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Yildizel S, Arayici ME, Umay C, Sahin S. Hope, coping strategies, and their predictors in older patients with prostate and breast cancer undergoing radiotherapy: A cross-sectional study. J Med Imaging Radiat Oncol 2024; 68:481-488. [PMID: 38576403 DOI: 10.1111/1754-9485.13645] [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: 11/12/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION The aim of this paper was to evaluate the level of hope, coping methods, and the factors affecting them in patients aged 60 years and over who were diagnosed with breast and prostate cancer and who were receiving radiotherapy (RT) as part of their treatment. METHODS A total of 66 patients (37 breast cancer and 29 prostate cancer patients) were included in this cross-sectional study. The RT and treatment information of the patients were collected by using the records in the hospital database. The scale responses, baseline characteristics, and demographic information of the participants were collected through the questionnaire form and scales [HHI (Heart Hope Index), COPE (Coping Attitudes Assessment Scale), and VAS (Visual Analogue Scale)]. Two surveys were administered to the participants before and after radiotherapy treatment. A first survey was administered to the participants 10-15 days before radiotherapy treatment, and the second survey was administered within 2-3 weeks after radiotherapy treatment. The weight and waist circumference of the patients were also measured before and after radiotherapy. RESULTS The median age of the participants was 65 (interquartile range (IQR): 62.0-70.2) years. There was a decrease in the weight (mean change (MC): -1.5, 95% CI: -2.9 to -0.2, P = 0.029) and waist circumference (MC: -1.8, 95% CI: -3.2 to -0.4, P = 0.014) of the participants after RT. There was no significant change in the HHI (MC: 0.4, 95% CI: -0.7 to 1.5) and COPE (MC: -0.6, 95% CI: -3.2 to 2.0) total scores of the patients before and after RT (P = 0.459 and P = 0.650, respectively). When only patients with prostate cancer were studied, the self-help sub-dimension of COPE (MC: -1.5, 95% CI: -2.7 to -0.3, P = 0.013) was found to be lower. CONCLUSION Multidimensional evaluations and interventions may be required in terms of hope levels and coping attitudes of cancer patients receiving radiotherapy. There is an increasing need for further studies in larger populations and cohorts related to this topic in the literature.
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Affiliation(s)
- Sema Yildizel
- Division of Geriatrics, Department of Internal Medicine, Institute of Health Sciences, Ege University, Bornova, Izmir, Turkey
| | - Mehmet Emin Arayici
- Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Inciralti, Izmir, Turkey
| | - Cenk Umay
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Inciralti, Izmir, Turkey
| | - Sevnaz Sahin
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
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Blake C, Lai R, Brown T, Pelecanos A, Moroney L, Helios J, Smith D, Hughes BGM, Kenny L, Chua B, Bauer J. Nutrition outcomes and treatment toxicities in patients with head and neck cancer receiving helical intensity-modulated radiotherapy. J Hum Nutr Diet 2024; 37:182-192. [PMID: 37737485 DOI: 10.1111/jhn.13243] [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: 02/05/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Helical intensity-modulated radiotherapy (H-IMRT) provides excellent limitation of dose to tissues not requiring treatment, although acute toxicity still occurs. The present study aimed to determine how treatment-related acute toxicities affect nutrition outcomes in patients with head and neck cancer. METHODS A prospective observational study was conducted in 194 patients undergoing curative intent H-IMRT with or without other treatment modalities. Weight outcomes (kg) and acute toxicity and dysphagia data were collected during treatment using Common Toxicity Criteria for Adverse Effects (CTCAE), version 4.0. RESULTS Significant weight loss (> 10%) was observed in 30% of high nutritional risk patients and 7% of low nutritional risk patients. Nausea, adjusted for baseline dysphagia, in high nutritional risk patients and nausea, dysphagia and pharyngeal mucositis in low nutritional risk patients were significant factors in explaining the percentage loss in baseline weight to treatment completion. CONCLUSIONS Significant weight loss remains an issue during treatment, despite improvements in radiotherapy technology and high-level multidisciplinary care.
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Affiliation(s)
- Claire Blake
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Rainbow Lai
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Teresa Brown
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Laura Moroney
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sci, Brisbane, QLD, Australia
| | - Jennifer Helios
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - David Smith
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Brett G M Hughes
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Lizbeth Kenny
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Benjamin Chua
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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Rachi T, Ariji T, Takahashi S. Development of programs to predict the occurrence of mucositis from digital imaging and communications in medicine data by machine learning in head and neck volumetric modulated radiotherapy. J Appl Clin Med Phys 2023; 24:e14125. [PMID: 37602786 PMCID: PMC10691621 DOI: 10.1002/acm2.14125] [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: 08/15/2022] [Revised: 01/10/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Volumetric modulated arc therapy (VMAT) with cisplatin for head and neck cancer is often accompanied by symptoms of pharyngeal and oral mucositis. However, no standard medical program exists for the prevention and treatment of mucositis, and the mechanisms of mucositis have not yet been fully proven. Therefore, adaptive radiotherapy (ART), which is a re-planning process, is administered when severe mucositis develops during the treatment period. We extracted the treatment plans of patients who developed severe mucositis from DICOM data and used machine learning to determine its quantitative features. This study aimed to develop a machine learning program that can predict the development of mucositis requiring ART. This study included 61 patients who received concurrent chemotherapy and radiotherapy (RT). For each patient, the equivalent square field size of each segmental irradiation field used for VMAT, dose per segment (Gy), clinical target volume high, and mean dose of the oral cavity (Gy) were calculated. Furthermore, 671 five-dimensional lists were generated from the acquired data. Support vector machine (SVM) and K-nearest neighbor (KNN) were used for machine learning. For the accuracy score, the test size was varied from 10% to 90%, and the random number of data extracted in each test size was further varied from 1 to 100 to calculate a mean accuracy score. The mean accuracy scores of SVM and KNN were 0.981 ± 0.020 and 0.972 ± 0.033, respectively. The presence or absence of ART for mucositis was classified with high accuracy. The classification of the five-dimensional list was implemented with high accuracy, and a program was constructed to predict the onset of mucositis requiring ART before treatment began. This study suggests that it may support preventive measures against mucositis and the completion of RT without having to re-plan.
