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Reed WT, Jiang R, Ohnuma T, Kahmke RR, Pyati S, Krishnamoorthy V, Raghunathan K, Osazuwa-Peters N. Malnutrition and Adverse Outcomes After Surgery for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:14-21. [PMID: 37883116 PMCID: PMC10603580 DOI: 10.1001/jamaoto.2023.3486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
Importance Patients with head and neck cancer (HNC) have an increased risk of malnutrition, partly due to disease location and treatment sequelae. Although malnutrition is associated with adverse outcomes, there is little data on the extent of outcomes and the sociodemographic factors associated with malnutrition in patients with HNC. Objectives To investigate the association of race, ethnicity, and payer type with perioperative malnutrition in patients undergoing HNC surgery and how malnutrition affects clinical outcomes. Design, Setting, and Participants This retrospective cohort study used data from the Premier Healthcare Database to assess adult patients who had undergone HNC surgery from January 2008 to June 2020 at 482 hospitals across the US. Diagnosis and procedure codes were used to identify a subset of patients with perioperative malnutrition. Patient characteristics, payer types, and hospital outcomes were then compared to find associations among race, ethnicity, payer type, malnutrition, and clinical outcomes using multivariable logistic regression models. Analyses were performed from August 2022 to January 2023. Exposures Race, ethnicity, and payer type for primary outcome, and perioperative malnutrition status, race, ethnicity, and payer type for secondary outcomes. Main Outcomes and Measures Perioperative malnutrition status. Secondary outcomes were discharge to home after surgery, hospital length of stay (LOS), total cost, and postoperative pulmonary complications (PPCs). Results The study population comprised 13 895 adult patients who had undergone HNC surgery during the study period; they had a mean (SD) age of 63.4 (12.1) years; 9425 male (67.8%) patients; 968 Black (7.0%), 10 698 White (77.0%), and 2229 (16.0%) individuals of other races; and 887 Hispanic (6.4%) and 13 008 non-Hispanic (93.6%) individuals. Among the total sample, there were 3136 patients (22.6%) diagnosed with perioperative malnutrition. Compared with White patients and patients with private health insurance, the odds of malnutrition were higher for non-Hispanic Black patients (adjusted odds ratio [aOR], 1.31; 95% CI, 1.11-1.56), Medicaid-insured patients (aOR, 1.68; 95% CI, 1.46-1.95), and Medicare-insured patients (aOR, 1.24; 95% CI, 1.10-1.73). Black patients and patients insured by Medicaid had increased LOS, costs, and PPCs, and lower rates of discharge to home. Malnutrition was independently associated with increased LOS (β, 5.20 additional days; 95% CI, 4.83-5.64), higher costs (β, $15 722 more cost; 95% CI, $14 301-$17 143), increased odds of PPCs (aOR, 2.04; 95% CI, 1.83-2.23), and lower odds of discharge to home (aOR, 0.34; 95% CI, 0.31-0.38). No independent association between malnutrition and mortality was observed. Conclusions and Relevance This retrospective cohort study found that 1 in 5 patients undergoing HNC surgery were malnourished. Malnourishment disproportionately affected Black patients and patients with Medicaid, and contributed to longer hospital stays, higher costs, and more postoperative complications.
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Affiliation(s)
- William T. Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tetsu Ohnuma
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
| | - Shreyas Pyati
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Vijay Krishnamoorthy
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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Ascoli A, Missale F, Giordano GG, Vallin A, Gradaschi R, Guiddo E, Schenone G, Sukkar SG, Copello F, Parrinello G, Iandelli A, Peretti G, Marchi F. Immunonutrition in major oncologic head and neck surgery: Analysis of complications, plasmatic equilibrium, and costs. Head Neck 2023; 45:449-463. [PMID: 36490206 DOI: 10.1002/hed.27270] [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: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Malnutrition, in patients with solid tumors, is associated with a worse clinical outcome and about 40% of patients affected by head and neck cancers (HNC) are malnourished at the time of cancer diagnosis. We investigated the potential benefit of a standardized immunonutritional protocol (INP) to patients with HNC receiving major ablative surgery. METHODS An observational study was conducted enrolling 199 patients: 50 treated with the INP and 149 with standard enteral nutrition. Complication rates, need for medications, and costs were considered as outcomes. RESULTS INP played a protective role in development of major surgical complications (OR 0.23, p = 0.023), albumin administration (RR 0.38, p = 0.018), and antibiotic duration (p < 0.001) and is cost-effective in patients with moderate or severe malnutrition (-6083€ and -11 988€, p < 0.05). CONCLUSIONS Our study supports the utility of INP, and accurate nutritional screening can help to identify malnourished patients who would receive the most benefits from this protocol.
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Affiliation(s)
- Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Head & Neck Oncology & Surgery Otorhinolaryngology, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Giorgio-Gregory Giordano
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alberto Vallin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Raffaella Gradaschi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Erica Guiddo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | | | - Samir Giuseppe Sukkar
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Dietetics and Clinical Nutrition Unit, University of Genova, Genoa, Italy
| | - Francesco Copello
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
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3
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Hoang BV, Tran TT, Duong YT, Nguyen LT, Ngo DQ, Nguyen DV, Ngo QX, Nguyen HT, LE QV, LE HT. The Effects of Nutrition Intervention on Postoperative Patients with Tongue Cancer and Floor of Mouth Cancer. J Nutr Sci Vitaminol (Tokyo) 2022; 68:488-495. [PMID: 36596546 DOI: 10.3177/jnsv.68.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study is to evaluate the effect of intensive nutrition support on patients with tongue cancer and floor of mouth cancer after surgery at K Hospital, Tan Trieu campus. Study the clinical intervention with a control group. We conducted the intensive nutrition intervention for our patients by giving counseling materials, sample menu and nutritional supplements, while the control group had only advice about dietary regimens. We evaluated a group before and after the intervention, at the same time compare the two groups before and after the intervention. After 1 mo, the intervention group increased 0.51±1.43 kg in comparison with their weight at the beginning; the weight of the control group lost -0.59±2.33 kg; the difference had statistical significance (p=0.025). After 1 and 2 mo of intervention, the rates of the participants without risk of malnutrition in the intervention group increased significantly in comparison with that in the control group; the difference has statistical significance with p=0.001 and p=0.003. In terms of quality of life, patients' problems related to areas including health status, functioning, symptoms of the intervention group improved more greatly than those of the control group. Especially, anorexia symptoms and financial impact were improved well in the intervention group (p=0.033, p=0.018). Nutrition intervention in patients with tongue cancer and floor of mouth cancer has shown a beneficial effect of nutrition counseling and intervention to improve patients' status in terms of nutrition and their quality of life.
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Affiliation(s)
| | - Thuy Thi Tran
- Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health, Hanoi Medical University
| | | | | | | | | | | | | | | | - Huong Thi LE
- Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health, Hanoi Medical University
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4
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Won SH, Hiratsuka Y, Suh SY, Bae H, Choi SE, Kim YJ, Kang B, Lee SW, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW. Mid-upper Arm Circumference as an Indicator of Quality of Life of Patients with Advanced Cancer. J Palliat Care 2022; 38:24-29. [PMID: 36065585 DOI: 10.1177/08258597221121321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mid-upper arm circumference (MUAC) has been used to assess malnutrition and health status across various disease groups. However, it is unclear whether MUAC is associated with quality of life (QOL) of patients with advanced cancer. Our goal was to investigate the relationship between MUAC and QOL in ambulatory out-patients with advanced cancer. METHOD This was a cross-sectional study conducted in a tertiary cancer center in South Korea. A total of 200 patients with advanced cancer at oncology clinics of Seoul National University Bundang Hospital from March 2016 to January 2019 were enrolled. Out-patients with advanced cancer whose survival was expected to be less than one year by their oncologists were enrolled. QOL of patients was evaluated using the European Organization for Research and Treatment of Cancer quality of life questionnaire core 30 (EORTC QLQ-C30). Associations of QOL with MUAC and nutritional parameters were examined with generalized linear models. RESULTS The most common cancer sites were the lung, colon or rectum, and genitourinary tract. In univariate analyses, significant factors associated with higher summary score of EORTC QLQ-C30 were higher MUAC (≥ 26.5 cm, p < 0.001), higher body mass index (BMI) (≥ 22 kg/m2, p < 0.001), higher serum albumin (≥ 3.7 g/dL, p < 0.01), higher creatinine (≥ 0.8 mg/dL, p = 0.023), and higher uric acid (≥ 5 mg/dL, p < 0.01). In multivariate analysis, higher serum albumin (≥ 3.7 g/dL, p < 0.01) and higher MUAC (≥ 26.5 cm, p = 0.03) were independently associated with better summary score of EORTC QLQ-C-30. CONCLUSION MUAC was highly associated with QOL in terms of summary score and overall health status. Thus, MUAC, with its simplicity, can be a useful tool to reflect QOL in patients with advanced cancer.
