locally advanced head and neck cancer (HNC) is based on extensive resections followed by concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy; BRT). Malnutrition, which occurs in up to 60% of patients before treatment commencement, severely increases the risk of CRT/BRT drug dose reductions and the incidence of treatment-related adverse events. A prospective observational study was performed regarding the influence of nutritional care on nutritional status, compliance with the treatment’s planned regimen, and the incidence of treatment-related complications in patients with advanced HNC during CRT and BRT. The study population encompassed 153 patients compared with a retrospective control group of 72 patients treated before nutritional care was included in the standard of oncological care. Patients enrolled in the nutritional care programme received significantly higher doses of platinum derivatives or cetuximab than patients in the control group. A significant difference between the compared populations was observed in patients below 70 years of age (92.8% of the study population), after prior surgery, and with initial weight loss lower than 10%. Nutritional care reduced final weight loss and prevented a decline within the laboratory markers of nutritional status. Weight loss was comparable in both modes of treatment—CRT and BRT. The incidence of treatment-related complications was significantly higher in patients without nutritional support in the subgroups of patients under 70 years of age and after primary surgery. Nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit, defined as preventing down-dosing, weight loss, and the incidence of complications. Platinum derivatives and cetuximab had comparable influence on weight loss.
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Affiliation(s)
- Aleksandra Kapała
- Department of Clinical Nutrition, Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-546-3396
| | - Agnieszka Surwiłło-Snarska
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland; (A.S.-S.); (M.J.)
| | - Magdalena Jodkiewicz
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland; (A.S.-S.); (M.J.)
| | - Andrzej Kawecki
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland;
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COVID-19 in Patients with Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:315-331. [PMID: 33973186 DOI: 10.1007/978-3-030-63761-3_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With more than 5 million cases and 333,212 deaths, COVID-19 (or SARS-CoV-2) continues to spread. General symptoms of this disease are similar to that of many other viral respiratory diseases, including fever, cough, dyspnea, and fatigue, with a chance of progression to more severe complications. However, the virus does not affect all people equally, and cases with comorbidities such as malignancies, cardiovascular diseases, respiratory diseases, and kidney diseases are at higher risk of developing severe events, including requiring intensive ventilation, intensive care unit (ICU) admission, and death. Patients with cancer are more likely to be infected with COVID-19, which is possibly due to their immunological dysfunction or frequent clinic visits. Also, there is a higher chance that these patients experience severe events because of the medication they receive. In this chapter, we will review the main clinical manifestations of COVID-19 in patients with cancer. Recommendations and challenges for managing resources, organizing cancer centers, treatment of COVID-19-infected cancer patients, and performing cancer research during this pandemic will also be discussed.
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40
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Chen Y, Wu X, Wei X, Xu L, Ren X. The effect of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer undergoing radiotherapy and chemotherapy: A protocol for randomized controlled trial. Medicine (Baltimore) 2021; 100:e25342. [PMID: 33879663 PMCID: PMC8078272 DOI: 10.1097/md.0000000000025342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The incidence of malnutrition in patients with esophageal cancer is high, which seriously affects the therapeutic effect and quality of life. Oral nutritional supplement is the first choice of nutritional support recommended by current guidelines, which can supplement the lack of energy and protein in patients with esophageal cancer, improve nutritional status and improve the quality of life, but there are few clinical studies. Therefore, the purpose of this randomized controlled trial is to evaluate the effect of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer treated undergoing radiotherapy and chemotherapy. METHODS This is a prospective randomized controlled trial to study the effects of oral nutritional supplement therapy on nutritional status and quality of life in patients with esophageal cancer undergoing radiotherapy and chemotherapy. This study is approved by the Clinical Research Society of our hospital. Patients will be randomly divided into ONS group and traditional diet group. The nutritional status, quality of life score and adverse reactions will be observed before and after radiotherapy and chemotherapy. The data will be analyzed by SPSS 16.0. DISCUSSION This study will evaluate the effect of oral nutritional supplement therapy on nutritional status and quality of life of patients with esophageal cancer undergoing radiotherapy and chemotherapy. The results of this experiment will establish clinical evidence for the application of oral nutritional supplement therapy in patients with esophageal cancer undergoing radiotherapy and chemotherapy. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/9ZW34.