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Affiliation(s)
- Toshiya Rachi
- Department of Radiological TechnologyNational Cancer Center Hospital EastKashiwaJapan
| | - Takaki Ariji
- Department of Radiological TechnologyNational Cancer Center Hospital EastKashiwaJapan
| | - Shinichi Takahashi
- Department of Radiological TechnologyNational Cancer Center Hospital EastKashiwaJapan
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Lønbro S, Gam S, Hermann AP, Hansen CR, Johansen J. Accelerated loss of lean body mass in head and neck cancer patients during cisplatin-based chemoradiation. Acta Oncol 2023; 62:1403-1411. [PMID: 37589161 DOI: 10.1080/0284186x.2023.2245558] [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: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND This study investigated changes in body weight, lean body mass (LBM), fat mass (FM), muscle strength and functional performance during radiation treatment in head and neck cancer (HNSCC) patients. Secondly, it investigated the impact of cisplatin-based chemoradiation (CCRT) on LBM loss compared with radiation alone. METHODS 48 patients (all tumor sites) received either 6 weeks of radiation alone (n = 16) with 66-68 Gy in 33-34 Fx, 5-6 Fx/week or CCRT, adding weekly cisplatin or carboplatin (n = 32). LBM and FM was evaluated using Dual-energy X-ray Absorptiometry bi-weekly from pre- to two weeks post-treatment. Maximal muscle strength (knee extension, leg - and chest press) and functional performance (stair climb, chair rise, and arm curl) were assessed pre- and post-treatment. RESULTS Body weight and LBM had declined significantly already week 2 into treatment and declined significantly further through week 4 and 6 before leveling off after week 6. Bi-weekly, from treatment start to week 2, 2-4, and 4-6, LBM declined 1.2 ± 0.4 kg (p = .002; 95% CI: 0.4;2.0), 2.0 ± 0.4 kg (p < .0001; 1.2;2.8) and 1.4 ± 0.4 kg (p = .001; 0.6;2.2). With a two-week delay, FM declined significantly from week 2-8. All measures of muscle strength declined significantly from pre- to post-treatment. Functional performance was unchanged. LBM loss from pre- to post-treatment was significantly associated with impaired muscle strength (R2 = 0.3-0.5). CCRT patients lost 3.1 ± 0.8 kg of LBM (p = .0001; 1.5;4.7) more from pre- to post-treatment compared with patients receiving radiation alone. Analyses adjusting for nimorazole, tumor stage, baseline BMI, mean radiation dose to constrictor muscles and oral cavity confirmed this. CONCLUSION Accelerated and substantial LBM loss was already initiated within the first two weeks of treatment - before the onset of radiation-induced mucositis. LBM loss was associated with muscle strength impairment. Patients receiving CCRT experienced significantly larger LBM loss than patients receiving radiation alone. Registered on clinincaltrials.gov (Identifier: NCT05890859).
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Affiliation(s)
- Simon Lønbro
- Department of Public Health, Section for Sport Science, Aarhus University, Aarhus, Denmark
| | - Søren Gam
- Department of Diabetes and Endocrinology, University of Southern Denmark, Esbjerg, Denmark
| | - Anne Pernille Hermann
- Department of Endocrinology, University Hospital of Southern Denmark, Odense, Denmark
| | - Christian Rønn Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Alexidis P, Kolias P, Mentesidou V, Topalidou M, Kamperis E, Giannouzakos V, Efthymiadis K, Bangeas P, Timotheadou E. Investigating Predictive Factors of Dysphagia and Treatment Prolongation in Patients with Oral Cavity or Oropharyngeal Cancer Receiving Radiation Therapy Concurrently with Chemotherapy. Curr Oncol 2023; 30:5168-5178. [PMID: 37232849 DOI: 10.3390/curroncol30050391] [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: 02/21/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Radiation therapy (RT) treatment for head and neck cancer has been associated with dysphagia manifestation leading to worse outcomes and decrease in life quality. In this study, we investigated factors leading to dysphagia and treatment prolongation in patients with primaries arising from oral cavity or oropharynx that were submitted to radiation therapy concurrently with chemotherapy. The records of patients with oral cavity or oropharyngeal cancer that received RT treatment to the primary and bilateral neck lymph nodes concurrently with chemotherapy were retrospectively reviewed. Logistic regression models were used to analyze the potential correlation between explanatory variables and the primary (dysphagia ≥ 2) and secondary (prolongation of total treatment duration ≥ 7 days) outcomes of interest. The Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate dysphagia. A total of 160 patients were included in the study. Age mean was 63.31 (SD = 8.24). Dysphagia grade ≥ 2 was observed in 76 (47.5%) patients, while 32 (20%) experienced treatment prolongation ≥ 7 days. The logistic regression analysis showed that the volume in the primary site of disease that received dose ≥ 60 Gy (≥118.75 cc, p < 0.001, (OR = 8.43, 95% CI [3.51-20.26]) and mean dose to the pharyngeal constrictor muscles > 40.6 Gy (p < 0.001, OR = 11.58, 95% CI [4.84-27.71]) were significantly associated with dysphagia grade ≥ 2. Treatment prolongation ≥ 7 days was predicted by higher age (p = 0.007, OR = 1.079, 95% CI [1.021-1.140]) and development of grade ≥ 2 dysphagia (p = 0.005, OR = 4.02, 95% CI [1.53-10.53]). In patients with oral cavity or oropharyngeal cancer that receive bilateral neck irradiation concurrently with chemotherapy, constrictors mean dose and the volume in the primary site receiving ≥ 60 Gy should be kept below 40.6 Gy and 118.75 cc, respectively, whenever possible. Elderly patients or those that are considered at high risk for dysphagia manifestation are more likely to experience treatment prolongation ≥ 7 days and they should be closely monitored during treatment course for nutritional support and pain management.
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Affiliation(s)
- Petros Alexidis
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Pavlos Kolias
- Section of Statistics and Operational Research, Department of Mathematics, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece
| | - Vaia Mentesidou
- Medical Oncology Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Maria Topalidou
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Efstathios Kamperis
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Vasileios Giannouzakos
- Radiation Oncologist, Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Konstantinos Efthymiadis
- Medical Oncology Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Petros Bangeas
- 1st University Surgery Department, Nanomedicine and Nanotechnology Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Eleni Timotheadou
- Medical Oncologist, Medical Oncology Clinic Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece
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Fourati N, Trigui R, Dhouib F, Nouri O, Siala W, Khanfir A, Mnejja W, Daoud J. Quality of weight loss during chemoradioherapy in patients with nasopharyngeal cancers. Cancer Radiother 2023:S1278-3218(23)00060-4. [PMID: 37095056 DOI: 10.1016/j.canrad.2022.12.001] [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: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 04/26/2023]
Abstract
PURPOSE Radiation therapy with chemotherapy (CCR) is currently the gold standard treatment for nasopharyngeal carcinoma (NPC). Anatomical changes are mainly due to weight loss. Our prospective study aimed to evaluate the nutritional status and the quality of weight loss in our patients to adapt the subsequent nutritional management of patients during treatment for NPC. PATIENTS AND METHODS A prospective, single-center study of 27 patients with non-metastatic NPC treated in our oncology radiotherapy department between August 2020 and March 2021. Data from interrogation, physical examination, and bioelectrical impedancemetry (weight [W], body mass index [BMI], fat index [GI], fat mass [FM], and fat-free mass (FFM]) were collected at the beginning, the mid, and the end of treatment. RESULTS Weight loss from mid to end of treatment (median=-4kg [-9.4; -0.9]) was greater than that from baseline to mid-treatment (median=-2.9kg [-8.8; 1.8]) (P=0.016). Weight loss during the entire treatment was -6.2kg [-15.6; -2.5] (8.4%). The losses of FM were identical between the beginning-mid treatment and the mid-end treatment; they were respectively -1.4kg [-8.5; 4.2] and -1.4kg [-8.2; 7.8] (P=0.4). FFM losses between the mid- and the end of treatment (-2.5kg [-27.8; 0.5]) were greater than those between baseline and mid-treatment (-1.1kg [-7.1; 4.7]) (P=0.014). Median FFM loss during treatment was -3.6kg [-28.1; 2.6]). CONCLUSION The results of our study show that weight loss during CCR for NPC is complex and is not just about loss but about a disruption of body composition. Regular follow-ups by nutritionists are required to prevent denutrition during treatment.