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Affiliation(s)
- Seon-Hye Won
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, 38047Tohoku University School of Medicine, Sendai, Japan.,Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea.,Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Hayoung Bae
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Sung-Eun Choi
- Department of Statistics, 34942Dongguk University-Seoul, Seoul, South Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Beodeul Kang
- Division of Medical Oncology, 299466Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, 37991Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, South Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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5
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Forner D, Mok F, Verma N, Karam I, Goldstein D, Higgins K, Enepekides D, Nadler A, Pugash R, Husain Z, Chan K, Smoragiewicz M, Cohen L, Hazey JW, Fung EC, Kang SY, Seim NB, Simpson C, Eskander A. Placement technique impacts gastrostomy tube-related complications amongst head and neck cancer patients. Oral Oncol 2022; 130:105903. [DOI: 10.1016/j.oraloncology.2022.105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
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Pretreatment nutritional status is associated with quality of life in patients with gastric cancer: a cross-sectional study from Iran. Support Care Cancer 2022; 30:3313-3319. [PMID: 34985562 DOI: 10.1007/s00520-021-06792-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In the present study, we evaluated the association of nutritional status and quality of life (QoL) in patients with gastric cancer (GC). MATERIALS AND METHODS In the present cross-sectional study, the study sample consisted of 299 patients with GC. The assessment of the nutritional status and QoL of patients was done after diagnosis and before initiation of any treatment. The nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA). The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTCQLQ-C30) was used for the assessment of QoL score. Statistical significance was reported at the p < 0.05 level. RESULTS The mean age of participants was 67.39 ± 12.04 years and 65.5% of them were males. According to the PG-SGA, 28.5% of patients were in good nutritional condition. The patients with better nutrition status had significantly better global and functional categories scores (p < 0.001) except social functioning. Moreover, they had significantly lower scores in symptoms severity except for dyspnea, constipation, and diarrhea. The result of regression analysis indicated that after adjusting to confounders, nutrition status was significantly associated with global score and functional categories score except for social and emotional functioning scores. Moreover, in terms of symptom categories, there was a significant association between PG-SGA score and all symptoms except diarrhea and dyspnea. CONCLUSION The results of the present study showed the significant association between nutrition status and functioning and symptom categories of QoL in patients with GC.
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7
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr 2021; 40:4745-4761. [PMID: 34242915 DOI: 10.1016/j.clnu.2021.03.031] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the integration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.
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Affiliation(s)
- Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Marco Braga
- University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Franco Carli
- Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada
| | | | - Martin Hübner
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Lausanne, Lausanne, Switzerland
| | - Stanislaw Klek
- General Surgical Oncology Clinic, National Cancer Institute, Krakow, Poland
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Dan Waitzberg
- University of Sao Paulo Medical School, Ganep, Human Nutrition, Sao Paulo, Brazil
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Pierre Singer
- Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva, Israel
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8
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Solís-Martínez O, Álvarez-Altamirano K, Cardenas D, Trujillo-Cabrera Y, Fuchs-Tarlovsky V. Cancer Cachexia Affects Patients with Head and Neck Cancer in All Stages of Disease: A Prospective Cross-Sectional Study. Nutr Cancer 2021; 74:82-89. [PMID: 33455464 DOI: 10.1080/01635581.2020.1869792] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of the study was to determine the prevalence of cancer cachexia according to the clinical stage and determine differences in body composition, usual energy intake, and pro-inflammatory profile between cachectic and non-cachectic patients newly diagnosed with head and neck squamous cell carcinoma (HNSCC). A cross-sectional study was conducted in adult patients diagnosed with HNSCC admitted to the oncology unit before starting cancer treatment. Cancer cachexia was assessed according to Fearon criteria, and patients were divided into two groups: cachectic and non-cachectic patients. Body composition measured by bioelectrical impedance, energy intake, and biochemical and inflammatory markers were assessed. Comparative analyses were performed Student's-T test, using one-way ANOVA, chi-square and Mann Whitney-U test. Of the 79 consecutive patients included in the analysis, 72% (n = 57; 61 ± 15 years) were classified as cachectic and 28% (n = 22;59 ± 10 years) as non-cachectic. According to clinical stage, the prevalence of cachexia was stage I = 8.8%, stage II = 15.8%, stage III = 33.3% and stage IV = 42.1% (P = 0.564) and phase angle showed to be different between these groups (P < 0.05). Body composition showed that fat-free mass and total body water were significantly lower in patients with cachexia (p < 0.05). No differences were observed in phase angle, food intake or inflammatory markers between cachectic and non-cachectic patients. Cancer-cachexia is prevalent in all clinical stages in newly diagnosed patients with HNSCC. Early identification of cancer cachexia will allow initiate specialized nutrition support in a timely manner.
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Affiliation(s)
| | | | - Diana Cardenas
- Faculty of Medicine, Instituto de Nutrición, Genética y Metabolismo, Universidad del Bosque, Bogotá, Colombia
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Chang SW, Hsu CM, Tsai YH, Chang GH, Tsai MS, Huang EI, Tsai YT. Prognostic Value of Third Cervical Vertebra Skeletal Muscle Index in Oral Cavity Cancer: A Retrospective Study. Laryngoscope 2021; 131:E2257-E2265. [PMID: 33433021 DOI: 10.1002/lary.29390] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the prognostic utility of third cervical vertebra skeletal muscle index (C3 SMI) measured from preoperative head and neck computed tomography (CT) in patients with oral cavity squamous cell carcinoma (OSCC). STUDY DESIGN Retrospective study. METHODS We retrospectively reviewed the medical records of 125 patients who underwent primary curative surgery for OSCC between 2009 and 2017. Their preoperative C3 SMI was calculated by adjusting the C3 cross-sectional area delineated on head and neck CT by body height squared. A Cox proportional hazard model was employed to identify prognostic factors, and a novel nomogram based on C3 SMI was built for individualized survival prediction. RESULTS In Kaplan-Meier analysis, high C3 SMI was significantly associated with higher 5-year disease-free survival (DFS) and overall survival (OS) than low C3 SMI. In multivariate analysis, low C3 SMI was an independent risk factor for poor DFS and OS (hazard ratio [HR]: 2.197; 95% confidence interval [CI], 1.170-4.512, P = .032 and HR: 2.143; 95% CI, 1.232-3.728, P = .007, respectively). The concordance-index (C-index) of the nomogram based on C3 SMI was 0.814 for OS, higher than that of the nomogram based on tumor-node-metastasis staging alone (C-index = 0.731). CONCLUSIONS C3 SMI might serve as a novel prognosticator in OSCC patients undergoing curative surgery, and the nomogram based on C3 SMI might provide good prognostic discrimination ability for individualized survival prediction. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2257-E2265, 2021.
