Toxicities Caused by Head and Neck Cancer Treatments and Their Influence on the Development of Malnutrition: Review of the Literature

Abstract

Malnutrition poses a significant problem for oncology patients, resulting in fatalities within this population. Patients with head and neck cancer (HNC) are at high risk, with up to 90% developing malnutrition. Common treatments used for HNC can often lead to adverse side effects, including oral health conditions, gastrointestinal upsets, and several metabolic changes. Consequently, treatments can cause inadequate nutritional intake, resulting in a reduction in energy consumption, and alterations in energy utilization, contributing to the development of malnutrition. Furthermore, the presence of these treatment toxicities, and the related malnutrition can lead to reduced quality of life, weight loss, and psychological distress. There are interventions available (nutritional, medicinal, and physical therapies) that have demonstrated potential effectiveness in reducing the severity of symptomatic toxicities, reducing the risk of malnutrition, and improving survival outcomes of patients with HNC. Based on the findings of this review, there is an urgent need for the implementation or continuation of multi-disciplinary strategies, as well as updated and improved guidelines to assist in the prevention and treatment of malnutrition caused by treatment-related toxicities in patients with HNC.

Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision

“…Nonetheless, our observations regarding the interplay between nutritional status, mucositis toxicity, and interruption events among patients with HNC undergoing CCRT remain inconsistent with those of previous studies. Some investigations showed that patients with optimal nutritional status suffer less from mucositis toxicity [69,70], and those with less incidence of treatment-related toxicity experience fewer treatment interruption events [9,[71][72][73][74]. Russo et al reviewed the relationship between RT breaks and oral mucositis, and reported that nutritional counseling and diet therapy-such as nutritional supplements and feeding tube placement-could reduce mucositis toxicity and the resulting treatment interruption in patients with HNC undergoing RT or CCRT [9].…”

Clinical and economic value of oral nutrition supplements in cancer patients: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer.

“…surgery, RT, CT, or their combination) can often lead to consequences (e.g. dysphagia and xerostomia) that further complicate and challenge oral intake of food, with additional deleterious consequences on nutritional status (45).…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”