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Affiliation(s)
- N Fourati
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia.
| | - R Trigui
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - F Dhouib
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - O Nouri
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - W Siala
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - A Khanfir
- Service d'oncologie médicale, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - W Mnejja
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
| | - J Daoud
- Service de radiothérapie carcinologique, faculté de médecine, CHU de Habib-Bourguiba, université de Sfax, Sfax, Tunisia
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Development of Machine-Learning Prediction Programs for Delivering Adaptive Radiation Therapy With Tumor Geometry and Body Shape Changes in Head and Neck Volumetric Modulated Arc Therapy. Adv Radiat Oncol 2023; 8:101172. [PMID: 36817412 PMCID: PMC9932315 DOI: 10.1016/j.adro.2023.101172] [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: 08/10/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose During radiation therapy for head and neck cancer using volumetric modulated arc therapy, excessive dosing or underdosing occurs as a result of the decrease in tumor volume and changes in body weight. Adaptive radiation therapy (ART) is performed when significant changes are observed; however, the decision to implement ART depends on the oncologist's subjective judgment. The purpose of this study was to present objective indicators for ART and develop a program to predict the need for ART. Methods and Materials The study included 47 patients in the non-ART group and 21 patients in the ART group with shape changes. Patients who received ART could not be covered with the prescribed radiation therapy dose due to shape changes. For each patient, 1112 6-dimensional lists were created, including the number of irradiations, amount of change in the clinical target volume (CTV), rate of change in CTV, mean oral cavity dose, age, and body mass index. Support vector machine and k-nearest neighbor were used for machine learning. The random number of test data to be extracted varied from 1 to 9, and a mean accuracy score was calculated. These programs could predict the need for ART if the accuracy score was high. Results The classification accuracy of the list, including the amount of change in the CTV and rate of change in CTV up to 20 fractions, was 0.963 and 0.967 for support vector machine and k-nearest neighbor, respectively. Conclusions This program predicted the need for ART with more than 90% accuracy based on shape changes over time in cone beam computed tomography analysis for up to 20 fractions. This may provide significant support for objective decisions to implement ART based on the amount of change over time during treatment.
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Shimizu H. [7. Precautions for Radiotherapy Treatment Planning Revealed from Image Registration in the Head and Neck Region]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1473-1481. [PMID: 36543231 DOI: 10.6009/jjrt.2022-2125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Naser MA, Wahid KA, Grossberg AJ, Olson B, Jain R, El-Habashy D, Dede C, Salama V, Abobakr M, Mohamed ASR, He R, Jaskari J, Sahlsten J, Kaski K, Fuller CD. Deep learning auto-segmentation of cervical skeletal muscle for sarcopenia analysis in patients with head and neck cancer. Front Oncol 2022; 12:930432. [PMID: 35965493 PMCID: PMC9366009 DOI: 10.3389/fonc.2022.930432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/29/2022] [Indexed: 12/22/2022] Open
Abstract
Background/Purpose Sarcopenia is a prognostic factor in patients with head and neck cancer (HNC). Sarcopenia can be determined using the skeletal muscle index (SMI) calculated from cervical neck skeletal muscle (SM) segmentations. However, SM segmentation requires manual input, which is time-consuming and variable. Therefore, we developed a fully-automated approach to segment cervical vertebra SM. Materials/Methods 390 HNC patients with contrast-enhanced CT scans were utilized (300-training, 90-testing). Ground-truth single-slice SM segmentations at the C3 vertebra were manually generated. A multi-stage deep learning pipeline was developed, where a 3D ResUNet auto-segmented the C3 section (33 mm window), the middle slice of the section was auto-selected, and a 2D ResUNet auto-segmented the auto-selected slice. Both the 3D and 2D approaches trained five sub-models (5-fold cross-validation) and combined sub-model predictions on the test set using majority vote ensembling. Model performance was primarily determined using the Dice similarity coefficient (DSC). Predicted SMI was calculated using the auto-segmented SM cross-sectional area. Finally, using established SMI cutoffs, we performed a Kaplan-Meier analysis to determine associations with overall survival. Results Mean test set DSC of the 3D and 2D models were 0.96 and 0.95, respectively. Predicted SMI had high correlation to the ground-truth SMI in males and females (r>0.96). Predicted SMI stratified patients for overall survival in males (log-rank p = 0.01) but not females (log-rank p = 0.07), consistent with ground-truth SMI. Conclusion We developed a high-performance, multi-stage, fully-automated approach to segment cervical vertebra SM. Our study is an essential step towards fully-automated sarcopenia-related decision-making in patients with HNC.
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Affiliation(s)
- Mohamed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aaron J. Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brennan Olson
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, United States
| | - Rishab Jain
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Dina El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Clinical Oncology, Menoufia University Shibin El Kom, Shibin El Kom, Egypt
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Moamen Abobakr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Clifton D. Fuller,
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de Sousa Melo A, Andrade CL, de Lima Dantas JB, Medrado ARAP, Martins GB, Lima HR, Carrera M. Impact of photobiomodulation for oral mucositis on body weight and BMI of patients with head and neck cancer. Support Care Cancer 2022; 30:4897-4904. [PMID: 35169872 DOI: 10.1007/s00520-022-06899-6] [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: 10/19/2021] [Accepted: 02/05/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the impact of photobiomodulation for oral mucositis on body weight and body mass index (BMI) in head and neck cancer patients. METHODS Patients were separated into two groups: photobiomodulation (PBM) (n = 17) and SHAM (n = 19). Participants assigned to the PBM group received the photobiomodulation therapy on alternate days at 33 different sites of the oral mucosa (1 J for 10 s per application point) using a low-power aluminum gallium arsenide (AsGaAl) laser device with a maximum output power of 86.7 mW and a wavelength of 660 nm (red). The same protocol was performed in patients allocated in the SHAM group but with the device turned off. At the first and twenty-fourth radiotherapy sessions, participants from both groups underwent an intraoral examination to assess the presence or absence of mucositis using the WHO scale, and measurements of weight and height for BMI calculation were undertaken. RESULTS All patients had significant differences in weight and BMI throughout the study period. Patients in the PBM group lost less weight (p < 0.01) and had a reduced BMI loss (p < 0.01) in comparison to patients in the SHAM group. Although PBM did not prevent oral mucositis, it decreased its severity (p < 0.01). CONCLUSION Photobiomodulation for oral mucositis reduced weight loss and prevented a reduction in BMI in patients who underwent chemoradiotherapy for head and neck cancer. Retrospectively registered at https://data.mendeley.com//datasets/4kd7s49wk4/1 .