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Affiliation(s)
- Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ethan I Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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10
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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11
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Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment. Nutrients 2020; 12:nu12113493. [PMID: 33203000 PMCID: PMC7697929 DOI: 10.3390/nu12113493] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
Malnutrition is highly prevalent in people with head and neck cancer (HCN) and is associated with poorer outcomes. However, variation in malnutrition diagnostic criteria has made translation of the most effective interventions into practice challenging. This study aimed to determine the prevalence of malnutrition in a HNC population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and assess inter-rater reliability and predictive validity. A secondary analysis of data available for 188 patients with HNC extracted from two cancer malnutrition point prevalence studies was conducted. A GLIM diagnosis of malnutrition was assigned when one phenotypic and one etiologic criterion were present. Phenotypic criteria were ≥5% unintentional loss of body weight, body mass index (BMI), and subjective evidence of muscle loss. Etiologic criteria were reduced food intake, and presence of metastatic disease as a proxy for inflammation. The prevalence of malnutrition was 22.6% (8.0% moderately malnourished; 13.3% severely malnourished). Inter-rater reliability was classified as excellent for the GLIM criteria overall, as well as for each individual criterion. A GLIM diagnosis of malnutrition was found to be significantly associated with BMI but was not predictive of 30 day hospital readmission. Further large, prospective cohort studies are required in this patient population to further validate the GLIM criteria.
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12
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Peled O, Lavan O, Stein J, Vinograd I, Yahel A, Valevski A, Weizman A, Kimmel-Tamir E, Apter A, Fennig S, Yaniv I, Bernfeld Y, Benaroya-Milshtein N. Psychopharmacology in the Pediatric Oncology and Bone Marrow Transplant Units: Antipsychotic Medications Palliate Symptoms in Children with Cancer. J Child Adolesc Psychopharmacol 2020; 30:486-494. [PMID: 32845729 DOI: 10.1089/cap.2019.0164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives: The present study characterized the psychiatric diagnoses and symptoms that led to the administration of antipsychotic medications in children and adolescents with cancer, and to evaluate the benefits and tolerability of these drugs in a large hospital-based pediatric hematology-oncology practice. Methods: Efficacy and adverse effects of two second-generation antipsychotics were retrospectively analyzed in 43 patients 2.9-19.6 (mean 12.1) years of age. The Clinical Global Impression-Severity (CGI-S) Scale and Improvement (CGI-I) Scale were used to evaluate psychiatric symptom severity before and following treatment, while the incidence of side effects and drug-drug interactions were collected from medical records. Results: Olanzapine was administered to 58% of patients and risperidone to 42%; the choice of drug was at the discretion of the treating psychiatrist. The common psychiatric diagnoses among these patients included adjustment disorder (37%) and medication-induced psychiatric disorders (23%). The most common psychiatric-medical symptoms included irritability/agitation (79%) and depressed mood (74%). CGI-S improved significantly (p < 0.001) between assessments, with no statistically significant difference between olanzapine- and risperidone-treated patients. CGI-I scores at reassessment indicated superiority of olanzapine as compared with risperidone. Adverse effects of treatment were mild. Conclusions: Olanzapine and risperidone can be well tolerated and ameliorate severe psychiatric-medical symptoms in children and adolescents with cancer. The potential palliative benefits of these second-generation antipsychotics (e.g., rapid onset of action, antiemesis, sedation, and appetite stimulation) increase the utility of their use in children treated in oncology and bone marrow transplant units.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Lavan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Jerry Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Inbal Vinograd
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yahel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Avi Valevski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Unit, Geha Mental Health Center, and Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Unit, Geha Mental Health Center, and Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Ella Kimmel-Tamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Isaac Yaniv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Bernfeld
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Benaroya-Milshtein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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13
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Dharmawardana N, Goddard T, Woods C, Watson DI, Butler R, Ooi EH, Yazbeck R. Breath methane to hydrogen ratio as a surrogate marker of intestinal dysbiosis in head and neck cancer. Sci Rep 2020; 10:15010. [PMID: 32929151 PMCID: PMC7490703 DOI: 10.1038/s41598-020-72115-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/13/2020] [Indexed: 01/30/2023] Open
Abstract
Exhaled breath compounds can non-invasively detect head and neck squamous cell carcinoma (HNSCC). Here we investigated exhaled compounds related to intestinal bacterial carbohydrate fermentation. Fasting breath samples were collected into 3 litre FlexFoil PLUS bags from patients awaiting a biopsy procedure for suspected HNSCC. Samples were analysed using a Syft selected ion flow-tube mass spectrometer and a Quintron BreathTracker. Two tailed non-parametric significance testing was conducted with corrections for multiple imputations. 74 patients were diagnosed (histological) with HNSCC and 61 patients were benign (controls). The methane to hydrogen ratio was significantly different between cancer and non-cancer controls (p = 0.0440). This ratio increased with tumour stage with a significant difference between T1 and T4 tumours (p = 0.0259). Hydrogen levels were significantly higher in controls who were smokers (p = 0.0129), with no smoking dependent methane changes. There were no differences in short chain fatty acids between groups. Exhaled compounds of intestinal carbohydrate fermentation can detect HNSCC patients. These findings suggest a modified carbohydrate fermentation profile in HNSCC patients that is tumour stage and smoking status dependent.
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Affiliation(s)
- Nuwan Dharmawardana
- Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia. .,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Thomas Goddard
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Charmaine Woods
- Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ross Butler
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Eng H Ooi
- Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Roger Yazbeck
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Siu J, Fuller K, Nadler A, Pugash R, Cohen L, Deutsch K, Enepekides D, Karam I, Husain Z, Chan K, Singh S, Poon I, Higgins K, Xu B, Eskander A. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91:1005-1014.e17. [PMID: 31926149 DOI: 10.1016/j.gie.2019.12.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathologic characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers. METHODS This was a systematic review and meta-analysis of 6138 studies retrieved from Medline, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies. RESULTS The final analysis included 121 studies. Pooled analysis showed an overall event rate gastrostomy site metastasis of .5% (95% confidence interval [CI], .4%-.7%). Subgroup analysis showed an event rate of .56% (95% CI, .40%-.79%) with the pull technique and .29% (95% CI, .15%-.55%) with the push technique. Clinicopathologic characteristics observed with gastrostomy site metastasis were late-stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. The average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 cm (standard deviation, 2.02), and average length of survival was 7.26 months (standard deviation, 6.23). CONCLUSIONS Gastrostomy site metastasis is a rare but serious adverse event that occurs at an overall rate of .5%, particularly in patients with advanced-stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada
| | - Ashlie Nadler
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Pugash
- Vascular/Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lawrence Cohen
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin Chan
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, Michael Garron Hospital, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Science, Toronto, Ontario, Canada
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15
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Meng L, Wei J, Ji R, Wang B, Xu X, Xin Y, Jiang X. Effect of Early Nutrition Intervention on Advanced Nasopharyngeal Carcinoma Patients Receiving Chemoradiotherapy. J Cancer 2019; 10:3650-3656. [PMID: 31333782 PMCID: PMC6636293 DOI: 10.7150/jca.33475] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n=46) and late (n=32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or >10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p<0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p<0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusion: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients' life quality.
