Therapeutic Diet for Xerostomia in Head and Neck Cancer Patients: A Narrative Review

Clinical benefits from endoscopy screening of esophageal second primary tumor for head and neck cancer patients: Analysis of a hospital-based registry

Head and neck cancer (HNC) patients may experience neuropathic pain (NP) due to radiotherapy (RT), which may become chronic. Pregabalin, an anticonvulsant, alters the transmission of painful stimuli at the synaptic level, modifying their perception. Pregabalin is used in NP treatment, but limited data exist on RT-treated HNC patients. This retrospective study aimed to present a case series of HNC patients with chronic NP after RT managed with pregabalin. HNC patients' records from the Department of Oral Medicine and Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), were searched. Outcome measures were obtained using the Douleur Neuropathique 4 (DN4) scale for NP and the numeric rating scale (NRS) for pain. The use of additional analgesic medication was also recorded. Five HNC (four oral and one nasopharyngeal cancer) patients (mean age 58.5 years) who had received RT (mean total dose 64.7 gray (Gy)) and developed chronic (i.e., present for at least three months after RT) NP, characterized by a positive DN4 score ≥4, were identified. The initial assessment was five months to six years after RT (mean DN4=4.6±0.89 and mean NRS=6±3.08). "Burning," "pins and needles," and "numbness" were the NP descriptors mostly used. Pregabalin was titrated up to 150-300 mg per day; paracetamol and/or tramadol were also administered (daily doses 3000 mg and 100-150 mg, respectively). A substantial pain relief (≥50%) according to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) (mean DN4=1.6±1.67 and NRS=1.6±1.67) was reported after two to three months of treatment, when tapering was initiated. Two patients (2/5) had complete remission of symptoms (DN4=0, NRS=0). No serious adverse effects were reported; one patient reported excess salivation. Pregabalin may be a promising option for managing RT-related chronic NP in HNC patients. Further studies, including randomized controlled trials on RT-treated HNC patients, should be conducted.

The Presence of Second Primary Esophageal Tumor (Spet) is Still an Independent Negative Prognostic Factor for Head and Neck Cancer (Hnc) Patients: a Retrospective Study

Sleep quality is essential for optimal health and wellbeing of each individual. Previous research hypothesized that a good night’s sleep plays important role not only in energy conservation and emotional regulation, but also in maintaining diurnal rhythm of hypothalamic-pituitary-adrenal (HPA) axis. Sleep disturbances, together with physical and psychological distress, are known to disrupt HPA-axis activity, causing changes in normal fluctuation of cortisol level. This may further affect physiological functions of cortisol, among which the most important is regulation of inflammatory response. Despite extensive research on sleep quality in cancer patients in general, similar research in head and neck cancer (HNC) patients is scarce. HNC patients often suffer from psychological distress and physical symptoms starting from cancer diagnosis throughout treatment completion. These symptoms often compromise their quality of life and may play a role in their sleep quality. However, the prevalence of different kind of sleep disturbances in HNC patients throughout different treatment phases is unclear. We did not know which group of HNC patients already have poor sleep quality before the start of cancer treatment. We also did not know how sleep quality of HNC patients evolves overtime, and which HNC patients tend to have persistent poor sleep quality. Last but not least, there is lack of research which highlights the complex relationship between sleep quality, pain, fatigue, psychological distress, HPA-axis, and inflammation in newly diagnosed HNC patients. This thesis aims to address these research gaps by investigating the epidemiology, trajectories, and associated factors of poor sleep quality in newly diagnosed HNC patients, taking into account personal, physical, psychological, and biological parameters. Findings in this thesis suggest that screening for poor sleep quality in HNC patients should be started shortly after HNC diagnosis. Moreover, it is important to first clearly define the type of sleep disturbance of interest and then choose a validated sleep screening instrument accordingly. A periodic sleep evaluation should be aimed to HNC patients who are more at risk of having persistent poor sleep quality. This group of patients may benefit from early intervention which simultaneously targets poor sleep quality and other (psychoneurological) symptoms. These findings also provide directions for future research, for example into the long-term effects of poor sleep quality, disruptions of HPA-axis and inflammatory dysregulations on HNC progression and survival.