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Affiliation(s)
- Amanda de Sousa Melo
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins 2555, Cabula, Salvador, Bahia, Brazil
| | - Camila Lima Andrade
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins 2555, Cabula, Salvador, Bahia, Brazil
| | - Juliana Borges de Lima Dantas
- Interactive Processes of Organs and Systems Post Graduation Program, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.,Adventist College of Bahia, Cachoeira, Brazil.,Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Alena Ribeiro Alves Peixoto Medrado
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.,Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Gabriela Botelho Martins
- Interactive Processes of Organs and Systems Post Graduation Program, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.,Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Hayana Ramos Lima
- Center of Health Sciences, Federal University of Southern Bahia, Teixeira de Freitas, Bahia, Brazil
| | - Manoela Carrera
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins 2555, Cabula, Salvador, Bahia, Brazil. .,Faculty of Dentistry, Federal University of Bahia, Salvador, Brazil.
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11
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Acute Impact of Cancer Treatment on Head and Neck Cancer Patients: FIT4TREATMENT. Cancers (Basel) 2022; 14:cancers14112698. [PMID: 35681678 PMCID: PMC9179562 DOI: 10.3390/cancers14112698] [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: 04/17/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Head and neck cancer treatment causes toxicities that compromise health-related quality of life (HRQoL) and treatment efficacy. Exercise training (ET) benefits are reported for many cancer types. The aim of our prospective observational study was to analyse acute treatment’s impact and ET preferences. In the pretreatment phase (n = 18), most patients presented low physical function, were moderately malnourished or at risk of malnutrition, and were willing to participate in an ET program. Patients submitted to radical chemoradiotherapy (n = 7) experienced a significant decline in HRQoL and social functioning, an increase in dysphagia severity, a reduction in handgrip strength, and nutritional status deterioration. An ET program may optimize patients’ physical fitness, achieving more efficacy with less toxicity. Abstract Head and neck cancer (HNC) treatment’s toxicities impact several health domains. Exercise training (ET) may be beneficial. This prospective observational study (NCT04996147) aimed to analyse the acute impact of HNC curative multimodal treatment on health-related quality of life (HRQoL), nutritional status, physical and cognitive functions, and ET preferences. Eighteen patients with stage III/IV HNC were evaluated at baseline (T0), and 10 patients were evaluated at the end of treatment (T1), 7 of them after radical chemoradiotherapy (rCRT). At T0, the majority referred a good HRQoL on the EORTC QLQ-C30 questionnaire (median score: 70.8), were moderately malnourished or at risk of malnutrition (78%), recognized the benefits of an ET program, and were willing to participate (78%). After rCRT, there was worsening in HRQoL (75 vs. 50 score, p = 0.014), dysphagia severity (Eating Assessment Tool: 7 vs. 31, p = 0.027; Functional Oral Intake Scale: 6 vs. 4, p = 0.041), handgrip strength (dominant: 40.9 vs. 35.8 kgf, p = 0.027; nondominant: 37.2 vs. 33.9 kgf, p = 0.043), and nutritional status (Patient-Generated Subjective Global Assessment: 7 vs. 18, p = 0.028). HNC patients subjected to radical treatment represent a vulnerable population that might benefit from multimodal supportive care strategies including an ET program.
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Leelasawatsuk P, Prapaisit U, Chaiyarukjirakun V, Plodpai Y. Long-term monitoring and predictive factors of critical weight loss among patients with nasopharyngeal carcinoma in a curative treatment setting. Am J Otolaryngol 2022; 43:103407. [PMID: 35210108 DOI: 10.1016/j.amjoto.2022.103407] [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: 01/27/2022] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to determine weight change over time and identify risk factors of critical weight loss among patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS In this retrospective study, we investigated weight change over time in 445 patients with NPC who underwent curative treatment. Logistic regression analysis was used to identify possible predictors of critical weight loss. RESULTS The incidence of critical weight loss was 67.87%. The long-term monitoring demonstrated a rapid weight loss, especially in the first 2 months of treatment, which continued up to 5 months. Patients with critical weight loss did not regain weight until 3 years. Univariate analysis showed that the following factors were significantly associated with critical weight loss: lower pretreatment body mass index (BMI), tumor stage, subjective global assessment score, Eastern Cooperative Oncology Group (ECOG) score, and enteral tube feeding. Multivariate analysis showed four factors that were associated with a lower critical weight loss: pretreatment BMI < 18.5 kg/m2 (p < 0.001, 95% confidence interval [CI] = 0.25 [0.12-0.52]), early tumor stage (p = 0.004, 95% CI = 0.46 [0.27-0.79]), ECOG grade II (p = 0.006, 95% CI = 0.15 [0.04-0.51]), and early prophylactic percutaneous gastrostomy (PEG) tube feeding (p = 0.001, 95% CI = 0.26 [0.12-0.59]). CONCLUSION Patients having NPC with critical weight loss showed a significantly rapid decline in their weight in the first 2 months; the weight was persistently less than the baseline value during a 36-month follow-up period. Patients with lower BMI, early-stage cancer, and early prophylactic PEG tube feeding had a significantly lower critical weight loss than those without the abovementioned characteristics.
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13
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Singh GK, Patil VM, Noronha V, Joshi A, Menon N, Lashkar SG, Mathrudev V, Satam KN, Prabhash K. Weight loss and its impact on outcome in head and cancer patients during chemo-radiation. Oral Oncol 2021; 122:105522. [PMID: 34571463 DOI: 10.1016/j.oraloncology.2021.105522] [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: 12/21/2020] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Weight loss during chemotherapy and its impact on the cancer outcomes have been invariably reported in the literature. We also did a post-hoc analysis of a randomized phase III trial to see the same. MATERIALS AND METHODS The database of a recently published randomized study comparing cisplatin-radiation with nimotuzumab cisplatin-radiation was used for this analysis. Week-wise weight loss during the course of treatment was noted. The impact of severe weight loss (grade 2-3) on progression-free survival (PFS), locoregional control (LRC) and overall survival (OS) was studied using the Kaplan Meier method. Binary logistic regression analysis was used to see the effect of various factors. RESULTS Out of a total of 536 patients, weight loss was captured in 524. Out of these 524 patients, any degree of weight loss was seen in 293 (55.91%) patients. Grade 1 weight loss was noted in 192 (36.6%) patients, grade 2 in 96 (18.3%) and grade 3 in 5 (1%) patients. The 2-year PFS was 53% and 57.1% in severe and non-severe weight loss groups respectively (p-value = 0.36). The 2-year LRC was 60% in patients with severe weight loss, while it was 63.5% in those with non-severe weight loss (p-value = 0.47). The 2-year OS was 59.3% versus 62.2% in severe and non-severe weight loss cohorts respectively (p-value = 0.21). None of the factors was found to be associated with severe weight loss. CONCLUSION Severe weight loss was uncommon in our patients. Weight loss during treatment was not associated with poor survival outcomes.
