Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways

Platek, Mary E.; Myrick, Elizabeth; McCloskey, Susan A.; Gupta, Vishal; Reid, Mary E.; Wilding, Gregory E.; Cohan, David; Arshad, Hassan; Rigual, Néstor R.; Hicks, Wesley L.; Sullivan, Maureen; Warren, Graham; Singh, Anurag K.

doi:10.1007/s00520-013-1861-0

Cited by 33 publications

(12 citation statements)

References 43 publications

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“…Subjects treated with MuGard were better able to maintain baseline weights than controls. Consistent with prior studies mean weight loss in the SC cohort was 9.14%. In contrast, mean weight loss in the MuGard cohort was 5.28%.…”

Section: Discussionsupporting

confidence: 89%

Multi‐institutional, randomized, double‐blind, placebo‐controlled trial to assess the efficacy of a mucoadhesive hydrogel (MuGard) in mitigating oral mucositis symptoms in patients being treated with chemoradiation therapy for cancers of the head and neck

Allison

Ambrad²,

Arshoun

et al. 2014

Cancer

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BACKGROUNDThe objective of this trial was to determine how a mucoadhesive hydrogel (MuGard), a marketed medical device, would fare when tested with the strictness of a conventional multi‐institutional, double‐blind, randomized, placebo‐controlled study format.METHODSA total of 120 subjects planned to receive chemoradiation therapy (CRT) for treatment of head and neck cancers were randomized to receive either MuGard or sham control rinse (SC) during CRT. Subjects completed the validated Oral Mucositis Daily Questionnaire. Weight, opiate use, and World Health Organization (WHO) oral mucositis (OM) scores were recorded. Subjects who dosed at least once daily during the first 2.5 weeks of CRT were included in the efficacy analysis.RESULTSOf 120 subjects enrolled, 78 (SC, N = 41; MuGard, N = 37) were eligible for efficacy analysis. Both cohorts were similar in demographics, baseline characteristics, primary tumor type, and planned CRT regimen. MuGard effectively mitigated OM symptoms as reflected by area under the curve of daily patient‐reported oral soreness (P = .034) and WHO scores on the last day of radiation therapy (P = .038). MuGard was also associated with nonsignificant trends related to therapeutic benefit including opioid use duration, and OM scores (WHO criteria) at CRT week 4. Rinse compliance was identical between cohorts. No significant adverse events were reported, and the adverse event incidence was similar between cohorts.CONCLUSIONSTesting MuGard, a rinse marketed as a device, in a standard clinical trial format demonstrated its superiority to SC in mitigating OM symptoms, delaying OM progression, and its safety and tolerability. Cancer 2014;120:1433–1440. © 2014 Access Pharmaceuticals, Inc. Cancer published by Wiley Periodicals. Inc. on behalf of American Cancer Society.

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Section: Discussionsupporting

confidence: 89%

Multi‐institutional, randomized, double‐blind, placebo‐controlled trial to assess the efficacy of a mucoadhesive hydrogel (MuGard) in mitigating oral mucositis symptoms in patients being treated with chemoradiation therapy for cancers of the head and neck

Allison

Ambrad²,

Arshoun

et al. 2014

Cancer

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“…28,32 Head and neck cancers often have moderate to severe MN. [33][34][35][36] Findings here support these observations. Weight loss was common and severe; 72% of those assessed for UWL had either moderate or severe WL.…”

Section: Discussionsupporting

confidence: 92%

Underrecognition of Malnutrition in Advanced Cancer: The Role of the Dietitian and Clinical Practice Variations

Aktaş

Walsh

Galang

et al. 2016

Am J Hosp Palliat Care

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Malnutrition was prevalent and clinically important, even in those on nutritional support. Variations in MN identification were common. Physicians underrecorded MN but were accurate for prevalence and severity when recorded. The data confirm the RD's important role in MN assessment. Comparable clinical practice and better communication between physicians and dietitians should improve cancer care and optimize quality of life.

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“…Patients with head and neck squamous cell carcinoma (HNSCC) often experience unintentional weight loss during concomitant chemoradiotherapy (CCRT) . Studies have shown that up to 72% of this treatment‐related loss of body weight is due to loss of lean body mass (LBM) .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with head and neck squamous cell carcinoma (HNSCC) often experience unintentional weight loss during concomitant chemoradiotherapy (CCRT). [1][2][3] Studies have shown that up to 72% of this treatmentrelated loss of body weight is due to loss of lean body mass (LBM). 1,4 which again is associated with decline of functional performance, 4 quality of life (QoL), 5 as well as increased morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy

Lonkvist

Vinther

Zerahn

et al. 2017

Laryngoscope Investig Oto

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ObjectivesPatients with head and neck squamous cell carcinoma undergoing concomitant chemoradiotherapy (CCRT) frequently experience weight loss, especially loss of lean body mass (LBM), and reduced functional performance. This study investigated whether a 12‐week hospital‐based progressive resistance training (PRT) program during CCRT is feasible in the clinical setting before planning initiation of a larger randomized study which is the long‐term goal.Study designProspective pilot study.MethodsTwelve patients receiving CCRT were planned to attend a 12‐week PRT program. Primary endpoint was feasibility measured as attendance to training sessions. Secondary endpoints included changes in functional performance, muscle strength, and body composition measured by Dual‐energy X‐ray Absorptiometry (DXA) scans. Furthermore, sarcomeric protein content, pentose phosphate pathway (PPP) activity, and glycolysis were determined in muscle biopsies.ResultsTwelve patients with p16 positive oropharyngeal cancer were enrolled. The primary endpoint was met with 9 of the 12 patients completing at least 25 of 36 planned training sessions. The mean attendance rate was 77%. Functional performance was maintained during the treatment period and increased during follow‐up (p < 0.01). Strength was regained after an initial dip during treatment, paralleling responses in LBM and sarcomeric protein content. LBM began to increase immediately after treatment. The PPP was upregulated after the treatment period, whilst glycolysis remained unchanged. No adverse events were related to PRT and in questionnaires, patients emphasized the social and psychological benefits of attendance.ConclusionProgressive resistance training is feasible and safe during CCRT for head and neck cancer, and is associated with high patient satisfaction.Level of Evidence2C.

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Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways

Cited by 33 publications

References 43 publications

Multi‐institutional, randomized, double‐blind, placebo‐controlled trial to assess the efficacy of a mucoadhesive hydrogel (MuGard) in mitigating oral mucositis symptoms in patients being treated with chemoradiation therapy for cancers of the head and neck

Multi‐institutional, randomized, double‐blind, placebo‐controlled trial to assess the efficacy of a mucoadhesive hydrogel (MuGard) in mitigating oral mucositis symptoms in patients being treated with chemoradiation therapy for cancers of the head and neck

Underrecognition of Malnutrition in Advanced Cancer: The Role of the Dietitian and Clinical Practice Variations

Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy

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