Objective: Access to care is an important issue for head and neck cancer (HNC) patients as HNC is one of the most expensive cancers, particularly for late stage disease. While some data show increased insurance coverage with Medicaid expansion, evidence is limited for impacts on socioeconomic disparities in insurance or on stage at diagnoses. This study aimed to quantify the impact of state Medicaid expansion status on insurance status and stage at diagnosis in HNC patients. Methods: Using a quasi-experimental design, the 2011-2015 Surveillance, Epidemiology, and End Results database was queried for adults with HNC in the United States. Changes in insurance coverage and stage at diagnosis after 2014 in states that expanded Medicaid (EXP) were compared to changes in states that did not expand Medicaid (NEXP). Difference-in-differences analyses were used to assess changes in the percentage of Medicaid coverage, uninsured, and early stage diagnoses in EXP relative to NEXP states. Results: A total of 26,330 HNC cases were identified. In difference-in-difference analyses, we observed an increase in Medicaid insurance in expansion relative to non-expansion states (3.36 percentage points (PP), 95% CI = 1.32, 5.41, p=.001), especially for residents of low income and education counties. We also observed a reduction in uninsured status among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p=.002). Additionally, we found significant increases among young adults age 18-34 years (17.2 PP, 95% CI – 1.34, 33.10, p=0.034), females (7.54 PP, 95% CI = 2.00, 13.10, p=0.008), unmarried patients (3.83 PP, 95% CI = 0.30, 7.35, p=0.033), and patients with cancer of the lip (13.5 PP, 95% CI = 2.67, 24.30, p=0.015). There was some evidence for greater expansion-associated increases in early stage diagnoses for non-Hispanic blacks (8.53 PP) and other races (20.4 PP) relative to white HNC patients (p=.025). Conclusions: Medicaid expansion is associated with improved insurance coverage for HNC patients, particularly those with low income, and increased early stage diagnoses for young adults and for racial/ethnic minorities. Thus, Medicaid expansion may improve access to care for patients with HNC. Our findings are particularly relevant at a time when there is debate in the United States about healthcare financing, Medicaid, and the Affordable Care Act. Citation Format: Nosayaba Osazuwa-Peters, Justin M Barnes, Eric Adjei Boakye, Matthew E Gaubatz, Kenton J Johnston, Neelima Panth, Rosh KV Sethi, Uchechukwu Megwalu, Mark A Varvares. Effect of state Medicaid expansion status on insurance coverage and stage at diagnosis in head and neck cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A121.

Purpose:Head and neck cancer (HNC) patients experience various posttreatment side effects that decrease quality of life (QOL). Some previous study reported that QOL of HHC patients were returned baseline (before treatment) after a year post treatment. However, acute stage longitudinal changes of QOL in HNC patients remains unclear. This point might be important for early reintegration of HNC patients. This study aimed to investigate the acute stage longitudinal change of the relationship between QOL and oral function in HNC patients had surgery. Methods:45 HNC patients (23 men) scheduled for surgical treatment were enrolled in this study. Primary tumor sites were 22 tongue, 5 maxilla, 4 mandible, 3 pharynx and others. Weight, body mass index (BMI), whole body soft lean mass (SLM), and skeletal muscle mass (SMM) were evaluated as muscle mass-related measurements. Lip closure force (LC) and tongue pressure (TP) were evaluated as oral function measurements. Feeding function was evaluated using the Functional Oral Intake Scale (FOIS). QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaire QLQ-C30 and H&N 35. Measures were evaluated at pre-surgical treatment (PT), and 1 month (1M) and 3 months (3M) after surgery. The change of QOL parameters and relationships between measurements were assessed.Results:For QOL assessments, role functioning, fatigue, speech problems, trouble with social eating, trouble with social contact, and opening mouth significantly decreased from PT to 1M, but significantly increased from 1M to 3M. Weight, BMI, SLM, SMM, LC, TP, and FOIS demonstrated significant relationships with QOL from PT to 1M. Meanwhile, from 1M to 3M, weight, BMI, SLM, SMM, LC, and FOIS showed significant relationships with QOL assessments.Conclusions:Both oral function and muscle mass-related measurements significantly affected QOL in HNC patients.

The purpose of this study was to determine the phenotyping of Peripheral Blood Lymphocytes (PBL) in Head and Neck Cancers (HNCA) patients and to relate this with the level of Cell-Mediated Immunity (CMI) measured by in vitro lymphoproliferative assay, in order to evaluate immune suppression in HNCA patients and its possible mechanisms. Accordingly, one hundred twenty two HNCA patients and 100 control subjects were enrolled in this study. HNCA patients were classified into 42 nasopharyngeal carcinoma, 66 carcinoma of larynx and 14 Hypo Pharyngeal Carcinoma (HPC). For measuring CMI, Microculture Tetrazolium assay (MTT) was applied on the freshly isolated lymphocytes of HNCA patients and control group. Immunophenotyping of PBL was carried out for monitoring the blood level of CD3+, CD4+, CD8+, CD21+ cells in HNCA patients in comparison with controls. The results of both assays have been integrated, revealed the presence of remarked immune suppression in HNCA patients in comparison with the controls, especially for NasoPharyngeal Carcinoma (NPC) patients who were immunosuppressed more than other studied HNCA types. Surprisingly, NPC group showed the lowest CMI level along with the highest level of PBL subsets, particularly NPC patients expressed the highest level of CD8+ cells among HNCA. It was inferred that CD8+ cells were more likely immune suppressor rather than cytotoxic cells and this is the principal factor for inducing sustained immunosuppression in HNCA and in NPC in particular. Furthermore CD4/CD8 ratio proved to be a reliable index for assessing the immunological status of HNCA patients and more dependable index than other immunity-evaluating factors.