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Establishment and validation of a prognostic nomogram to predict early metastasis in nasopharyngeal carcinoma patients within six months after radiotherapy and to guide intensive treatment. Radiother Oncol 2021; 162:202-211. [PMID: 33839207 DOI: 10.1016/j.radonc.2021.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to establish an effective prognostic nomogram to predict the risk of early metastasis (EM) in nasopharyngeal carcinoma (NPC) patients, as a guide for intensive treatment. MATERIALS AND METHODS A total of 9021 patients with biopsy-confirmed NPC at our institute were enrolled in this study between December 2006 to December 2016. We randomized these patients using a proportion of 2/3 and 1/3 and selected 6044 and 2977 patients as the training and validation cohorts, respectively. All patients received radiotherapy with or without chemotherapy. Univariate and multivariate logistical regressions were used to identify independent risk factors. The nomogram's predictive value was evaluated by concordance indexes (C-indexes), calibration curves, probability density functions (PDFs), and clinical utility curves (CUCs). ROC analysis using Delong test was used to compare efficiency between the nomogram and other risk factors. RESULTS In total, 174 (2.9%) and 81 (2.7%) patients in training and validation cohorts, respectively, had EM. Pretreatment plasma EBV DNA, N stage, LDH, ALP, BMI, and sex were independent predictive factors of EM. The C-indexes of nomogram were 0.756 (95% CI = 0.719-0.793) and 0.766 (95% CI = 0.720-0.813), in the training and validation cohorts, respectively. The C-index of the nomogram was significantly superior to any one of independent factors. According to the PDFs and CUCs and considering the balance of the true positive EM patients and true positive non-EM patients, we chose 5.0% as a threshold probability for clinical decision-making, which could distinguish about 85% and 48% of non-EM and EM patients, respectively. CONCLUSION Our nomogram had good accuracy in predicting EM incidence, and a 5.0% threshold was appropriate for clinical decision-making.
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Keaver L, O'Callaghan N, O'Sullivan A, Quinn L, Loftus A, McHugh CM. Female cancer survivors are more likely to be at high risk of malnutrition and meet the threshold for clinical importance for a number of quality of life subscales. J Hum Nutr Diet 2021; 34:868-880. [PMID: 33761159 DOI: 10.1111/jhn.12877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study aimed to explore malnutrition risk, handgrip strength and quality of life (QOL) in cancer survivors. METHODS In total, 232 individuals completed a demographic questionnaire, Patient-Generated Subjective Global Assessment Short Form and the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30). Handgrip strength was determined using a spring-loaded handgrip dynamometer and anthropometric measurements were taken by an oncology nurse. Frequencies and distribution data, analysis of variance and chi-squared tests were then conducted. RESULTS The majority of the cohort were female (n = 141; 60.8%) had breast cancer (n = 62; 26.7%) and the mean ± SD body mass index (BMI) was 26.6 ± 6.2 kg m-2 . Less than a one-third reported seeing a dietitian (n = 68; 29.3%). Over one-third reported recent weight loss (n = 88; 37.3%). Some 40.9% (n = 95) were at moderate to high risk of malnutrition, with women more likely than men to be classified as high risk (p < 0.05). Mean ± SD handgrip strength was 25 ± 15 kg and this differed significantly by gender (p = 0.00), cancer type (p = 0.01) and BMI classification (p = 0.01). One-fifth of individuals were classified as having dynapenia (n = 48; 21.1%). Median (interquartile range) QOL score was 66.7 (33.3). The proportion of individuals meeting the threshold for clinical importance for QOL subscales ranged from 12.5% (constipation) to 42.7% (physical functioning). Females were more likely than males to meet the threshold for physical functioning (p = 0.00), fatigue (p = 0.02) and pain (p = 0.01). CONCLUSIONS Females are more likely than males to be at high risk of malnutrition and meet the threshold for clinical significance for several QOL subscales.
