Predictive Factors of Crucial Nutrition Impact Symptom Clusters in Patients With Head and Neck Cancer Undergoing Radiotherapy

Abstract

Purpose: To identify crucial nutrition impact symptom (NIS) clusters related to both weight loss rate (WLR) and quality of life (QoL) in patients with head and neck cancer (HNC) receiving RT, and analyze their predictive factors.Methods: This prospective study enrolled 334 patients. At baseline (T1), we collected the demographics, clinical information, nutritional risk (Nutritional risk screening 2002, NRS 2002), nutritional status (Global Leadership Initiative on Malnutrition, GLIM), weight, and QoL before RT. At the third week (T2) and the end of RT (T3), we evaluated the severity and interference of NIS using the head and neck patient symptom checklist (HNSC), weight, and QoL. Exploratory factor analysis was used to extract the symptom clusters. Generalized estimating equations were used to analyze NIS clusters’ relationship with WLR and QoL, and cluster’s predictive factors.Results: Four NIS clusters were identified: RT-specific symptom cluster, upper gastrointestinal symptom cluster, psychological status cluster, and eating experience cluster. The former two NIS clusters had a negative impact on both WLR and QoL, so they were defined as crucial NIS clusters. Patients who were female, with older age, oral cavity cancer, had nutritional risk or were malnutrition at baseline were more likely to get severe RT-specific symptom cluster. Patients who were female, accepted intensive therapy were more likely to get severe upper gastrointestinal symptom cluster.Conclusions: Healthcare professionals should recognize patients at risk and intervene early, and give early nutritional management before RT to improve HNC patients’ NIS severity, nutritional status and QoL during treatment.