Simple SummaryThe present review indicates that changes in food perception among head and neck cancer patients constitute more than changes in taste perception, but also changes in texture, temperature, and other oral sensations (e.g., spiciness, cooling sensation, carbonation). Food does not only carry physiological importance, but also conveys psychological and psychosocial values. Therefore, a comprehensive assessment of cancer patients’ food perception will allow the development of personalised dietary interventions to provide a more pleasant eating experience and improve their quality of life.Food-related sensory alterations are prevalent among cancer patients and negatively impact their relationship with food, quality of life, and overall health outcome. In addition to taste and smell, food perception is also influenced by somatosensation comprising tactile, thermal, and chemesthetic sensations; yet studies on oral somatosensory perception of cancer patients are lacking to provide patients with tailored nutritional solutions. The present review aimed to summarise findings on the oral somatosensory perception of head and neck cancer (HNC) patients and the potential aetiologies of somatosensory alterations among this population. Subjective assessments demonstrated alterations in oral somatosensory perception such as sensitivity to certain textures, spices, and temperatures. Physiological changes in oral somatosensation have been observed through objective assessments of sensory function, showing reduced localised tactile function and thermal sensitivity. Changes in whole-mouth tactile sensation assessed using texture discrimination and stereognosis ability seem to be less evident. Available evidence indicated oral somatosensory alterations among HNC patients, which may affect their eating behaviour, but more studies with larger sample sizes and standardised assessment methods are needed. Unlike other types of cancers, sensory alterations in HNC patients are not only caused by the treatments, but also by the cancer itself, although the exact mechanism is not fully understood. Prevalent oral complications, such as xerostomia, dysphagia, mucositis, and chemosensory alterations, further modify their oral condition and food perception. Oral somatosensory perception of cancer patients is an under-investigated topic, which constitutes an important avenue for future research due to its potential significance on eating behaviour and quality of life.

A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients

Objective To explore the prediction of weight loss to the function 1 month after surgery in head and neck cancer (HNC) patients with surgical treatment. Methods During August to November 2017, 122 HNC patients from a tertiary hospital in Chengdu were included and investigated by the General Information Questionnaire and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Results 1 month after surgery, the function scores of HNC patients ranged from 86.67(73.33, 93.33) to 100.00(100.00, 100.00), and the physical function score was the lowest. Patients with weight loss during hospitalization had lower score in physical, role and social function (P<0.05). According to the results of Logistic regression analysis, age (OR=6.262, P<0.05) and Weight loss during hospitalization (OR=4.363, P<0.05) were risk factors for the physical function of HNC patients 1 month after surgery. For social function 1 month after surgery, weight loss during hospitalization (OR=3.306, P<0.05) was the risk factor. Conclusions Weight loss during hospitalization in HNC patients with surgical treatment can predict the impairment of function 1 month after surgery. Healthcare providers should pay more attention to perioperative nutritional problems of HNC patients, especially the elder patients, and take effective interventions to control the weight during hospitalization to improve patients′ function and quality of life. Key words: Head and neck; Weight loss; Function

