A comparison of the MNA-SF, MUST, and NRS-2002 nutritional tools in predicting treatment incompletion of concurrent chemoradiotherapy in patients with head and neck cancer.

Shun-Wen Hsueh,Yu-Ching Lin,Kun-Yun Yeh,Chang-Hsien Lu,Cheng-Chou Lai,Pei-Hung Chang,Yu-Shin Hung,Ngan-Ming Tsang,Wen-Chi Chou,Chia-Yen Hung

doi:10.1007/s00520-021-06140-w

Abstract

Concurrent chemoradiotherapy (CCRT) treatment incompletion is a known negative prognosticator for patients with head and neck cancer (HNC). Malnutrition is a common phenomenon which leads to treatment interruption in patients with HNC. We aimed to compare the performance of three nutritional tools in predicting treatment incompletion in patients with HNC undergoing definitive CCRT. Three nutritional assessment tools, Mini Nutritional Assessment-Short Form (MNA-SF), Malnutritional Universal Screening Tool (MUST), and Nutritional Risk Screening 2002 (NRS-2002), were prospectively assessed prior to CCRT for HNC patients. Patients were stratified into either normal nutrition or malnourished groups using different nutrition tools. Treatment incompletion and treatment-related toxicities associated with CCRT were recorded. A total of 461 patients were included in the study; malnourished rates ranged from 31.0 to 51.0%. The CCRT incompletion rates were 4.9-6.3% and 14.5-18.2% for normal nutrition patients and malnourished patients, respectively. The tools had significant correlations with each other (Pearson correlation 0.801-0.837, p<0.001 for all) and accurately predicted the incompletion of CCRT. MNA-SF had the highest performance in predicting treatment-related toxicity, including emergency room visits, need for hospitalization, any grade III or higher hematological adverse events, and critical body weight loss, compared to the other tools. MNA-SF, MUST, and NRS2002 were all shown to be competent tools for prediction of treatment incompletionand treatment-related toxicity in HNC patients undergoing CCRT. We suggest implementing nutritional assessment prior to treatment to improve the rate of treatment completion and to reduce treatment-related toxicity in HNC patients.

Highlights

Primary head and neck cancer (HNC), accounting for 4% of all cancers, is a disease with more than 650,000 new cases diagnosed and 330,000 deaths annually worldwide [1]
We suggest implementing nutritional assessment prior to treatment to improve the rate of treatment completion and to reduce treatment-related toxicity in HNC patients
The completion rate of Concurrent chemoradiotherapy (CCRT) among patients with normal nutrition was 4.9%, 5.3%, and 6.3% as identified by the Mini Nutritional Assessment-Short Form (MNA-SF), Malnutritional Universal Screening Tool (MUST), and NRS-2002 tools, respectively, while the incompletion rate among the malnourished group ranged from 14.5–18.2%

Summary

Introduction

Primary head and neck cancer (HNC), accounting for 4% of all cancers, is a disease with more than 650,000 new cases diagnosed and 330,000 deaths annually worldwide [1]. Patients with HNC tend to have poor self-care and nutritional deterioration[4, 5]. While the standardized treatment for localized advanced HNC is concurrent chemoradiotherapy (CCRT), it is commonly associated with acute toxicities such as fatigue, nausea, mucositis, xerostomia, dysphagia, and odynophagia, which may worsen malnutrition status[6]. CCRT treatment incompletion is a well-known negative prognosticator as the premature termination of treatment decreases loco-regional control, increases the risk of distant metastases, and compromises overall survival[4, 6,7,8]. Concurrent chemoradiotherapy (CCRT) treatment incompletion is a known negative prognosticator for patients with head and neck cancer (HNC). Malnutrition is a common phenomenon which leads to treatment interruption in patients with HNC.

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