Nutritional challenges in head and neck cancer

Abstract

In head and neck cancer patients malnutrition impacts on quality of life, complications of therapy and also prognosis, in part via altered immunity. Dysphagia assessment is extremely valuable but more work is needed to optimize the rehabilitation of the incompetent swallow in this particular patient group. Proper nutritional assessment is mandatory pre-/peri-/post-treatment. The range and palatability of nutritional supplements has greatly increased over the past few years. Many of the early problems of percutaneous gastrostomy feeding have been addressed but complication rates still remain high. As accelerated radiotherapy and chemoradiation techniques become more widely advocated, nutrition is likely to become increasingly important. The authorship includes two otolaryngologists, a nutritionist and a speech and language therapist with an interest in head and neck dysphagia, thereby aiming to provide a broad perspective of these issues. However, there appears to be a lack of prospective evaluation of many aspects of dysphagia/nutrition in head and neck cancer, which needs to be addressed.

A prospective study on C-reactive protein as a prognostic factor for survival time of terminally ill cancer patients

“…The median survival was 17 days (95% confidence interval [CI; [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]). The average of serum CRP level was 6.12± 5.35 (mg/dl).…”

“…In our results, CRP is inversely correlated with hemoglobin or albumin, which reflected malnutrition status. It can be hypothesized that elevated CRP levels increase mortality through malnutrition because malnutrition is associated with impaired immunity [21].…”

A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer

“…percentage of weight loss, percentage of ideal body weight, nutrition index, serum albumin, total lymphocyte count, and body fat (20-67% range of abnormal scores), the one which has emerged as the most powerful predictor of major postoperative complications is a weight loss of >10% in the M. R. Chasen (*) : R. Bhargava 6 months before surgery [12]. An early prospective study of 114 patients showed that 38% with a nutritional deficit had a 2-year survival of only 7.5% compared with over 57% in the remainder of the cohort [13]. This manuscript will review both altered physiology in patients with head and neck cancers and the clinical consequences of those changes.…”

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

“…Consequently, the challenge ahead is to gain a better understanding of the nature of the dysphagia associated with new treatment modalities and the impact of this treatment modality on nutritional outcomes 10 .…”