Nutritional changes in patients with locally advanced head and neck cancer during treatment

Arribas, Lorena; Hurtós, L.; Cequier, Ángel; Peiró, Inmaculada; Vilajosana, E.; Lozano, A.; Vázquez, Silvia; Mesı́a, Ricard; Virgili, N.

doi:10.1016/j.oraloncology.2017.06.003

Cited by 61 publications

(74 citation statements)

References 54 publications

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“…The decrease in FFM was endorsed by a parallel significant decrease in HGS. This is in line with the study by Arribas et al, but in contrast with Cosway et al, who did not find a decreased HGS between start of therapy and 3 months post‐treatment. However, in the latter study, only weight loss was reported without any information on body composition.…”

Section: Discussionsupporting

confidence: 92%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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Section: Discussionsupporting

confidence: 92%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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“…As symptoms presented by HNC patients such as xerostomia, dysgeusia, dysphagia, mucositis, and thick saliva [36,37] can limit oral intake [22] and lead to changes in food consistency, our results for macronutrients were expected. A lower macronutrient intake is expected when patients opt for pasty, liquid, or mild food [9], impacting in particular fiber content.…”

Section: Discussionmentioning

confidence: 72%

“…Recent studies in the literature have evaluated dietary intake after treatment (long-term), but not during the treatment. They assessed at diagnosis and post induction chemotherapy, after RT, from one and three months after the end of treatment [22], or at baseline and post-treatment (after 4-6 weeks of RT and/or CT, and follow-up (8-10 weeks after completion of treatment) [10]. The difference in our study is that we identified the treatment time points at which there was the greatest impact on dietary intake and showed the high prevalence of the inadequacy of energy and nutrients (short-term).…”

Section: Discussionmentioning

confidence: 99%

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Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

et al. 2020

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Considering the symptoms of (chemo) radiotherapy and the reduction in food intake in head and neck cancer (HNC) patients, this study aimed to investigate the association between treatment time points and oral nutritional supplementation (ONS) on dietary intake to estimate the frequency of energy and nutrient inadequacy, and also to evaluate body weight changes (BWC). Dietary intake data of 65 patients were obtained from 24-h dietary recalls and prevalence of inadequacy was calculated before or at the beginning (T0), in the middle (T1), and at the end of treatment (T2). BWC were calculated as the weight difference considering the previous weight reported and/or measured. Energy and macronutrient intake decreased in T1 and then improved in T2 (p < 0.001 for both). Micronutrient intake increased during treatment due to ONS use, but still presented a high probability of inadequate intake. In particular, calcium, magnesium, and vitamin B6 showed almost 100% of probability of inadequacy for those who did not use ONS. Finally, overweight patients suffered a higher weight accumulated deficit with a delta of −15 kg compared to other BMI (body mass index) categories. Therefore, we strongly recommend initiating nutritional counseling in conjunction with prophylactic ONS prescription from diagnosis to adjust nutrient intake and minimize weight loss.

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“…The positive control groups showed greater weight loss at both experimental times, where this was significant in relation to the other groups at 7 days. Weight loss is a frequent consequence of anti-neoplastic treatments (Arribas et al, 2017;Lin et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Cannabidiol on 5‐FU‐induced oral mucositis in mice

et al. 2020

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Purpose The aim of this study was to evaluate the clinical, histological, hematological, and oxidative stress effects of cannabidiol (CBD) in mice with induced oral mucositis. Methods We used 90 mice of the CF‐1 strain in which oral mucositis was induced using a protocol with 5‐fluorouracil (5‐FU) chemotherapy. The animals were divided randomly into 10 study groups. Three groups were treated with different doses of CBD (3, 10, and 30 mg/kg), while 2 were control groups (positive control: 5‐FU + mechanical trauma + placebo; and negative control: mechanical trauma + placebo), and 2 experimental times were studied (4 and 7 days). All treatments were by intraperitoneal administration. Results In the clinical evaluation, the groups treated with CBD showed less severity of oral lesions compared with the positive control at both experimental times. The intensity of the inflammatory response was also lower in the groups treated with this drug, but there was no statistically significant difference when compared with the positive control. With regard to erythrocyte, leukocyte, and platelet counts and anti‐oxidant enzyme activity, the groups treated with CBD showed better results, but only some of these variables showed statistically significant differences. Conclusions CBD seems to exert an anti‐inflammatory and anti‐oxidant activity favoring a faster resolution of oral mucositis in this animal model.

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Nutritional changes in patients with locally advanced head and neck cancer during treatment

Cited by 61 publications

References 54 publications

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

Cannabidiol on 5‐FU‐induced oral mucositis in mice

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