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Affiliation(s)
- Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, Ireland
| | - Niamh O'Callaghan
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, Ireland
| | - Aoibheann O'Sullivan
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, Ireland
| | - Laoise Quinn
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, Ireland
| | - Amy Loftus
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, Ireland
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Rios TC, de Oliveira LPM, da Costa MLV, da Silva Baqueiro Boulhosa RS, Roriz AKC, Ramos LB, Bueno AA. A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients. Health Qual Life Outcomes 2021; 19:90. [PMID: 33731093 PMCID: PMC7968230 DOI: 10.1186/s12955-021-01735-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/08/2021] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients. METHOD 432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann-Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL. RESULTS 37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (βo = - 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship. CONCLUSION Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.
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Affiliation(s)
| | | | | | | | - Anna Karla Carneiro Roriz
- Department of Nutrition Sciences, School of Nutrition, Federal University of Bahia, Salvador, Bahia, 40110-150, Brazil
| | - Lilian Barbosa Ramos
- Department of Nutrition Sciences, School of Nutrition, Federal University of Bahia, Salvador, Bahia, 40110-150, Brazil
| | - Allain Amador Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester, UK
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Duan YY, Deng J, Su DF, Li WQ, Han Y, Li ZX, Huan XZ, Zhu SH, Yang QL, Hu W, Xin MZ, Tang LQ, Mai HQ, Fan YY, He Y. Construction of a comprehensive nutritional index and comparison of its prognostic performance with the PNI and NRI for survival in older patients with nasopharyngeal carcinoma: a retrospective study. Support Care Cancer 2021; 29:5371-5381. [PMID: 33686519 DOI: 10.1007/s00520-021-06128-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the relationship between the Comprehensive Nutritional Index (CNI) and survival in older patients with nasopharyngeal carcinoma (NPC) and to compare the prognostic performance of three nutritional indicators (CNI, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)) for overall survival (OS). METHODS This retrospective study involved 309 older NPC patients in Guangzhou (China) from November 2006 to November 2017. The CNI comprised five parameters: the body mass index (BMI), usual body weight percentage (UBW%), hemoglobin (Hb) level, albumin level, and total lymphocyte count (TLC). All single nutritional indicators were evaluated before and immediately after treatment. The principal component analysis (PCA) was used for calculation of the CNI by single nutritional indicators after treatment. The cutoff point for the CNI was evaluated and logistic regression used to explore the risk factors for the CNI. Univariable, multivariable Cox regression, and Kaplan-Meier methods were applied for OS and disease-free survival (DFS) analyses. Cox proportional hazards models were used to compare the prognostic value of the CNI, PNI, and NRI for OS. RESULTS All single nutritional indicators decreased significantly after treatment (P < 0.05). The CNI cutoff point for mortality was 0.027, and the logistic regression indicated more complex treatments or higher cancer stage for NPC was associated with a low CNI (HR = 0.179; 95% CI: 0.037-0.856; 0.545, 0.367-0.811, respectively). In multivariable Cox regression, the CNI remained an independent prognostic factor of OS and DFS (HR = 0.468, 95% CI: 0.263-0.832; 0.527, 0.284-0.977, respectively). Kaplan-Meier curves showed that a low CNI was associated with worse OS and DFS (P = 0.001 and 0.013, respectively). The prognostic predictive performance of the CNI was superior to that of the PNI or NRI. CONCLUSIONS The CNI can be recommended as an appropriate indicator reflecting the integrated nutritional status of older NPC patients. A low CNI predicted a poor survival outcome and the prognostic performance of CNI was superior to PNI or NRI.
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Affiliation(s)
- Yu-Yu Duan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Neurosurgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, China
| | - Jun Deng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, China
| | - Dong-Fang Su
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Clinical Nutrition, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wen-Qiong Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Yuan Han
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen-Xiu Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Xue-Zhen Huan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Shi-Heng Zhu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Qiu-Lan Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wen Hu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Ming-Zhu Xin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Yu-Ying Fan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China.
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
| | - Yan He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China.