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Affiliation(s)
- Gunjesh Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Sarbani Ghosh Lashkar
- Department of Radiotherapy, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Kavita Nawale Satam
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre and HBNI, Mumbai 400012, India.
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14
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Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia. Clin Nutr ESPEN 2021; 44:348-355. [PMID: 34330489 DOI: 10.1016/j.clnesp.2021.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. The purpose of this study is two-fold: to identify the risk of malnutrition in patients with oropharyngeal dysphagia (OD) secondary to HNC, and to determine the relationship between the risk of malnutrition versus tumor characteristics, treatment modality, time interval (between the end of oncological treatment and swallowing assessment date), level of oral intake, body mass index (BMI), aspiration, pharyngeal pooling, and OD-related quality of life (QoL). METHODS The Short Nutritional Assessment Questionnaire (SNAQ) was used to screen patients for the risk of malnutrition. Patients underwent a standardized swallowing examination protocol including an endoscopic evaluation of swallowing. RESULTS Seventy-five dysphagic HNC patients were included. Forty-eight percent of the patients presented a high risk of malnutrition using SNAQ. The majority of the patients (81.3%) was on a total oral diet. Moreover, BMI did not appear to be a reliable measure to screen for malnutrition as a normal BMI was often associated with an increased risk of malnutrition on the SNAQ. In contrast, patients who were underweight or overweight did not show an association with a high risk of malnutrition. With the exception of BMI, no other patient and tumor characteristics were found to be associated with the risk of malnutrition. CONCLUSIONS This study emphasizes the importance of early nutritional screening in dysphagic HNC patients, as almost half of these patients presented a high risk of malnutrition. Malnutrition screening using SNAQ can identify HNC patients with OD who are at risk of malnutrition and subsequently need to be referred to a dietician for additional nutritional assessment, diagnosis of malnutrition, and nutritional support, even when their BMI is within normal range.
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15
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Han HR, Hermann GM, Ma SJ, Iovoli AJ, Wooten KE, Arshad H, Gupta V, McSpadden RP, Kuriakose MA, Markiewicz MR, Chan JM, Platek ME, Ray AD, Gu F, Hicks WL, Singh AK. Matched pair analysis to evaluate weight loss during radiation therapy for head and neck cancer as a prognostic factor for survival. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:914. [PMID: 34164548 PMCID: PMC8184423 DOI: 10.21037/atm-20-4969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background One frequent consequence of radiation therapy (RT) for head and neck cancer (HNC) is weight loss (WL). HNC patients reportedly lose about 9% of their weight during treatment, regardless of pre-treatment WL and nutritional support. We investigated whether high WL during RT has an association with overall (OS) and cancer-specific survival (CSS). Methods We retrospectively reviewed weight during RT in HNC patients treated at Roswell Park Comprehensive Cancer Center between 2003 and 2017. High WL was defined as greater than or equal to the median WL. Logistic regression analysis was performed to identify predictors for WL during RT. Multivariate Cox regression and Kaplan-Meier analyses were used to estimate survival outcomes. Propensity score matching was performed to obtain balanced matched-pairs and compare survival outcomes. Results A total of 843 patients received either definitive (71%) or post-operative (29%) RT. Median follow-up was 53.6 months [interquartile range (IQR) 35.7–88.9]. Median WL was 5.8% (IQR 0.24–10.6) from baseline weight. Patients with high WL had better OS [hazard ratio (HR) 0.75, 95% confidence interval (CI), 0.61–0.93, P=0.01] and CSS (HR 0.71, 95% CI, 0.55–0.93, P=0.01). 258 matched-pairs were analyzed. Median follow-up was 54.8 months (IQR 35.8–90.4). Median OS was 39.2 months (IQR 21.4–75.7) for high WL versus 36.7 months (IQR 14.6–61.7) for low WL cohorts (P=0.047). Conclusions Different from previous reports, this study shows that patients with less WL have worse OS. WL during RT may not be a reliable marker for worse prognosis. A better way to evaluate malnutrition in patients undergoing RT is warranted.
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Affiliation(s)
- Hye Ri Han
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, New York, NY, USA
| | - Gregory M Hermann
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Austin J Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Kimberly E Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Hassan Arshad
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Ryan P McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Moni A Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Michael R Markiewicz
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA.,Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, New York, NY, USA.,Department of Surgery and Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, New York, NY, USA
| | - Jon M Chan
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Mary E Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, NY, USA.,Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, New York, NY, USA.,Department of Dietetics, D'Youville College, New York, NY, USA
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Wesley L Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, New York, NY, USA
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, NY, USA
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16
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Zhang X, Liu J, Yu H, Su X, Chen H, He Y, Liu Z, Hu X. Weight Change Trajectory in Patients With Locally Advanced Nasopharyngeal Carcinoma During the Peri-Radiation Therapy Period. Oncol Nurs Forum 2021; 48:65-79. [PMID: 33337441 DOI: 10.1188/21.onf.65-79] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To analyze the weight change trajectory in patients with locally advanced nasopharyngeal carcinoma (LANPC) before, during, and after radiation therapy for a time span of 40 weeks. SAMPLE & SETTING 147 patients from a university-affiliated medical center in China were included. METHODS & VARIABLES Body weight was measured weekly during intensive treatment and biweekly after radiation therapy. RESULTS All 147 patients experienced critical weight loss during the peri-radiation therapy period. Overall, body weight remained basically unchanged during induction chemotherapy, followed by a sharp and severe decrease during radiation therapy. At 20 weeks after radiation therapy, body weight had increased only slightly from the lowest point. IMPLICATIONS FOR NURSING A time-tailored intervention based on the weight change trajectory is necessary for patients with LANPC. According to the weight change trajectory, relevant interventions for maintaining body weight should be initiated as early as the second week of radiation therapy and no later than the fourth week of radiation therapy, and these interventions should continue for at least four weeks after radiation therapy.