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Affiliation(s)
- Lingbin Meng
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
- Department of Internal Medicine, Florida Hospital, Orlando, FL 32804, USA
| | - Jinlong Wei
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
| | - Rui Ji
- Department of Biology, Valencia College, Orlando, FL 32825, USA
| | - Bin Wang
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
| | - Xiaochun Xu
- Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Ying Xin
- The Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, China
| | - Xin Jiang
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
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16
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Liao LJ, Hsu WL, Lo WC, Cheng PW, Shueng PW, Hsieh CH. Health-related quality of life and utility in head and neck cancer survivors. BMC Cancer 2019; 19:425. [PMID: 31064331 PMCID: PMC6505071 DOI: 10.1186/s12885-019-5614-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study seeks to assess quality of life (QOL) and utility scores of head and neck cancer survivors. Methods We compared QOL as indicated by EORTC QLQ-C30, QLQ-H&N35, utility scores by time trade off (TTO) with previous published reference values and tested series characteristics related to global QOL and utility. Results A total of 127 patients were recruited. Of the patients, 102 (80%) completed the utility assessment. Cancer survivors had lower scores compared with norm values. Patients without a spouse had a lower utility than those with a spouse. Patients with a low annual family income also had lower global QOL and utility scores (p < 0.05). Other factors were not significantly related to QOL and utility scores. Conclusion Disease and treatment of head and neck cancer lead to disability and poor health-related QOL and utility. Economic status may contribute to health-related QOL and utility, while marital status is related to utility for head and neck cancer patients.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Wan-Lun Hsu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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17
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Lundberg M, Dickinson A, Nikander P, Orell H, Mäkitie A. Low-phase angle in body composition measurements correlates with prolonged hospital stay in head and neck cancer patients. Acta Otolaryngol 2019; 139:383-387. [PMID: 30900483 DOI: 10.1080/00016489.2019.1566779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a method for estimating body composition. Clinically the most important parameter is the phase angle (PA), which decreases with progressing malnutrition and is highly predictive for impaired survival and mortality. AIM To evaluate the association of low PA with the complication rate and length of hospital stay. MATERIAL AND METHODS A cohort of 61 head and neck cancer (HNC) patients underwent BIA prior to surgical treatment. Information on patient and tumour characteristics, treatment, and surgical complications were gathered from hospital records and correlated with BIA results. RESULTS The median PA was 4.5 (range, 2.7-6.5), and, in 67% of the patients, it was lower than reference values. Low PA was associated with longer hospital stay (p = .002) in the whole cohort and in the patient group with radical neck dissections it correlated with a higher surgical complication rate (p = .014), but not with Clavien-Dindo scoring for surgical complications. CONCLUSIONS AND SIGNIFICANCE BIA is a feasible instrument for analysing body composition that reflects nutritional status in cancer patients. Our results show that HNC patients have a low PA at diagnosis. Low PA is associated with a long hospital stay and an increase in the complication rate. BIA can be of clinical value in preoperative risk evaluation.
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Affiliation(s)
- Marie Lundberg
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Amy Dickinson
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Pia Nikander
- Clinical Nutrition Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | - Helena Orell
- Clinical Nutrition Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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18
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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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19
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Naffouje SA, De La Cruz K, Berard D, Guy S, Salti GI. Knowledge, attitudes and practice of surgeons regarding nutritional support in CRS and HIPEC patients: Are we missing something? Eur J Cancer Care (Engl) 2018; 28:e12930. [PMID: 30298962 DOI: 10.1111/ecc.12930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 04/05/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022]
Abstract
Nutrition's impact on the surgical outcome has been established in various surgical specialties. However, data addressing the nutritional aspect following surgery for peritoneal surface malignancies are considered scarce. We aim to evaluate the knowledge, attitudes, and practice of surgeons regarding their nutritional support for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) via a survey directed to self-evaluate nutritional knowledge, screening, and practice toward patients. The survey was submitted to the attendees of the International Regional Cancer Therapies Symposium. The response rate was 37% (56/151). Most surgeons estimated their knowledge and malnutrition screening skills in CRS and HIPEC to be 'adequate' or better. Only 35.19% reported the availability of nutritional screening and assessment tools for CRS and HIPEC patients. 86.5% of participants stated that their CRS and HIPEC patients have access to a dietitian on inpatient and outpatient basis. However, only 32.69% reported to 'always' consult a dietitian. Otherwise, the involvement of a nutrition specialist is considered on variable basis. Despite the consensus on the importance of nutrition in HIPEC patients, there appears to be a profound underutilization of nutrition specialists in the patients' management, which may have had in impact on their surgical outcome.
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Affiliation(s)
- Samer A Naffouje
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Katia De La Cruz
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Doreen Berard
- Department of Dietetics, Edward Cancer Center, Naperville, Illinois
| | - Sandra Guy
- Department of Surgical Oncology, Edward Cancer Center, Naperville, Illinois
| | - George I Salti
- Department of Surgical Oncology, Edward Cancer Center, Naperville, Illinois.,Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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20
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Caulley L, Hunink MG, Kilty S, Metha V, Scangas G, Rodin D, Randolph G, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes. Otolaryngol Head Neck Surg 2018; 160:11-21. [PMID: 30252610 DOI: 10.1177/0194599818800477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.
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Affiliation(s)
- Lisa Caulley
- 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G Hunink
- 4 Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.,5 Center for Health Decision Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shaun Kilty
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vikas Metha
- 6 Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, USA
| | - George Scangas
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Rodin
- 8 Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,9 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Randolph
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Melissant HC, Jansen F, Schutte LER, Lissenberg-Witte BI, Buter J, Leemans CR, Sprangers MA, Vergeer MR, Laan ETM, Verdonck-de Leeuw IM. The course of sexual interest and enjoyment in head and neck cancer patients treated with primary (chemo)radiotherapy. Oral Oncol 2018; 83:120-126. [PMID: 30098767 DOI: 10.1016/j.oraloncology.2018.06.016] [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: 02/21/2018] [Revised: 06/04/2018] [Accepted: 06/17/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of this prospective study was to investigate the course of sexual interest and enjoyment in relation to sociodemographic and clinical factors, health-related quality of life (HRQOL), and symptoms of psychological distress in head and neck cancer (HNC) patients treated with primary (chemo)radiotherapy. METHODS HNC patients (n = 354) completed patient-reported outcome measures (PROMs) on HRQOL (EORTC QLQ-C30 and QLQ-H&N35, including the sexuality subscale covering less sexual interest and enjoyment), and psychological distress (HADS) pretreatment, at 6-week follow-up and at 3-, 6-, 12-, 18-, and 24-month follow-up (i.e., after treatment). Linear mixed models were used to analyze the course of sexuality from pretreatment to 24-month follow-up, and to investigate its relation to sociodemographic and clinical factors, HRQOL, and psychological distress as measured at baseline, and to investigate the course of sexuality from 6- to 24-month follow-up in relation to these factors measured at 6-month follow-up. RESULTS Before start of treatment, 37% of patients reported having less sexuality, which increased to 60% at 6-week follow-up, and returned to baseline level from 12-month follow-up onwards. Older age (p = 0.037) and trouble with social contact (p < 0.001), weight loss (p = 0.013), and constipation (p = 0.041) before treatment were associated with less sexuality over time. Female gender (p = 0.021) and poor social functioning (p < 0.001) at 6-month follow-up were associated with less sexuality from 6- to 24-month follow-up. DISCUSSION Less sexuality is often reported in HNC patients treated with (chemo)radiotherapy. Using PROMs in clinical practice may help identify patients who might benefit from supportive care targeting sexuality.
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Affiliation(s)
- H C Melissant
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - F Jansen
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - L E R Schutte
- Department of Sexology and Psychosomatic OBGYN, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands.
| | - J Buter
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - C R Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - M A Sprangers
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - M R Vergeer
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - E T M Laan
- Department of Sexology and Psychosomatic OBGYN, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
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22
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Abstract
Head and neck cancer (HNC) patients often face multiple nutritional challenges before, during, and after treatment due to the close proximity of the cancer to organs that are vital for normal eating function. Common treatment-related side effects, such as dysphagia, odynophagia, dysgeusia, xerostomia, thick saliva, mucositis, nausea, and vomiting, all further impair the patient's ability to maintain adequate oral intake. Malnutrition and unintentional weight loss in HNC patients during and after treatment are associated with poorer treatment outcomes, increased morbidity and mortality, and poor quality of life, even in overweight and obese patients whose Body Mass Index (BMI) is not suggestive of malnutrition. The main nutrition goal for HNC patients is thus to maximize nutrition intake either orally or through nutrition support therapy in order to prevent or limit weight loss, preserve lean body mass, minimize treatment delays and unplanned hospitalizations, and improve treatment outcomes. This chapter will discuss nutrition interventions to manage common symptoms before, during, and after treatment for HNC. Guidelines will be provided for patients that require enteral nutrition or less commonly, parenteral nutrition.
