Abstract
Background: Locally advanced head and neck cancer is managed either by combined surgery and (chemo) radiotherapy or definitive (chemo) radiotherapy, which may deteriorate nutritional status. Previous data have shown that intensive nutritional intervention by a dietician reduces radiation-induced adverse events including weight loss.Objective: To determine if on-demand nutritional counseling (ODC, control group) would be as efficacious as intensive nutritional counseling (INC, experimental group) in patients undergoing (chemo) radiotherapy.Methods: Fifty-eight patients were randomly assigned to receive INC (n = 26) or ODC (n = 32). Outcome measures were nutritional status (PG-SGA), weight loss, handgrip strength (HGS), body composition, and survival.Results: Weight loss and impaired nutritional parameters during oncological treatment were seen equally in both groups (NS). Leaner patients at baseline maintained their weight, while overweight patients lost both weight and handgrip strength during treatment. Disease-free survival (DFS) (median = 43 months) was not affected by weight loss during treatment. Lower baseline HGS and malnutrition were associated with worse DFS (low vs. normal HGS: 15 vs. 42 months; p = 0.05 and malnutrition vs. good nutrition status: 17 vs. 42 months; p = 0.014, respectively). Survival according to low vs. normal HGS in the INC group was 4 vs. 44 months (p = 0.007) and in the ODC group 28 vs. 40 months (p = 0.944). According to malnutrition vs. good nutritional status in the INC group, DFS was 21 vs. 43 months (p = 0.025) and in the ODC group 15 vs. 41 months (p = 0.03).Conclusions: As for our primary endpoint, individualized on-demand nutritional counseling was as efficacious as intensive counseling in preventing deterioration of nutritional status and incidence of malnutrition during (chemo) radiotherapy. This should be verified with larger number of patients. Additional findings were that overweight patients had more severe weight loss, but not poorer survival. Low HGS and malnutrition at baseline were associated with poor survival.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02159508.
Highlights
Adjuvant chemo for locally advanced head and neck squamous cell cancer (HNSCC) results in better survival than radiotherapy alone but causes worse oral and systemic symptoms and decreased food intake and thereby causes weight loss and adverse outcomes [1]
88 patients were eligible for inclusion and 65 (74%) gave their written informed consent to participate in the study
The current study showed that overweight patients (BMI > 25 kg/m2) lost significantly more weight due to more profound treatment-induced anorexia and nausea
Summary
Adjuvant chemo (radiotherapy) for locally advanced head and neck squamous cell cancer (HNSCC) results in better survival than radiotherapy alone but causes worse oral and systemic symptoms and decreased food intake and thereby causes weight loss and adverse outcomes [1]. Weight loss is a major predictive marker for impaired response to cancer treatment and poor survival [3, 5, 6]. Most patients with locally advanced HNSCC report weight loss already before diagnosis, which tends to persist during anti-neoplastic treatments, mainly due to acute adverse effects of chemoradiotherapy [6]. Advanced head and neck cancer is managed either by combined surgery and (chemo) radiotherapy or definitive (chemo) radiotherapy, which may deteriorate nutritional status. Previous data have shown that intensive nutritional intervention by a dietician reduces radiation-induced adverse events including weight loss
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