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17
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Yurut-Caloglu V, Caloglu M, Turkkan G. The importance of weight loss during definitive radiotherapy in patients with laryngeal carcinoma. J Cancer Res Ther 2021; 18:638-643. [DOI: 10.4103/jcrt.jcrt_727_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Anjanappa M, Corden M, Green A, Roberts D, Hoskin P, McWilliam A, Choudhury A. Sarcopenia in cancer: Risking more than muscle loss. Tech Innov Patient Support Radiat Oncol 2020; 16:50-57. [PMID: 33385074 PMCID: PMC7769854 DOI: 10.1016/j.tipsro.2020.10.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia is characterised by progressive and extensive skeletal muscle degeneration and is associated with functional decline. Sarcopenia has primary and secondary aetiology, arising as a result of the ageing process or through chronic cytokine-mediated inflammation (associated with health conditions including cancer), respectively. Diagnosis of sarcopenia is dependent upon detection of reduced skeletal muscle strength, mass and performance. A combination of non-radiological and radiological methods can be used to assess each of these in turn to accurately diagnose sarcopenia. Sarcopenia is known to adversely affect outcomes of patients with various forms of cancer. Early identification of sarcopenia is imperative in improving patient care and overall prognosis. Various interventions, such as resistance exercise, nutritional support, and amino acid and vitamin supplementation have shown promise in the management of sarcopenia. However, further insight into novel interventions and indeed, assessment of the benefits of management of sarcopenia in terms of survival, are required to better support cancer patients.
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Affiliation(s)
- Milan Anjanappa
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Michael Corden
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
| | - Andrew Green
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
| | - Darren Roberts
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
| | - Peter Hoskin
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
- Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | - Alan McWilliam
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
- Department of Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester M20 4BX, UK
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19
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de Oliveira Faria S, Howell D, Vamondes Kulcsar MA, Eluf-Neto J. Nutritional outcomes in head and neck cancer patients: is intensive nutritional care worth it? Cancer Treat Res Commun 2020; 25:100233. [PMID: 33161323 DOI: 10.1016/j.ctarc.2020.100233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to compare nutritional outcomes before and after implementation of weekly dietetic counseling (intensive nutritional care) in head and neck cancers patients. METHODS A retrospective study with all head and neck patients, who received radiotherapy between January 2010 and December 2017 were performed. The main outcome was significant weight loss. Compliance to caloric and protein recommendations were also evaluated. RESULTS In all, 472 patients were included. Weight loss was not different between before and after implementation (-6.7%; IQ -10.5/-1.9 vs -5.0%; IQ -9.8/-0.7;p=0.06).There were no significant difference in terms of meeting the recommended intake. Higher baseline body mass index and oral nutritional support predicted significant weight loss. CONCLUSION Implementation of intensive nutritional care did not have an impact on weight loss and energy and protein intake in head and neck cancer patients. Further research would be of value to determine the appropriate service-delivery model to achieve optimal patient outcomes.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | - Doris Howell
- Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Marco Auré Vamondes Kulcsar
- Cirurgia de Cabeça e Pescoço, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose Eluf-Neto
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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20
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Mapping impact factors leading to the GLIM diagnosis of malnutrition in patients with head and neck cancer. Clin Nutr ESPEN 2020; 40:149-155. [PMID: 33183529 DOI: 10.1016/j.clnesp.2020.09.174] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS In head and neck cancer, the combination of weight loss and elevated C-reactive protein levels means that patients have malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). This study aimed to identify impact factors for malnutrition as defined by the GLIM criteria among patients with head and neck cancer at the start of treatment and up to 12 months post-treatment. METHODS In a prospective, observational study, patient, tumour, treatment, and nutritional data from 229 patients with head and neck cancer were collected at the start of treatment and at three follow-ups (7 weeks after the start of treatment and at 3 and 12 months after the termination of treatment). These clinical variables were statistically analysed in relation to malnutrition at each follow-up using univariate and multivariate analyses. Malnutrition was defined according to the two GLIM criteria of >5% body weight loss during the last 6 months and C-reactive protein >5 mg/L. RESULTS The following factors were predictive for malnutrition in the multivariate analysis performed 7 weeks after the start of treatment: moderate or severe mucositis, chemoradiotherapy ± surgery, and the need for nutritional support (total or partial use of tube feeding/parenteral nutrition). Advanced tumour stage (III-IV) was significant for malnutrition at the start of treatment and at the 7 week and 3 month follow-ups, but not at 12 months. CONCLUSIONS Severe mucositis, chemoradiotherapy ± surgery, and advanced tumour stage were found to be impact factors for the diagnosis of malnutrition using GLIM at different follow-up times from the start of treatment up to 12 months after the end of treatment. Few patients with head and neck cancer are diagnosed with malnutrition according to the GLIM criteria in a long-term perspective after the termination of treatment. Research on the validity of the GLIM criteria is needed to build a comprehensive evidence base of impact factors for malnutrition in head and neck cancer.
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Validation of the Chinese version of chemotherapy-induced Taste Alteration Scale among patients with head and neck cancer undergoing radiotherapy. Eur J Oncol Nurs 2020; 48:101818. [PMID: 32937262 DOI: 10.1016/j.ejon.2020.101818] [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: 05/10/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To validate the Chinese version of the Chemotherapy-induced Taste Alteration Scale (CiTAS) among patients with head and neck cancer (HNC) undergoing radiotherapy (RT). METHODS Patients with HNC undergoing RT were enrolled from a cancer hospital. Data were collected by face-to-face interview. Patients' subjective taste alterations (TAs) were assessed by the CiTAS. The content validity was evaluated by five experts. Confirmatory and exploratory factor analysis were used to assess construct validity. Convergent validity was assessed by the correlation between the CiTAS score and the Quality of Life Questionnaire-Core 30 (QLQ-C30) score. A single-item subjective intensity taste alteration question and quartiles of RT duration were used to assess the discriminant validity. The reliability was assessed by the Cronbach's alpha and test-retest reliability. RESULTS 253 patients participated this investigation and 25 patients completed twice. Confirmatory factor analysis showed that the original CiTAS structure with four dimensions was not applicable to patients with HNC undergoing RT. The Chinese version of modified-CiTAS (m-CiTAS) retained 17 items (the item "bothered by the smell of food" was deleted) loading onto three factors: decline in taste, discomfort, and phantogeusia and parageusia. The m-CiTAS showed acceptable correlations with the QLQ-C30. It could effectively discriminate the intensity of subjective TAs according to the single-item question and quartiles of RT duration. The m-CiTAS showed acceptable internal consistency (Cronbach's alpha = 0.573-0.958) and test-retest reliability (r = 0.726-0.831, P < 0.05). CONCLUSIONS The Chinese version of m-CiTAS is an acceptable and applicable instrument to evaluate TAs among patients with HNC undergoing RT.