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Affiliation(s)
- Denise Ackerman
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Meghan Laszlo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arlene Provisor
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Adern Yu
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
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23
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van Overveld L, Takes R, Turan A, Braspenning J, Smeele L, Merkx M, Hermens R. Needs and preferences of patients with head and neck cancer in integrated care. Clin Otolaryngol 2017; 43:553-561. [DOI: 10.1111/coa.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L.F.J. van Overveld
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - R.P. Takes
- Department of Otolaryngology, Head and Neck surgery; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A.S. Turan
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
- Radboud University Medical Centre; Nijmegen the Netherlands
| | - J.C.C. Braspenning
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - L.E. Smeele
- Department of Head and Neck Surgery and Oncology; Antoni van Leeuwenhoek Nederlands Kanker Instituut; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academisch Medisch Centrum; Amsterdam Zuid-Oost the Netherlands
| | - M.A.W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - R.P.M.G. Hermens
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
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Jin T, Li KX, Li PJ, Huang S, Chen XZ, Chen M, Hu QY, Shi L, Chen YY. An evaluation of nutrition intervention during radiation therapy in patients with locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:83723-83733. [PMID: 29137377 PMCID: PMC5663549 DOI: 10.18632/oncotarget.19381] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the effectiveness of nutrition intervention during radiation for patients with locoregionally advanced (III-IVa) nasopharyngeal carcinoma (NPC). Materials and Methods We retrospectively reviewed 117 patients with locoregionally advanced (III-IVa) NPC treated between December 2015 and March 2016 in Zhejiang Cancer Hospital. All the patients underwent radical chemo-radiotherapy. First, all the patients were divided into the nutrition intervention group and the control group, depending on whether they accepted nutrition intervention. Repeated measures were used to analyze the change of nutritional indicators before, during, and after radiation therapy and to simultaneously compare the difference in nutritional status between the two groups at the same time point. Subsequently, the 117 patients were divided into the malnourished group (weight loss > 5%) and the non-malnourished group (weight loss ≤ 5%) according to whether their weight loss was over 5% of their body weight during radiotherapy. Chi-square tests and logistic regression analysis were used to explore the influence factors for the weight loss. Results The repeated measures showed that all indicators including weight, body mass index (BMI), albumin, pre-albumin(PA), and prognostic nutritional index (PNI) dramatically declined in both groups compared with their levels before radiation therapy (All p < 0.001). However, there was no significant difference between the intervention and non-intervention groups regarding the mean values of nutritional indicators at the same time point, that before, during, and after radiation therapy, except BMI (All p > 0.05). Logistic regression analysis revealed grade ≥ 3 radiation-induced oral mucositis as the prognostic factor for a poor nutrition status (odds ratio, OR = 3.232, p = 0.021, confidence interval, CI [1.198, 8.820]). Besides this, patients with a decrease of >15% in pre-albumin level were more likely to be malnourished (OR = 2.442, p = 0.041, CI [1.036, 5.757]). Similar to that observed in our former analysis, we did not find that existing nutrition intervention can significantly improve nutritional status (OR = 1.217, p = 0.704, CI [0.042, 3.348]). Conclusions Our study shows that the nutritional status of the patients gradually declined during treatment. We concluded that grade ≥ 3 radiation-induced oral mucositis would aggravate the extent of malnutrition during radiation therapy in patients with locoregionally advanced NPC. Pre-albumin level was a predictive marker for weight loss in patients with NPC. However, current nutrition intervention during radiation therapy can't significantly reverse nutritional status.
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Affiliation(s)
- Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Kai-Xin Li
- Department of Radiation Oncology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China
| | - Pei-Jing Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Shuang Huang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xiao-Zhong Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qiao-Ying Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Lei Shi
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yuan-Yuan Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
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25
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Nesemeier R, Dunlap N, McClave SA, Tennant P. Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer. CURRENT SURGERY REPORTS 2017; 5:18. [PMID: 32288971 PMCID: PMC7102400 DOI: 10.1007/s40137-017-0179-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with head and neck (H&N) cancer often present in a malnourished state for varied reasons; nutritional optimization is therefore critical to the success of treatment for these complex patients. This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population. RECENT FINDINGS Aggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not be universally applied. Perioperative nutritional optimization including preoperative carbohydrate loading and provision of arginine-supplemented immunonutrition has been shown to benefit at-risk H&N cancer patients. SUMMARY With multidisciplinary collaboration, H&N cancer patients can receive individualized nutritional support to withstand difficult cancer treatment regimens and return to acceptable states of nutritional health.
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Affiliation(s)
- Ryan Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, KY USA
| | - Stephen A. McClave
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, University of Louisville, Louisville, KY USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
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26
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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36:623-650. [DOI: 10.1016/j.clnu.2017.02.013] [Citation(s) in RCA: 966] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 02/07/2023]
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27
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Lundberg M, Nikander P, Tuomainen K, Orell-Kotikangas H, Mäkitie A. Bioelectrical impedance analysis of head and neck cancer patients at presentation. Acta Otolaryngol 2017; 137:417-420. [PMID: 28079435 DOI: 10.1080/00016489.2016.1266510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
CONCLUSION Finnish head and neck cancer (HNC) patients show signs of severe malnutrition already at presentation, measured by bioelectric impedance analysis (BIA). BIA may be a practical method to detect malnutrition, analyze body composition, and to identify high-risk patients in this population. OBJECTIVES BIA is a validated method for evaluating body composition and detecting malnutrition. Low phase angle (PA) is associated with increased mortality and morbidity. Vector analysis (BIVA) provides a qualitative measure for hydration and cell mass, independent of body size. This study describes BIA results in Finnish HNC patients at presentation. METHODS Forty-one newly-diagnosed HNC patients at the Helsinki University Hospital were included. BIA measures (resistance, reactance, PA, fat-free mass index [FFMI], and fat mass index [FMI]), body mass index (BMI), and Charlson Comorbidity Index (CCI) were determined. RESULTS The majority of patients were men (78%), with a normal average BMI of 25.2. Low FFMI was seen in 44% of women and 28% of men. The PA (median = 4.6; IQ range = 4-5) was lower than the reference values in 76% (n = 31) of cases. In BIVA, only 13 (32%) of the patients were within normal range and 15 (37%) were plotted in the quadrant indicating malnutrition.