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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Hazzard E, Walton K, McMahon AT, Milosavljevic M, Tapsell L. Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study. J Interprof Care 2021; 35:813-820. [PMID: 33587011 DOI: 10.1080/13561820.2020.1865290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.
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Affiliation(s)
- Emily Hazzard
- Department of Nutrition and Dietetics, The Wollongong Hospital Illawarra Shoalhaven Local Health District, NSW, Australia.b School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW,
| | - Karen Walton
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia, .
| | - Anne-Therese McMahon
- Clinical Associate Professor, The Wollongong Hospital, School of Health and Society, University of Wollongong, Northfields Ave, Wollongong NSW, Australia
| | - Marianna Milosavljevic
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Linda Tapsell
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia,g School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW,
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Zheng Z, Zhao X, Zhao Q, Zhang Y, Liu S, Liu Z, Meng L, Xin Y, Jiang X. The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy. Front Oncol 2021; 10:595632. [PMID: 33598427 PMCID: PMC7882690 DOI: 10.3389/fonc.2020.595632] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
Radiation-induced oral mucositis (RIOM) is a common side effect after radiotherapy (RT) in head and neck cancer (HNC) patients. RIOM patients with severe pain have difficulty in eating, which increases the incidence of malnutrition and affects patients' quality of life and the process of RT. The mechanism of RIOM is not fully understood, and inflammatory response and oxidative stress appear to be important for RIOM occurrence and development. The nutritional status of patients is very important for their RT tolerance and recovery. Malnutrition, which can lead to anemia, low protein, decreased immunity and other problems, is an important clinical factor affecting tumor progression and treatment. Recent studies have shown that early nutritional intervention can ameliorate oral mucositis and nutritional status of patients with HNC. However, in clinical practice, early nutritional intervention for patients with HNC is not a conventional intervention strategy. Therefore, this review summarized the possible pathogenesis of RIOM, commonly used assessment tools for malnutrition in patients, and recent studies on the effects of early nutritional interventions on RIOM and nutritional status of patients with HNC. We hope to provide the basis and reference for the clinical application of early nutritional intervention models.
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Affiliation(s)
- Zhuangzhuang Zheng
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Xin Zhao
- Department of Orthopedic, The Second Hospital of Jilin University, Changchun, China
| | - Qin Zhao
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Yuyu Zhang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Shiyu Liu
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Zijing Liu
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
| | - Lingbin Meng
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Ying Xin
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, China
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Radiation Oncology & Therapy, The First Hospital of Jilin University, Changchun, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun, China
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Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status. Nutrients 2020; 13:nu13010057. [PMID: 33375430 PMCID: PMC7823874 DOI: 10.3390/nu13010057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.
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Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment. Nutrients 2020; 12:nu12113493. [PMID: 33203000 PMCID: PMC7697929 DOI: 10.3390/nu12113493] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
Malnutrition is highly prevalent in people with head and neck cancer (HCN) and is associated with poorer outcomes. However, variation in malnutrition diagnostic criteria has made translation of the most effective interventions into practice challenging. This study aimed to determine the prevalence of malnutrition in a HNC population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and assess inter-rater reliability and predictive validity. A secondary analysis of data available for 188 patients with HNC extracted from two cancer malnutrition point prevalence studies was conducted. A GLIM diagnosis of malnutrition was assigned when one phenotypic and one etiologic criterion were present. Phenotypic criteria were ≥5% unintentional loss of body weight, body mass index (BMI), and subjective evidence of muscle loss. Etiologic criteria were reduced food intake, and presence of metastatic disease as a proxy for inflammation. The prevalence of malnutrition was 22.6% (8.0% moderately malnourished; 13.3% severely malnourished). Inter-rater reliability was classified as excellent for the GLIM criteria overall, as well as for each individual criterion. A GLIM diagnosis of malnutrition was found to be significantly associated with BMI but was not predictive of 30 day hospital readmission. Further large, prospective cohort studies are required in this patient population to further validate the GLIM criteria.
