Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review

Abstract

Background and AimsMalnutrition is prevalent among head and neck cancer (HNC) patients and leads to undesirable outcomes such as reduced treatment response and increased treatment-related side effects. This systematic review summarizes the recent evidence regarding the effect of immunonutrition in HNC patients undergoing radiotherapy and chemotherapy.MethodsA literature search was conducted of the CENTRAL, ProQuest, MEDLINE, EBSCOhost, Web of Science and CINAHL databases; and further supplemented with internet and manual searches. Studies published between January 2011 and May 2011 were identified, screened, retrieved, and data extraction was performed.ResultsTwenty studies involving 1535 patients were included, 15 were randomized controlled trials (RCTs), three were retrospective study and two were comparative cohort studies. Five out of seven studies reported improvement or maintenance of nutrition status with continuous supplementation using immunonutrient-enriched formula. Three studies reported functional status as an outcome, with one study reporting significant improvement, one study reporting maintenance, and another study reporting no difference in the functional status of patients supplemented with immunonutrient-enriched formulas. Supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis and had significantly less incidence of severe oral mucositis.ConclusionSupplementation with immunonutrient-enriched formulas in HNC patients during radiotherapy and chemotherapy may improve or maintain nutrition status. Supplementation with glutamine during HNC radiotherapy and chemotherapy may delay the onset of oral mucositis and reduce incidences of severe oral mucositis. Further investigations are required, focusing on the timing, dosage, and duration of immunonutrition.Systematic Review Registration: PROSPERO, identifier CRD42021241817.

Utility of modified Glasgow prognostic score for head and neck squamous cell carcinoma: Systematic review and meta‐analysis

“…Tan et al conducted a meta-analysis involving 1535 patients with HNSCC and revealed that immunonutrient-enriched supplements may decrease the severity of oral mucositis and improve overall nutrition status during radiotherapy and chemotherapy. 45 In addition, a meta-analysis involving 202 780 patients with cancer advocated using nonsteroidal anti-inflammatory drugs to decrease the risk of distant metastasis regardless of whether it is used before or after the cancer diagnosis. 46 On the basis of these findings, patients with a high mGPS may benefit from careful personalized treatment to improve their quality of life and prognosis.…”

IAPEN INDIA Consensus Statement on Nutritional Management in Head and Neck Cancers

“…A systematic review of twenty studies indicated that immunonutrient-enriched formulas in HNC patients during chemo-radiation may have a positive impact on maintaining nutrition status. (32) In another review paper, Immunonutrition showed to reduce postoperative fistula formation, but there was no other positive outcome on length of hospital stay, wound infection, and adverse events. (51) In a systematic search of oral or enteral immunonutrition versus standard nutrition, Miller et al concluded that there is insufficient evidence on the beneficial effects of immunonutrition on infectious episodes in heterogeneous populations including HNC patients during chemotherapy.…”

“…In a Randomized Control Trial (RCT), 37 ambulatory post-operative HNC patients showed improvement in blood protein concentration and lymphocyte levels after they consumed nutritional supplements enriched with omega-3 fatty acids (31) In a systematic review, five out of seven studies reported a beneficial effect of omega-3 enriched Immunonutrient formula on the nutritional status of HNC patients by reducing treatment toxic effects. (32) Studies strongly indicate that ω3 PUFA increases nutrient intake and has a significant role in improving increasing body weight and body composition in cancer patients. (33)(34)(35)(36)(37)(38)(39) Couple of studies have demonstrated the protective effect of omega-3 fatty acids on chemo-induced neuropathy.…”

“…A systematic review of twenty studies involving 1535 patients suggested supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis. (32) In another systematic review conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO), out of 78 papers that were identified, 29 papers were analyzed. Some of these studies had heterogeneous patient populations with varying degrees of CTRT treatment.…”

Effect of omega-3 supplementation on the nutritional status of patients with pancreatic cancer: A protocol for systematic review of clinical trials

“…Although some systematic reviews explored the modulatory role of omega-3 in patients with head and neck cancer, [ 18 ] surgery for gastrointestinal malignancy, [ 19 ] prostate cancer, [ 20 ] and lung cancer undergoing radiotherapy and chemotherapy, [ 21 ] there had been no evidence of its role in the nutritional status of patients with pancreatic cancer.…”