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Culié D, Schiappa R, Pace-Loscos T, Guelfucci B, Vergez S, Garrel R, Fakhry N, Dassonville O, Poissonnet G, Lallemant B, Sudaka A, Saada-Bouzid E, Benezery K, Temam S, Gorphe P, Chamorey E, Bozec A. Enteral Nutrition during Radiotherapy for Oropharyngeal Cancers: Prevalence and Prognostic Factors Based on HPV Status (A GETTEC Study). J Clin Med 2023; 12:jcm12093169. [PMID: 37176609 PMCID: PMC10179627 DOI: 10.3390/jcm12093169] [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: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic factors during definitive radiotherapy for OPSCC. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. The impact of tumor p16 status on the risk of RFT was assessed through multivariate analyses. Among the 543 patients, 103 patients required an RFT (19.0%). The use of RFT differed between centers (5% to 32.4%). In multivariate analysis, only tongue base involvement and concurrent chemotherapy were significantly associated with RFT (OR = 2.18 and 3.7, respectively). Tongue base involvement and concomitant chemotherapy were prognostic factors for RFT. HPV status was not a prognostic factor for enteral nutrition during radiotherapy for OPSCC.
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Affiliation(s)
- Dorian Culié
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Renaud Schiappa
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Tanguy Pace-Loscos
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, 83100 Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, 31100 Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, 34295 Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance-Hospitals of Marseille, 13005 Marseille, France
| | - Olivier Dassonville
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Gilles Poissonnet
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, 30900 Nîmes, France
| | - Anne Sudaka
- Antoine Lacassagne Centre, Department of Pathology, Côte d'Azur University, 06000 Nice, France
| | - Esma Saada-Bouzid
- Antoine Lacassagne Centre, Department of Medical Oncology, Côte d'Azur University, 06000 Nice, France
| | - Karen Benezery
- Antoine Lacassagne Centre, Department of Radiotherapy, Côte d'Azur University, 06000 Nice, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Emmanuel Chamorey
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Alexandre Bozec
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
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Yanni A, Dequanter D, Lechien JR, Loeb I, Rodriguez A, Javadian R, Van Gossum M. Malnutrition in head and neck cancer patients: Impacts and indications of a prophylactic percutaneous endoscopic gastrostomy. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:S27-S33. [PMID: 30846293 DOI: 10.1016/j.anorl.2019.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/12/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Head and neck cancer (HNC) patients often experience malnutrition before and during treatment. Prophylactic gastrostomy has emerged as an efficient tool for ensuring adequate nutrition. However, there is no suitable algorithm able to identify patients at high risk of malnutrition. The aim of this study was to describe the nutritional management, to assess the impact of prophylactic gastrostomy, and to identify predictors of malnutrition. METHODS This retrospective study included 152 patients treated with surgery, radiotherapy, or chemotherapy for HNC. The patients were classified according to their gastrostomy status (prophylactic or non-prophylactic). Nutritional, tumoral and treatment characteristics were reported. Clinical and nutritional outcomes were measured 6 weeks after the beginning of treatment. In order to describe the nutritional management and the impact of prophylactic gastrostomy on patients, univariate analysis was generated using chi-square test and Mann-Whitney test or Student's t-test. Logistic regression was performed to identify factors associated with malnutrition. RESULTS Forty-one patients received prophylactic gastrostomy whereas 111 patients had no nutritional support. Prophylactic gastrostomy placement was associated with a lower initial body mass index, with severe malnutrition, and with initial oral intake disorder. Patients who did not experienced prophylactic gastrostomy had much worse outcomes such as hospital readmissions (P=0.042), relative weight loss at 6 weeks (P<0.0001), dysphagia, severe malnutrition, and poor state of health (P=0.001). Our complication rates (4.9%) were lower than the usual range (5.9-9.3%) and no life-threatening complication was reported. Positive N status, oral intake disorder, concomitant radiochemotherapy, nasopharyngeal, and hypopharyngeal tumor site were significant predictive factors for malnutrition. CONCLUSIONS Prophylactic percutaneous endoscopic gastrostomy showed advantages in terms of hospital readmissions, relative weight loss at 6 weeks, dysphagia, severe malnutrition, and poor state of health. Tumoral, nutritional and treatment characteristics seem to be predictors for malnutrition. Hence, physicians should integrate these factors in their nutrition algorithm approach.
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Affiliation(s)
- A Yanni
- Department of Stomatology and maxillofacial surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
| | - D Dequanter
- Department of Stomatology and maxillofacial surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
| | - J R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium; Laboratory of Anatomy and Cell Biology, Department of Anatomy and Experimental Oncology, Faculty of Medicine, Mons School of Medicine, University of Mons (UMons), UMONS Research Institute for Health Sciences and Technology, Avenue du Champ-de-Mars, 6, 7000 Mons, Belgium.
