Background Cancer cachexia affects up to over 50% of advanced head and neck cancer (HNC) patients. To date, the potential utility of anabolic steroids in perioperative cachectic HNC patients has not been determined. Methods Retrospective review of pre‐ and post‐oxandrolone administration prealbumin levels in 18 perioperative HNC patients between October 2007 and October 2014 at a tertiary academic medical center. Results The median pretreatment prealbumin was 88.5 mg/L. The median post‐treatment prealbumin was 227 mg/L. The median interval improvement of the prealbumin level was 131.5 mg/L. The median differences between the pretreatment and post‐treatment prealbumin levels were found to be statistically significant ( P < .001). Subjective improvement in wound healing was also observed. Conclusions Perioperative administration of oxandrolone resulted in objective improvements in prealbumin levels and subjective improvements in surgical wounds. Oxandrolone administered 10 mg twice daily (BID) for 10 days may be a useful adjunct in the perioperative care of nutritionally deficient HNC patients who are at risk for or have demonstrated impaired wound healing. Level of Evidence 3

OBJECTIVE: Head and neck cancer patients often demonstrate wound healing difficulties in the post-operative period due to associated poor nutritional status. Cancer-related cachexia has been reported to respond to anabolic steroid treatment. The purpose of the study is to review our experience in the administration of the anabolic steroid, Oxandrolone, in improving the state of cancer cachexia as measured by prealbumin and wound healing. METHOD: A retrospective review was performed at a tertiary care cancer institute over the period 2008-present. The pharmaceutical database was utilized to identify patients with head & neck cancer treated with Oxandrolone perioperatively. Data collected included patient demographics, duration of drug administration, pre-and post-treatment pre-albumin scores, and clinical response/wound healing. The median change in prealbumin scores was analyzed using a paired sample Wilcoxon signed rank test. RESULTS: Seventeen patients ages 44-75 received Oxandrolone for an average of 23.4 days (range 7-45). The median pre-treatment pre-albumin was 85.0 mg/L (range 75 to 143 mg/L). We saw a median interval improvement of pre-albumin of 127.0 mg/L (range 61 to 252 mg/L improvement), which was statistically significant (pϽ0.001). The treatment duration to detect improvement in pre-albumin was 1-2 weeks, with continued increases seen during treatment. Concurrent improvement in wound healing was also observed. CONCLUSION: In a small sample of head and neck patients with challenging wound healing problems from malnourishment, the administration of anabolic steroids, specifically Oxandrolone, statistically improved their nutritional status as measured by pre-albumin and may have improved wound healing.