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Endo K, Ueno T, Hirai N, Komori T, Nakanishi Y, Kondo S, Wakisaka N, Yoshizaki T. Low Skeletal Muscle Mass Is a Risk Factor for Aspiration Pneumonia During Chemoradiotherapy. Laryngoscope 2020; 131:E1524-E1529. [PMID: 33030229 DOI: 10.1002/lary.29165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to investigate whether pretreatment skeletal muscle mass index (SMI) is a predictor for the risk of aspiration pneumonia and to explore the relationship between low SMI and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC) receiving chemoradiotherapy (CRT). METHODS We retrospectively reviewed the data of patients with HNSCC who received CRT during 2010-2019. Patients received a combination of radiotherapy and cisplatin-based chemotherapy (3 cycles of 80 mg/m2 cisplatin on days 1, 22, and 43). Aspiration pneumonia were defined as the presence of both subjective and objective symptoms. Kaplan-Meier curves were generated to analyze survival. RESULTS Among the 159 patients, 36 (22.6%) developed aspiration pneumonia during treatment. Median SMI in patients with and without pneumonia was 12.4 cm2 /m2 (9.0-20.7) and 13.6 cm2 /m2 (8.1-19.7), respectively (P < .01). Multivariate logistic regression revealed that SMI was the only independent predictor of aspiration pneumonia (P = .0026). Mean OS was significantly shorter for patients with low SMI than for patients with normal SMI (66.9 months vs. 92.7 months, P = .001). CONCLUSION Pretreatment low SMI predicts development of aspiration pneumonia and is a strong negative prognostic predictor for OS in patients with HNSCC undergoing CRT. Supportive treatment can be provided to patients at high risk of a low SMI. This study is the first to report SMI as a prognostic predictor in HNSCC. Laryngoscope, 131:E1524-E1529, 2021.
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Affiliation(s)
- Kazuhira Endo
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Takayoshi Ueno
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Nobuyuki Hirai
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Takeshi Komori
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Yosuke Nakanishi
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Satoru Kondo
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Naohiro Wakisaka
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan
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Barker T, Fulde G, Moulton B, Nadauld LD, Rhodes T. An elevated neutrophil-to-lymphocyte ratio associates with weight loss and cachexia in cancer. Sci Rep 2020; 10:7535. [PMID: 32371869 PMCID: PMC7200806 DOI: 10.1038/s41598-020-64282-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Systemic inflammation is present during and serves as a diagnostic tool for cancer-associated cachexia and is detrimental to serum 25-hydroxyvitamin D (25(OH)D) concentrations in non-cancer conditions. The neutrophil-to-lymphocyte ratio (NLR) is a desirable measure of systemic inflammation because it is easily calculated from a routine complete blood cell count with differentials. We sought to determine if an elevation in the NLR associates with greater weight loss, cachexia, and lower serum 25-hydroxyvitamin D (25(OH)D) concentrations in patients with advanced cancer. Advanced colon, lung, and prostate cancer patients (stages III/IV; n = 50) were retrospectively studied and separated into one of two groups: 1) Above (n = 25) or 2) Below (n = 25) the median NLR of 3.15 determined at diagnosis. Around the time of diagnosis, serum 25(OH)D and body weight were assessed, while body weight was assessed again at a later date. Weight loss and cachexia were significantly (both p < 0.05) greater and there was a trend (p < 0.10) for lower serum 25(OH)D concentrations in the Above group. We conclude that an elevation in the NLR associates with greater weight loss and cachexia, and potentially, a lower serum 25(OH)D concentration in patients with advanced colon, lung, or prostate cancer.
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Affiliation(s)
- Tyler Barker
- Precision Genomics, Intermountain Healthcare, St. George, UT 84790, USA. .,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA.
| | - Gail Fulde
- Precision Genomics, Intermountain Healthcare, St. George, UT 84790, USA
| | - Bryce Moulton
- Precision Genomics, Intermountain Healthcare, St. George, UT 84790, USA
| | - Lincoln D Nadauld
- Precision Genomics, Intermountain Healthcare, St. George, UT 84790, USA.,School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Terence Rhodes
- Precision Genomics, Intermountain Healthcare, St. George, UT 84790, USA
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