| | - I Loeb
- Department of Stomatology and maxillofacial surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
| | - A Rodriguez
- Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
| | - R Javadian
- Department of Stomatology and maxillofacial surgery, School of Medicine, Université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
| | - M Van Gossum
- Department of gastroenterology, School of Medicine, université Libre de Bruxelles, CHU Saint-Pierre, Brussels, Belgium
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NUTRISCORE: A new nutritional screening tool for oncological outpatients. Nutrition 2016; 33:297-303. [PMID: 27751743 DOI: 10.1016/j.nut.2016.07.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to design a new nutritional screening tool (NUTRISCORE) to detect nutritional risk in outpatients with cancer. METHODS A multicenter, cross-sectional study was conducted. We randomly selected outpatients receiving onco-specific, palliative, or symptomatic treatment for malignant neoplasms (including solid tumors and hematologic malignancies). These patients were assessed using the NUTRISCORE tool, the Malnutrition Screening Tool (MST), and the Patient-Generated Subjective Global Assessment (PG-SGA) to detect risk for malnutrition. The new tool included questions regarding the cancer site and active treatment. Sensitivity, specificity, and positive and negative predictive values were calculated for NUTRISCORE and MST using the PG-SGA as a reference method. RESULTS We evaluated 394 patients. According to NUTRISCORE, 22.6% were at risk for malnutrition. The MST detected a risk in 28.2%, and the PG-SGA found that 19% were malnourished or at nutritional risk. Using the PG-SGA as a reference method, the MST had a sensitivity of 84% and a specificity of 85.6%, whereas NUTRISCORE exceeded these values, at 97.3% sensitivity and 95.9% specificity. The better performance of NUTRISCORE as compared with MST was confirmed by the receiver operating characteristic curve analysis, with area under the curve values of 0.95 (95% confidence interval, 0.92-0.98) for NUTRISCORE and 0.84 (95% confidence interval, 0.79-0.89) for the MST. CONCLUSIONS NUTRISCORE has been found to be a novel, fast, and valid nutritional screening tool for outpatients with cancer. Its simplicity and high level of accuracy in detecting nutritional risk facilitates its applicability.
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Fonseca J, Santos CA, Brito J. Malnutrition and Clinical Outcome of 234 Head and Neck Cancer Patients who Underwent Percutaneous Endoscopic Gastrostomy. Nutr Cancer 2016; 68:589-97. [PMID: 27144413 DOI: 10.1080/01635581.2016.1158297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Head and neck cancer (HNC) patients who underwent percutaneous endoscopic gastrostomy (PEG) present malnutrition risk and speech impairments. Their assessment relies on objective anthropometric/laboratory data. Focusing on HNC PEG patients, our aims were to evaluate: 1) outcome; 2) nutritional status when the patients underwent PEG; and 3) association of nutritional status/outcome, creating a survival predictive model. We evaluated the outcome based on NRS 2002, dietary assessment, body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), albumin, transferrin, and cholesterol on the day of gastrostomy. Using BMI, TSF, MAMC, and laboratory data, a survival predictive model was created. Of the 234 patients (cancer stages III-IV), 149 died, 33 were still PEG-fed, and 36 resumed oral intake (NRS-2002≥3, caloric needs <50% in all). BMI was 12.7-43. 189, 197, and 168 patients displayed, respectively, low MUAC, TSF, and MAMC. 91, 155, and 119 patients displayed low albumin, transferrin, and cholesterol. Albumin, cholesterol, and transferrin were strongly associated with the outcome. A predictive model was created, discriminating between short-term survivors (<4 months) and long-term survivors. HNC patients were malnourished. Using anthropometric/laboratory parameters, a predictive model provides discrimination between patients surviving PEG for <4 months and long-term survivors. Teams taking care of PEG patients may provide special support to potential short-term survivors.
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Affiliation(s)
- Jorge Fonseca
- a GENE - Hospital Garcia de Orta , Almada , Portugal.,b CiiEM - Center for Interdisciplinary Research Egas Moniz , Monte de Caparica , Portugal
| | | | - José Brito
- b CiiEM - Center for Interdisciplinary Research Egas Moniz , Monte de Caparica , Portugal
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Kouhen F, Afif M, Benhmidou N, El Majjaoui S, Elkacemi H, Kebdani T, Benjaafar N. [What nutritional management in patients with head and neck cancers undergoing radiotherapy? An overview]. Bull Cancer 2015; 102:874-9. [PMID: 26384695 DOI: 10.1016/j.bulcan.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/04/2015] [Accepted: 07/22/2015] [Indexed: 11/24/2022]
Abstract
Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects, which lead to malnutrition. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival hence the importance of early nutritional management prior to radiotherapy. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy tubes. The goal of this overview is to search the predictive factors of malnutrition and an overview of the different types of nutritional interventions and their impact on the local control of the disease, mortality and quality of life of patients treated with radiotherapy or concomitant chemoradiotherapy.
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Affiliation(s)
- Fadila Kouhen
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc.
| | - Mohammed Afif
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Naoual Benhmidou
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Sanaa El Majjaoui
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Hanan Elkacemi
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Tayeb Kebdani
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
| | - Noureddine Benjaafar
- Université Mohammed 5 Souissi, Institut national d'oncologie, service de radiothérapie, Rabat, Maroc
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Thureau S, Lefebvre L, Dandoy S, Guérault F, Ebran M, Lebreton M, Veresezan O, Rigal O, Clatot F. [Nutritional management of patients with head and neck cancer treated with radiation]. Cancer Radiother 2015; 19:552-5. [PMID: 26321684 DOI: 10.1016/j.canrad.2015.07.153] [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: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Abstract
Radiotherapy and chemotherapy are standard treatment of head and neck cancer alone or associated to surgical treatment. Early (during treatment or the following weeks) and late side effects contribute to malnutrition in this population at risk. In this context, nutritional support adapted by dietary monitoring and enteral nutrition (nasogastric tube or gastrostomy) are often necessary. The early identification of the patients with high malnutrition risk and requiring enteral nutrition is necessary to improve the tolerance and efficacy of treatment.
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Affiliation(s)
- S Thureau
- Quantif-Litis EA 4108, département de radiothérapie et de physique médicale, département de médecine nucléaire, centre Henri-Becquerel, 76038 Rouen, France.
| | - L Lefebvre
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - S Dandoy
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - F Guérault
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - M Ebran
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - M Lebreton
- Service de soins de support, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - O Veresezan
- Quantif-Litis EA 4108, département de radiothérapie et de physique médicale, département de médecine nucléaire, centre Henri-Becquerel, 76038 Rouen, France
| | - O Rigal
- Service de soins de support, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - F Clatot
- Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
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