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Affiliation(s)
- Marie Lundberg
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Nikander
- Clinical Nutrition Unit, Helsinki University Hospital, Helsinki, Finland
| | - Katja Tuomainen
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Antti Mäkitie
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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28
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Thompson KL, Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T. Oncology Evidence-Based Nutrition Practice Guideline for Adults. J Acad Nutr Diet 2017; 117:297-310.e47. [DOI: 10.1016/j.jand.2016.05.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 01/04/2023]
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Visser E, van Rossum PSN, Leeftink AG, Siesling S, van Hillegersberg R, Ruurda JP. Impact of diagnosis-to-treatment waiting time on survival in esophageal cancer patients - A population-based study in The Netherlands. Eur J Surg Oncol 2016; 43:461-470. [PMID: 27847286 DOI: 10.1016/j.ejso.2016.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/27/2016] [Accepted: 10/21/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether the waiting time from diagnosis to treatment with curative intent for esophageal cancer impacts oncologic outcomes. PATIENTS AND METHODS All patients treated by esophagectomy for esophageal carcinoma in 2005-2013 were identified from the Netherlands Cancer Registry. Patients who underwent multimodality treatment and patients treated with surgery only were analyzed separately. Multivariable logistic regression analyses were performed to evaluate the impact of diagnosis-to-treatment waiting time on pT-status, pN-status, and R0 resection rates. Cox regression was applied to estimate the influence of waiting time on overall survival. Analyses were performed with the original scale and in three categorized groups of waiting time (≤5 weeks, 5-8 weeks, and >8 weeks) based on guidelines and previous studies. RESULTS Of 3839 patients, 2589 underwent multimodality treatment and 1250 were treated with surgery only. In both groups, pT-status, pN-status, and R0 resection rates were not significantly influenced by waiting time (p-values >0.05). Also, waiting time was not significantly associated with overall survival in the multimodality treatment group (5-8 weeks vs. ≤5 weeks, hazard ratio [HR] 1.12, p = 0.171; and >8 weeks vs. ≤5 weeks, HR 1.21, p = 0.167), nor in the surgery only group (5-8 weeks vs. ≤5 weeks, HR 0.92, p = 0.432; and >8 weeks vs. ≤5 weeks, HR 1.00, p = 0.973). CONCLUSION This large population-based cohort study demonstrates that longer waiting time from diagnosis to treatment in patients treated for esophageal cancer with curative intent does not negatively impact pT-status, pN-status, R0 resection rates, and overall survival.
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Affiliation(s)
- E Visser
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - P S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - A G Leeftink
- Center for Healthcare Operations Improvement and Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands; UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Hoedemakerplein 2, 7511 JP, Enschede, The Netherlands; Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
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30
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Władysiuk MS, Mlak R, Morshed K, Surtel W, Brzozowska A, Małecka-Massalska T. Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer. ACTA ACUST UNITED AC 2016; 23:e481-e487. [PMID: 27803609 DOI: 10.3747/co.23.3181] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer. METHODS We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan-Meier method was used to calculate survival. RESULTS Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446). CONCLUSIONS Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.
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Affiliation(s)
- M S Władysiuk
- HTA Consulting, Cracow, Medical University of Lublin, Lublin, Poland
| | - R Mlak
- Human Physiology Department, Medical University of Lublin, Lublin, Poland
| | - K Morshed
- Epidemiology Department, Medical University of Lublin, Poland
| | - W Surtel
- Electronics Department, Lublin University of Technology, Lublin, Poland
| | - A Brzozowska
- Oncology Department, Medical University of Lublin, Lublin, Poland
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31
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Van Liew JR, Brock RL, Christensen AJ, Karnell LH, Pagedar NA, Funk GF. Weight loss after head and neck cancer: A dynamic relationship with depressive symptoms. Head Neck 2016; 39:370-379. [PMID: 27704695 DOI: 10.1002/hed.24601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Weight loss and depressive symptoms are critical head and neck cancer outcomes, yet their relation over the illness course is unclear. METHODS Associations between self-reported depressive symptoms and objective weight loss across the year after head and neck cancer diagnosis were examined using growth curve modeling techniques (n = 564). RESULTS A reciprocal covariation pattern emerged-changes in depressive symptoms over time were associated with same-month changes in weight loss (t [1148] = 2.05; p = .041), and changes in weight loss were associated with same-month changes in depressive symptoms (t [556] = 2.43; p = .015). To the extent that depressive symptoms increased, patients lost incrementally more weight than was lost due to the passage of time and vice versa. Results also suggested that pain and eating-related quality of life might explain the reciprocal association between depressive symptoms and weight loss. CONCLUSION In head and neck cancer, a transactional interplay between depressive symptoms and weight loss unfolds over time. © 2016 Wiley Periodicals, Inc. Head Neck 39: 370-379, 2017.
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Affiliation(s)
- Julia R Van Liew
- Department of Psychology, The University of Iowa, Iowa City, Iowa
| | - Rebecca L Brock
- Department of Psychology, The University of Nebraska - Lincoln, Lincoln, Nebraska
| | - Alan J Christensen
- Department of Psychology, The University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City, Iowa
| | - Lucy Hynds Karnell
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa College of Medicine, Iowa City, Iowa
| | - Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa College of Medicine, Iowa City, Iowa
| | - Gerry F Funk
- Department of Otolaryngology, Grande Ronde Hospitals and Clinics, La Grande, Oregon
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Roussel LM, Micault E, Peyronnet D, Blanchard D, Guarnieri S, Choussy O, Géry B, Béquignon A, Joubert C, Parienti JJ, Babin E. Intensive nutritional care for patients treated with radiotherapy in head and neck cancer: a randomized study and meta-analysis. Eur Arch Otorhinolaryngol 2016; 274:977-987. [DOI: 10.1007/s00405-016-4278-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
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33
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Sealy MJ, Nijholt W, Stuiver MM, van der Berg MM, Roodenburg JL, van der Schans CP, Ottery FD, Jager-Wittenaar H. Content validity across methods of malnutrition assessment in patients with cancer is limited. J Clin Epidemiol 2016; 76:125-36. [DOI: 10.1016/j.jclinepi.2016.02.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/01/2016] [Accepted: 02/22/2016] [Indexed: 12/30/2022]
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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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Mücke T, Koschinski J, Wolff KD, Kanatas A, Mitchell DA, Loeffelbein DJ, Deppe H, Rau A. Quality of life after different oncologic interventions in head and neck cancer patients. J Craniomaxillofac Surg 2015; 43:1895-8. [PMID: 26421469 DOI: 10.1016/j.jcms.2015.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/05/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022] Open
Abstract
Patient reported outcomes following head and neck cancer are of great importance, given the functional, psychological, and social impacts of the disease and its treatment. In addition, not only is the number of publications on health-related quality of life (HRQOL) increasing in a variety of specialties, but there is also a growing awareness of the potential role of HRQOL in practice. Therefore, we aimed to investigate the HRQOL of head and neck cancer patients following different oncologic interventions, using an internationally established test. In this cross-sectional study, we included three different groups of 32 patients each. Participants had histologically confirmed invasive oral squamous cell carcinoma (OSCC) in the anterior floor of the mouth. Group allocation was based on treatment modality, as follows: only surgery (group 1), operation and adjuvant radiotherapy (XRT) (group 2), and the additional presence of osteoradionecrosis (ORN) (group 3). All patients were questioned about their HRQOL, using the standardized University of Washington Quality of Life Questionnaire (UW-QOL). Surveys for groups 1 and 2 were conducted at least 24 months after the end of tumor-related treatment, in cases of ORN (group 3) 12 months after completion of disease-related treatment. A total of 96 patients were included into this study. The mean age was 62.79 ± 8.93 years. The patients in groups 1 and 2 revealed a reduced quality of life, of a greater magnitude after radiation therapy. Patients felt that radiotherapy was much worse than surgery; however, half of the patients stated that they would repeat radiation therapy if necessary. The subjective evaluation of the HRQOL after surgery and radiotherapy was a valuable instrument for assessing the rehabilitation of patients in the context of their function and quality of life. Radiation therapy can be considered a trigger of functional limitations and emotional distress that contributes to decreased HRQOL in patients with head and neck cancer.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Janett Koschinski
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Anastasios Kanatas
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - David A Mitchell
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany.