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Pandit P, Patil R, Palwe V, Yasam VR, Nagarkar R. Predictors of Weight Loss in Patients With Head and Neck Cancer Receiving Radiation or Concurrent Chemoradiation Treated at a Tertiary Cancer Center. Nutr Clin Pract 2020; 35:1047-1052. [PMID: 32329543 DOI: 10.1002/ncp.10488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Radiation therapy (RT) has remained the mainstay treatment approach for head and neck cancers. Weight loss due to tumor or tumor-related factors remains a major health issue among head and neck cancer patients. METHODS A total of 357 patients were identified for the study. Possible weight-loss predictors were determined in the patients undergoing RT based on the patient demographics, tumor site, and treatment characteristics. RESULTS The mean age of patients was 52 years, whereas the median age was 51 years (range, 18-87). Two hundred and thirteen (66%) patients had oral cavity cancers, 43 (14%) had oropharyngeal cancer, 26 (8%) had hypopharyngeal cancer, 13 (6%) had larynx cancer, and 19 (6%) had other site involvement. A total of 192 patients received 3-dimensional conformal radiation therapy (3DCRT), whereas 127 patients received intensity modulated radiation therapy-image guided radiation therapy (IMRT-IGRT), 212 (66%) received concurrent chemotherapy, and 107 (34%) patients did not receive concurrent chemotherapy. A total of 127 (40%) of the patients gained weight during the first week of RT; on the other hand, maximum weight loss among patients was occurred during the third and fourth weeks of RT. CONCLUSION Analysis by logistic regression determined there is significant weight loss (>10%) in patients receiving radical RT as compared with adjuvant RT. Better outcomes were observed in patients receiving RT by IMRT-IGRT technique as compared with 3DCRT technique.
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Affiliation(s)
- Prakash Pandit
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | - Roshankumar Patil
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | - Vijay Palwe
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
| | | | - Rajnish Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, Maharashtra, India
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23
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Predictors of weight loss during and after radiotherapy in patients with head and neck cancer: A longitudinal study. Eur J Oncol Nurs 2019; 39:98-104. [DOI: 10.1016/j.ejon.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/22/2019] [Accepted: 02/14/2019] [Indexed: 12/24/2022]
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Jin S, Lu Q, Jin S, Zhang L, Cui H, Li H. Relationship between subjective taste alteration and weight loss in head and neck cancer patients treated with radiotherapy: A longitudinal study. Eur J Oncol Nurs 2018; 37:43-50. [PMID: 30473050 DOI: 10.1016/j.ejon.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To conduct a dynamic and comprehensive evaluation of subjective taste alteration (STA)and identify the association between STA and weight loss in patients with head and neck cancer (HNC) who were treated with radiotherapy. METHODS STA and weight of 114 patients were recorded at baseline, mid-treatment, post-treatment, and one to two months after radiotherapy (follow-up). Generalized estimating equations (GEE) were used to conduct repeated measures analyses of STA and weight loss at four time-points and assess the relationship between them. RESULTS The prevalence of STA was 13.2% (baseline), 83.3% (mid-treatment), 92.1% (post-treatment), and 77.9% (follow-up), respectively; the prevalence of ≥10% weight loss increased from 1.8% (mid-treatment) to 44.2% (follow-up). The severity of STA was increasingly poor with radiation therapy and did not return to the baseline level at the follow-up. Meanwhile, the weight of patients did not increase at the follow-up. Among the four subscales of STA (decline in basic taste, general taste alterations, phantogeusia and parageusia, and discomfort), only the discomfort score (β = -2.988; p = 0.005; 95%confidence interval: -5.084-0.891) had a significant effect on weight loss. CONCLUSIONS The main finding of this study was that STA, particularly the discomfort symptom associated with dietary intake, as a common and persistent symptom among HNC patients during and after radiotherapy, might promote weight loss in patients, which should be afforded greater attention from medical staff.
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Affiliation(s)
- Shuai Jin
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, 100191, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, 100191, Beijing, China.
| | - Sanli Jin
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, 100191, Beijing, China
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, 100191, Beijing, China
| | - Hangjing Cui
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, 100191, Beijing, China
| | - Hongmei Li
- ShanXi Hospital of Integrated Traditional and Western Medicine, 030013, Taiyuan, China
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25
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Baptistella AR, Hilleshein KD, Beal C, Brambatti JS, Caron R, Baptistella SF, Zuquello RÁ, Rossoni C, Manfro G. Weight loss as a prognostic factor for recurrence and survival in oropharyngeal squamous cell carcinoma patients. Mol Clin Oncol 2018; 9:666-672. [PMID: 30546899 DOI: 10.3892/mco.2018.1737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
Although the mortality rate of oropharyngeal squamous cell carcinoma (OPSCC) has been decreasing over the last 30 years, there has been a significant increase in the frequency of diagnosis of this type of cancer in several countries. Beyond the classic prognostic factors, such as TNM stage, there is a lack of predictive factors for recurrence and treatment response. A retrospective analysis of patients with OPSCC treated at the Oncology Department of the Santa Terezinha University Hospital between 2007 and 2012 was performed, with the aim of identifying new prognostic factors. In addition to the significance of clinical stage as a prognostic factor for recurrence, OPSCC patients with advanced TNM stage and those treated with radiotherapy, chemoradiation or palliative measures, had a worse prognosis. Patients with moderate or severe weight loss (>5%) at diagnosis had a higher tumor recurrence rate compared with those with mild or no weight loss (P=0.007). Furthermore, 76.9% of patients with moderate or severe weight loss, as opposed to 13.3% of patients with mild or no weight loss, eventually succumbed to the disease (P=0.0001). These data suggest that moderate and severe weight loss at diagnosis is a prognostic factor for OPSCC and it is associated with disease recurrence.
