Abstract
Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients’ (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing >10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p ≤ 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.
Highlights
Introduction conditions of the Creative CommonsThe prevalence of malnutrition in people with head and neck cancer (HNC) is one of the highest of all cancers [1,2]
We found that treatment has a detrimental effect on nutritional outcomes for Human papillomavirus (HPV)-positive as negative oropharyngeal squamous cell carcinoma (OPSCC) patients and these patients require equivocal if not more intense nutritional intervention
The difference in nutritional outcomes between studies could be explained by differences in measurement of malnutrition, as these previous studies used weight loss alone as a marker of nutritional status whereas the more comprehensive Patient Generated-Subjective Global Assessment (PG-SGA) was used in this current study
Summary
Introduction conditions of the Creative CommonsThe prevalence of malnutrition in people with head and neck cancer (HNC) is one of the highest of all cancers [1,2]. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL), need for feeding tube (FT) insertion, long term gastrostomy tube dependence and potentially reduced survival rate in people with OPSCC who are undergoing treatment [1,2,3,5]. These morbidities worsen with increasing treatment intensity and with certain types of chemotherapy such as cisplatin which is recommended for OPSCC treatment [6,7]. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative
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