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
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Pretreatment quality of life as a prognostic factor for early survival and functional outcomes in patients with head and neck cancer. Qual Life Res 2015; 25:165-74. [DOI: 10.1007/s11136-015-1063-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
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Nund RL, Scarinci NA, Cartmill B, Ward EC, Kuipers P, Porceddu SV. Third-party disability in carers of people with dysphagia following non-surgical management for head and neck cancer. Disabil Rehabil 2015; 38:462-71. [DOI: 10.3109/09638288.2015.1046563] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Małecka-Massalska T, Mlak R, Smolen A, Morshed K. Bioelectrical impedance phase angle and subjective global assessment in detecting malnutrition among newly diagnosed head and neck cancer patients. Eur Arch Otorhinolaryngol 2015; 273:1299-305. [DOI: 10.1007/s00405-015-3626-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
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Gellrich NC, Handschel J, Holtmann H, Krüskemper G. Oral cancer malnutrition impacts weight and quality of life. Nutrients 2015; 7:2145-60. [PMID: 25825828 PMCID: PMC4425137 DOI: 10.3390/nu7042145] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022] Open
Abstract
Diet is important for both quality of life (QoL) and survival of patients with oral cancer. Their intake of food is impeded by functional restrictions in chewing and swallowing. In the DÖSAK REHAB STUDY 1652 patients from 38 hospitals within the German-language area of Germany; Austria and Switzerland were examined with regard to functional and psychological variables having an impact on diet. Chewing and swallowing are correlated with mobility of the tongue and the mandible as well as opening of the mouth. Thirty five percent of the patients lost weight; 41% maintained their weight and 24% gained weight. The QoL of patients who were able to maintain their weight and of those who gained weight was significantly better than that of patients who lost weight. A normal diet was important for maintaining weight. Mashed food; liquid food and loss of appetite were closely associated with loss of weight; although it was possible for nutritional counseling and dietary support to be implemented particularly favorably in this respect. Due to problems with eating patients' strength deteriorated; thus restricting activity. Radiotherapy had a negative impact on diet and weight. It influenced sense of taste; dryness of the mouth; swelling and discomfort when ingesting food. Pain and scars in the region of the operation also cause patients to dislike hard; spicy and sour food. Support from a nutritional counselor in implementing a calorie-rich diet remedied this and such support needs to be integrated into patient management. The fact that a poor nutritional status is of such great importance is well-known; but what is often lacking is the systematic implementation of continued professional nutritional counseling over a long period of time; weight control and psycho-social support of the operated patients; particularly those who also have had radiotherapy.
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Affiliation(s)
- Nils-Claudius Gellrich
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Street 1, Hannover D-30625, Germany.
| | - Jörg Handschel
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.
| | - Henrik Holtmann
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.
| | - Gertrud Krüskemper
- Department of Medical Psychology, Ruhr University of Bochum, Universitätsstr. 150, Building MA 0/145, D-44780 Bochum, Germany.
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Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr 2014; 38:196-204. [PMID: 24748626 DOI: 10.1177/0148607113502674] [Citation(s) in RCA: 470] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate on 1 day the prevalence of malnutrition in different types of cancer and the use of nutrition support in patients with cancer. METHODS A 1-day prevalence survey was carried out in 154 French hospital wards. Malnutrition was defined as a body mass index (BMI) <18.5 in patients <75 years old or <21 in patients ≥75 years old and/or body weight loss >10% since disease onset. Oral food intake was measured using a visual analog scale. RESULTS Nutrition status was collected for 1903 patients (1109 men and 794 women, 59.3 ± 13.2 years). Cancer was local in 25%, regional in 31%, and metastatic in 44% of patients. Performance status was 0 or 1 in 49.8%, 2 in 23.7%, 3 or 4 in 19.6% and not available in 6.5% of patients. Overall, 39% of patients were malnourished. The prevalence of malnutrition by disease site was as follows: head and neck, 48.9%; leukemia/lymphoma, 34.0%; lung, 45.3%; colon/rectum, 39.3%; esophagus and/or stomach, 60.2%; pancreas, 66.7%; breast, 20.5%; ovaries/uterus, 44.8%; and prostate, 13.9%. Regional cancer (odds ratio, 1.96; 95% confidence interval, 1.42-2.70), metastatic cancer (2.97; 2.14-4.12), previous chemotherapy (1.41; 1.05-1.89), and previous radiotherapy (1.53; 1.21-1.92) were associated with malnutrition. Only 28.4% of non-malnourished patients and 57.6% of malnourished patients received nutrition support. In all, 55% of patients stated that they were eating less than before the cancer, while 41.4% of patients stated that they had received nutrition counseling. CONCLUSIONS The prevalence of malnutrition is high in patients with cancer, and systematic screening for and treatment of malnutrition is necessary.
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Affiliation(s)
- Xavier Hébuterne
- Gastroenterology and Clinical Nutrition, Nice Teaching Hospital (CHU), University of Nice Sophia-Antipolis, Nice
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Egestad H, Nieder C. Differences in quality of life in obese and normal weight head and neck cancer patients undergoing radiation therapy. Support Care Cancer 2014; 23:1081-90. [DOI: 10.1007/s00520-014-2463-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/22/2014] [Indexed: 11/12/2022]
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Jain S, Jain A, Palekar U, Shigli K, Pillai A, Pathak AD. Nutritional considerations for patients undergoing maxillofacial surgery – A literature review. Indian J Dent 2014. [DOI: 10.1016/j.ijd.2013.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Couch ME, Dittus K, Toth MJ, Willis MS, Guttridge DC, George JR, Barnes CA, Gourin CG, Der-Torossian H. Cancer cachexia update in head and neck cancer: Definitions and diagnostic features. Head Neck 2014; 37:594-604. [DOI: 10.1002/hed.23599] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/21/2013] [Accepted: 01/07/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marion E. Couch
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Kim Dittus
- Division of Hematology - Oncology; Department of Medicine; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Michael J. Toth
- Department of Molecular Physiology and Biophysics; University of Vermont, College of Medicine; Burlington Vermont
| | - Monte S. Willis
- Department of Pathology and Laboratory Medicine; McAllister Heart Institute; University of North Carolina; Chapel Hill North Carolina
| | - Denis C. Guttridge
- Department of Molecular Virology; Immunology; and Medical Genetics; Ohio State University; Columbus Ohio
| | - Jonathan R. George
- Department of Otolaryngology - Head and Neck Surgery; University of California; San Francisco California
| | - Christie A. Barnes
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Christine G. Gourin
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Hirak Der-Torossian
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
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Prevost V, Joubert C, Heutte N, Babin E. Assessment of nutritional status and quality of life in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:113-20. [PMID: 24657191 DOI: 10.1016/j.anorl.2013.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to identify tools for the assessment of nutritional status in head and neck cancer patients, to evaluate the impact of malnutrition on therapeutic management and quality of life and to propose a simple screening approach adapted to routine clinical practice. The authors conducted a review of the literature to identify tools for the assessment of nutritional status in head and neck cancer patients published in French and English. Articles were obtained from the PubMed database and from the references of these articles and selected journals, using the keywords: "nutritional assessment", and "head and neck" and "cancer". Anthropometric indices, laboratory parameters, dietary intake assessment, clinical scores and nutritional risk scores used in patients with head and neck cancers are presented. The relevance of these tools in clinical practice and in research is discussed, together with the links between nutritional status and quality of life. This article is designed to help teams involved in the management of patients with head and neck cancer to choose the most appropriate tools for assessment of nutritional status according to their resources and their objectives.