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Affiliation(s)
- Antuani Rafael Baptistella
- Oncology Research Group, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil.,Postgraduate Program in Bioscience and Health, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil
| | | | - Caroline Beal
- Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil
| | - Juliana S Brambatti
- Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil
| | - Ruggero Caron
- Oncology Research Group, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil.,Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Department of Clinical Oncology, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil
| | - Shaline Ferla Baptistella
- Oncology Research Group, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil.,Postgraduate Program in Bioscience and Health, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Department of Clinical Oncology, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil
| | - Radamés Ádamo Zuquello
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Carina Rossoni
- Oncology Research Group, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil.,Postgraduate Program in Bioscience and Health, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil
| | - Gabriel Manfro
- Oncology Research Group, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil.,Faculty of Medicine, University of West Santa Catarina, Joaçaba, SC 89600-000, Brazil.,Department of Oncological Surgery, Santa Terezinha University Hospital, Joaçaba, SC 89600-000, Brazil
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26
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Volpe S, Marvaso G, Alterio D, Ciardo D, Sabbatini A, Zagallo E, Valoriani F, Fanetti G, Ferrari A, Cossu Rocca M, Ansarin M, Jereczek-Fossa BA. Nutritional Intervention for Nonsurgical Head and Neck Cancer Patients Treated with Radiation Therapy: Results from a Prospective Stepped-Wedge Clinical Protocol. Nutr Cancer 2018; 70:1051-1059. [DOI: 10.1080/01635581.2018.1497187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefania Volpe
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Daniela Alterio
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Annarita Sabbatini
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - Emanuela Zagallo
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - Filippo Valoriani
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - Giuseppe Fanetti
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Annamaria Ferrari
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Maria Cossu Rocca
- Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology, Milan, Italy
| | - Mohssen Ansarin
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology, Milan, Italy
- Department of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - Barbara A. Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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27
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Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients. Cancer Nurs 2017; 40:471-478. [DOI: 10.1097/ncc.0000000000000445] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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28
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Vangelov B, Venchiarutti RL, Smee RI. Critical Weight Loss in Patients With Oropharynx Cancer During Radiotherapy (± Chemotherapy). Nutr Cancer 2017; 69:1211-1218. [DOI: 10.1080/01635581.2017.1367943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
- Department of Nutrition and Dietetics, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rebecca L. Venchiarutti
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
| | - Robert I. Smee
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
- University of New South Wales Clinical Teaching School, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
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30
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Li G, Jiang XY, Qiu B, Shen LJ, Chen C, Xia YF. Vicious circle of acute radiation toxicities and weight loss predicts poor prognosis for nasopharyngeal carcinoma patients receiving intensity modulated radiotherapy. J Cancer 2017; 8:832-838. [PMID: 28382146 PMCID: PMC5381172 DOI: 10.7150/jca.17458] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 12/22/2016] [Indexed: 12/30/2022] Open
Abstract
Background: Weight loss during radiotherapy has been known as a negative prognostic factor for nasopharyngeal carcinoma (NPC) patients, but the factors related to weight loss during radiotherapy were not fully understood. Methods: A total of 322 newly diagnosed NPC patients receiving intensity modulated radiotherapy (IMRT) in Sun Yat-sen University Cancer Center between June 2002 and August 2006 were enrolled. Kaplan-Meier methods and log-rank test were applied for survival analysis; a multiple regression was used to identify the factors related to weight loss during radiotherapy. Results: The mean and median values of weight loss (%) during radiotherapy were 6.85% and 6.70%. NPC patients with critical weight loss (> 5.4%) have poorer overall survival (OS) and distant metastasis-free survival (DMFS) than the patients without critical weight loss (p = 0.002 and 0.021, respectively). Pre-radiotherapy weight, acute mucosal toxicity, acute pharynx and esophagus toxicity, and acute upper gastrointestinal toxicity were related to the weight loss during radiotherapy independently (p = 0.01, p < 0.001, p < 0.001, and p = 0.009, respectively). Conclusions: Acute radiation toxicities had significant and independent impact on weight loss during radiotherapy. The vicious circle of acute radiation toxicities and weight loss had bad effect on prognosis of NPC patients.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong 510095, P. R. China;; State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Xiong-Ying Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong 510120, P. R. China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Lu-Jun Shen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong 510060, P. R. China;; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
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Zeng Q, Shen LJ, Guo X, Guo XM, Qian CN, Wu PH. Critical weight loss predicts poor prognosis in nasopharyngeal carcinoma. BMC Cancer 2016; 16:169. [PMID: 26926144 PMCID: PMC4772285 DOI: 10.1186/s12885-016-2214-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impacts of weight loss on prognosis in nasopharyngeal carcinoma (NPC) remain unclear. The present study was therefore undertaken to investigate the association between critical weight loss and long-term survival in NPC patients. METHODS The eligible 2399 NPC patients were reviewed. Weight change was categorized into critical weight loss (CWL) and non-critical weight loss (Non-CWL). The associations of CWL with long-term survival were analyzed by Cox regression in the entire patient and two subsets. Propensity score matching was performed to reduce the effects of confounding factors. RESULTS CWL was defined as body weight loss of ≥4.6 %. Compared with patients without CWL, patients with CWL had significantly lower 5-year OS (72.4 vs. 79.3 %, P < 0.001), FFS (71.1 vs. 78.4 %, P <0.001), and LR-FFS (78.1 vs. 84.8 %, P <0.001), respectively. After adjustment for potential confounders, CWL remained an independence prognostic factor for OS (HR = 1.352; 95 % CI 1.160-1.576; P < 0.001), FFS (HR = 3.275; 95 % CI 1.101-9.740; P = 0.033), and LR-FFS (HR = 6.620; 95 % CI 2.990-14.658; P < 0.001), respectively. Furthermore, subgroup analysis in the cohort of patients received concurrent chemoradiotherapy or radiotherapy alone confirmed the results in the entire patient even after the propensity-score matching. In IMRT cohort, CWL was also significantly associated with a lower OS (P = 0.04) and FFS (P = 0.04). CONCLUSIONS CWL has a significant and independent impact on long-term survival in nasopharyngeal carcinoma patients.
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Affiliation(s)
- Qi Zeng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China.
| | - Lu-Jun Shen
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China.
| | - Xiang Guo
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Xin-Ming Guo
- Department of Pharmacy, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000, PR China.
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
| | - Pei-Hong Wu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Medical Imaging and Interventional Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, PR China.
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32
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Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo)radiotherapy. Oral Oncol 2016; 52:91-6. [DOI: 10.1016/j.oraloncology.2015.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/24/2015] [Accepted: 10/26/2015] [Indexed: 12/14/2022]
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Lønbro S, Petersen GB, Andersen JR, Johansen J. Prediction of critical weight loss during radiation treatment in head and neck cancer patients is dependent on BMI. Support Care Cancer 2015; 24:2101-2109. [PMID: 26553031 DOI: 10.1007/s00520-015-2999-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/26/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aims of the present study were to explore pre-treatment predictors of weight loss during radiation treatment only in head and neck cancer (HNSCC) patients and investigate the weight loss in patients with or without a feeding tube. METHODS Retrospectively, weight change during curative radiotherapy was investigated in 476 consecutive HNSCC patients. Independent predictors were identified using multivariate regression analysis with weight loss below or above 5 % as the primary dependent variable. RESULTS Baseline BMI, tumor site, and stage predicted weight loss above 5 %. The odds of weight loss above 5 % in patients with BMI >25 were 3.00 ± 0.64 times higher compared with patients with BMI <25 (p < 0.0001). Patients with pharyngeal, oral cavity, or supraglottic tumors had 3.12 ± 0.80 times higher odds of weight loss above 5 % compared with glottic cancer patients (p < 0.0001), and the odds were 1.68 ± 0.40 times higher in stage III-IV patients compared with stage I-II patients (p = 0.03). Seperate analyses revealed that tumor site and stage only predicted weight loss in patients with BMI >25 but not in patients with BMI <25. Patients receiving a feeding tube weighed less than patients without (73.8 vs 78.3 kg) and feeding tube reduced, but did not prevent, weight loss which averaged 6.7 ± 4.7 kg (7.4 ± 4.7 %) compared with 4.7 ± 5.9 kg (5.5 ± 6.0 %) in patients without a feeding tube (P < 0.0001). CONCLUSION Pre-treatment BMI, tumor site and stage predicted weight loss above 5 % in HNSCC patients during radiotherapy. BMI should be considered when analyzing weight loss in HNSCC patients receiving curative radiotherapy.
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Affiliation(s)
- Simon Lønbro
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark
| | - Gry Bjerg Petersen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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