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Affiliation(s)
- V Prevost
- Inserm U1086, Cancers et Préventions, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032 Caen cedex 05, France; Centre Régional de Lutte contre le Cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
| | - C Joubert
- Unité Transversale de Nutrition Clinique, CHU, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - N Heutte
- Inserm U1086, Cancers et Préventions, avenue de la Côte-de-Nacre, 14000 Caen, France; Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032 Caen cedex 05, France; Centre Régional de Lutte contre le Cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - E Babin
- Inserm U1086, Cancers et Préventions, avenue de la Côte-de-Nacre, 14000 Caen, France; Service ORL et Chirurgie Cervico-Faciale, CHU, avenue de la Côte-de-Nacre, 14000 Caen, France; CERReV EA3918, Esplanade de la Paix, 14000 Caen, France
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Małecka-Massalska T, Smoleń A, Morshed K. Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers. ACTA ACUST UNITED AC 2014; 21:e62-6. [PMID: 24523622 DOI: 10.3747/co.21.1671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The ratio of extracellular mass to body cell mass (ecm/bcm), determined by bioelectrical impedance analysis, has been found to be a potentially useful indicator of nutrition status. Subjective global assessment (sga) is a subjective method of evaluating nutrition status in head-and-neck cancer. The present study was conducted to investigate the association between ecm/bcm and sga in head-and-neck cancer. METHODS Patients were classified as either well-nourished or malnourished by sga. Bioelectrical impedance analysis was conducted on a population of 75 patients with histologically confirmed head-and-neck cancer, and the ecm/bcm was calculated. Receiver operating characteristic curves were estimated using the nonparametric method to determine an optimal cut-off value of the ecm/bcm. RESULTS Compared with malnourished patients, those who were well-nourished had a statistically significantly lower ecm/bcm (1.11 vs. 1.28, p = 0.005). An ecm/bcm cut-off of 1.194 was 76% sensitive and 63% specific in detecting malnutrition. CONCLUSIONS The ecm/bcm can be an indicator that detects malnutrition in patients with head-and-neck cancer. Further observations are needed to validate the significance of the ecm/bcm and to monitor nutrition interventions.
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Affiliation(s)
| | - A Smoleń
- Mathematics and Biostatistics Department, Medical University of Lublin, Lublin, Poland
| | - K Morshed
- Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
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Henry L. Effect of Malnutrition on Cancer Patients. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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A systematic review of health-related quality of life instruments in patients with cancer cachexia. Support Care Cancer 2013; 21:2625-36. [PMID: 23797577 DOI: 10.1007/s00520-013-1881-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/06/2013] [Indexed: 01/06/2023]
Abstract
PURPOSE Assessing the health-related quality of life (HRQOL) of cancer patients with cachexia is particularly important because treatments for cachexia are currently aimed at palliation and treatment efficacy must be measured in ways other than survival. The aim of this systematic review was to evaluate HRQOL assessment in cancer patients with cachexia. METHODS Using guidance from the Centre for Reviews and Dissemination, relevant databases were searched from January 1980 to January 2012 with terms relating to cancer, cachexia and HRQOL for papers including adult cancer patients with cachexia or documented weight loss at baseline. RESULTS We found one cachexia-specific instrument, the Functional Assessment of Anorexia/Cachexia Therapy, but the tool has not been fully validated, does not cover all the relevant domains and the consensus-based standards for the selection of health status measurement instruments checklist highlighted a number of weaknesses in the methodological quality of the validation study. Sixty-seven studies assessed HRQOL in cachectic or weight-losing cancer patients. Most used generic cancer HRQOL instruments, limiting the amount of useful information they provide. A modified version of the Efficace minimum data checklist demonstrated that the quality of reporting on HRQOL tool use was inadequate in many of the studies. A negative relationship between HRQOL and weight loss was found in 23 of the 27 studies which directly examined this. CONCLUSION There is a pressing need for a well-designed HRQOL tool for use with this patient group in both clinical trials and clinical practice.
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Nugent B, Lewis S, O'Sullivan JM. Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev 2013; 2013:CD007904. [PMID: 23440820 PMCID: PMC6769131 DOI: 10.1002/14651858.cd007904.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 3, 2010.For many patients with head and neck cancer, oral nutrition will not provide adequate nourishment during treatment with radiotherapy or chemoradiotherapy due to the acute toxicity of treatment, obstruction caused by the tumour, or both. The optimal method of enteral feeding for this patient group has yet to be established. OBJECTIVES To compare the effectiveness of different enteral feeding methods used in the nutritional management of patients with head and neck cancer receiving radiotherapy or chemoradiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications. SEARCH METHODS Our extensive search included the Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science. The date of the most recent search was 13 February 2012. SELECTION CRITERIA Randomised controlled trials comparing one method of enteral feeding with another, e.g. nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding, for adult patients with a diagnosis of head and neck cancer receiving radiotherapy and/or chemoradiotherapy. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data using standardised forms. We contacted study authors for additional information. MAIN RESULTS One randomised controlled trial met the criteria for inclusion in this review. No further studies were identified when we updated the searches in 2012.Patients diagnosed with head and neck cancer, being treated with chemoradiotherapy, were randomised to PEG or NG feeding. In total only 33 patients were eligible for analysis as the trial was terminated early due to poor accrual. A high degree of bias was identified in the study.Weight loss was greater for the NG group at six weeks post-treatment than for the PEG group (P = 0.001). At six months post-treatment, however, there was no significant difference in weight loss between the two groups. Anthropometric measurements recorded six weeks post-treatment demonstrated lower triceps skin fold thickness for the NG group compared to the PEG group (P = 0.03). No statistically significant difference was found between the two different enteral feeding techniques in relation to complication rates or patient satisfaction. The duration of PEG feeding was significantly longer than for the NG group (P = 0.0006). In addition, the study calculated the cost of PEG feeding to be 10 times greater than that of NG, though this was not found to be significant. There was no difference in the treatment received by the two groups. However, four PEG fed patients and two NG fed patients required unscheduled treatment breaks of a median of two and six days respectively.We identified no studies of enteral feeding involving any form of radiologically inserted gastrostomy (RIG) feeding or comparing prophylactic PEG versus PEG for inclusion in the review. AUTHORS' CONCLUSIONS There is not sufficient evidence to determine the optimal method of enteral feeding for patients with head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Further trials of the two methods of enteral feeding, incorporating larger sample sizes, are required.
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Affiliation(s)
- Brenda Nugent
- Department of Nutrition and Dietetics, Belfast Health and Social Care Trust, Northern Ireland Cancer Centre, Belfast, UK.
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Bartaire E, Mouawad F, Mallet Y, Milet P, El Bedoui S, Ton Van J, Chevalier D, Lefebvre JL. Morphologic assessment of mandibular reconstruction by free fibula flap and donor-site functional impairment in a series of 23 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:230-7. [DOI: 10.1016/j.anorl.2011.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 06/20/2011] [Accepted: 06/30/2011] [Indexed: 10/27/2022]
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Sattianayagam PT, Lane T, Fox Z, Petrie A, Gibbs SDJ, Pinney JH, Risom SS, Rowczenio DM, Wechalekar AD, Lachmann HJ, Gilbertson JA, Hawkins PN, Gillmore JD. A prospective study of nutritional status in immunoglobulin light chain amyloidosis. Haematologica 2012; 98:136-40. [PMID: 22983575 DOI: 10.3324/haematol.2012.070359] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Weight loss is common in systemic immunoglobulin light chain amyloidosis but there are limited data on the impact of nutritional status on outcome. Using the Patient-Generated Subjective Global Assessment (PG-SGA) score, we prospectively examined nutritional status in 110 consecutive newly-diagnosed, treatment-naïve patients with immunoglobulin light chain amyloidosis attending the UK National Amyloidosis Centre. At study entry, 72 of 110 (66%) patients had a PG-SGA score of 4 or over, indicating malnutrition requiring specialist nutritional intervention. Number of amyloidotic organs, elevated alkaline phosphatase, presence of autonomic neuropathy and advanced Mayo disease stage were independently associated with poor nutritional status (P<0.05). Quality of life was substantially poorer among those with higher PG-SGA scores (P<0.001). Furthermore, PG-SGA score was a powerful independent predictor of patient survival (P=0.02). Malnutrition is prevalent and is associated with poor quality of life and reduced survival among patients with systemic immunoglobulin light chain amyloidosis. The PG-SGA score would be an appropriate tool to evaluate whether nutritional intervention could improve patient outcomes.
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Affiliation(s)
- Prayman T Sattianayagam
- National Amyloidosis Centre, Centre for Amyloidosis & Acute Phase Proteins, University College London, UK
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