&lt;b&gt;Introduction:&lt;/b&gt; The Ready for Safe Cancer Treatment (RESET) tool is a structured, multimodal program designed to optimize hospitalization and enhance the quality of perioperative care for oncological patients. While RESET has been developed as a general framework for surgical oncology, its adaptation to Head and Neck Cancer (HNC) patients remains unexplored despite their unique physiological and psychological needs. HNC patients frequently face severe functional impairments affecting speech, swallowing, and respiration, as well as heightened nutritional deficiencies, sarcopenia, and psychological distress. This study explores the feasibility of tailoring the RESET tool to meet the specialized requirements of HNC patients. &lt;br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to assess the feasibility of adapting the RESET to the specific needs of HNC patients. The research focuses on identifying key areas requiring modification to optimize perioperative care, including prehabilitation, nutritional support, functional rehabilitation, and psychological care. Epidemiological analysis, patient needs assessment, and a review of the core RESET modules will help determine effective strategies for improving treatment quality and recovery outcomes in this patient group. The ultimate goal is to develop a more personalized, evidence-based approach that could be implemented in oncology centers to enhance treatment outcomes for HNC patients. &lt;br&gt;&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; RESET is structured into four modules: pre-admission prehabilitation, advanced communication and need assessment upon admission, intra-hospital recovery optimization, and transitional care planning at discharge. This study includes a cross-sectional epidemiological assessment of HNC patient representation at two oncological centers in Poland, an analysis of prehabilitation requirements, a comparative evaluation of core RESET modules, and a gap analysis identifying necessary protocol enhancements. The proposed methodological approach integrates both quantitative and qualitative assessments to ensure a comprehensive evaluation of RESET's adaptation to HNC patients. &lt;br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Data from 2023-2024 indicate that HNC patients constitute 11-25% of the total oncological population at the studied centers, demonstrating distinct demographic characteristics such as younger age distribution and extended hospitalization periods. Prehabilitation needs analysis underscores the importance of structured nutritional support, targeted muscle preservation strategies, and psychological interventions, including cognitive behavioral therapy. Additionally, core RESET module evaluations highlight the necessity of enhanced post-discharge transitional care, particularly for patients requiring tracheostomy or prolonged enteral nutrition support. The gap analysis identifies critical areas requiring reinforcement, such as comprehensive sarcopenia screening, specialized dysphagia management protocols, and a multidisciplinary approach to psychosocial rehabilitation. &lt;br&gt;&lt;br&gt;&lt;b&gt;Discussion:&lt;/b&gt; HNC patients present unique challenges that demand tailored modifications to the RESET framework. Unlike other oncological cohorts, HNC patients are predisposed to functional impairments, high nutritional deficits, and significant psychosocial burdens. The inclusion of dedicated nutritional strategies, prehabilitation exercises, and psychological support within the RESET protocol may significantly improve treatment outcomes, reduce postoperative complications, and enhance the quality of life. Despite its structured approach, the main limitation of the RESET adaptation for HNC remains the need for dedicated funding and further validation through prospective clinical trials. &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Adapting the RESET tool to the needs of HNC patients has the potential to optimize perioperative care, ensuring a more individualized, evidence-based approach. The proposed modifications emphasize enhanced nutritional, physical, and psychological support, aligning RESET with the specific challenges faced by HNC patients. Further research and implementation studies are required to validate the effectiveness of this adapted framework in improving patient outcomes within oncological network hospitals.

This manuscript presents a systematic review of the impact of the COVID-19 pandemic on head and neck cancer (HNC) patients. A meta-analysis was made to compare the number of treated/operated HNC patients in pre-COVID-19 era (PCE) versus COVID-19 era (CE). This investigation is based on previous reports showing a delay in the diagnosis and treatment of new cases of cancer during the pandemic. Worsening in cancer prognosis would be expected as a result of the delayed treatments. An electronic search was conducted using the PubMed/MEDLINE, Embase, Web of Science, Scopus and The Cochrane Library databases. Relevant articles were selected based on specific inclusion criteria. A total of 8942 HNC patients were included. A higher prevalence in male (1873) in comparison to female (1695) was observed considering 3568 patients. Regarding staging, the majority of cases were stage III-IV. The treatment type more frequently described was surgery. Positive diagnosis for COVID-19 in the pre oncologic treatment was reported for 242 patients, and for post oncologic treatment in 119 patients. Mortality by COVID-19 was reported for 27 HNC patients. The meta-analysis revealed a significantly smaller number of surgeries/oncologic treatments of HNC patients performed (2666) in the CE when compared to PCE (3163) (M-H OR = 0.81, 95% CI = 0.65 to 1, P = 0.05). The impact of the COVID-19 pandemic on HNC patients occurred mainly in the number of surgeries/oncologic treatments, showing a significantly smaller number of surgeries/oncologic treatments performed in the CE rather than the PCE.

Simple SummaryFollowing radiotherapy for head and neck cancer, patients are at risk for developing a recurrent or second tumor. Often reirradiation is required in these patients, which is hampered in dose by the previous irradiation. Besides chemotherapy, hyperthermia can potentially increase the effectivity of the radiotherapy. In this study we have used a new hyperthermia applicator in order to increase the effectivity of the radiotherapy in patients requiring reirradiation. We show that the added hyperthermia treatment is tolerated by patients and that we reach a higher hyperthermia dose to the tumor compared to the previous applicator. In addition, we show that the tumor control and survival as well as toxicity are similar compared to what has been reported in literature using chemotherapy as an additive to reirradiation in head and neck cancer patients.(1) Background: Head and neck cancer (HNC) patients with recurrent or second primary (SP) tumors in previously irradiated areas represent a clinical challenge. Definitive or postoperative reirradiation with or without sensitizing therapy, like chemotherapy, should be considered. As an alternative to chemotherapy, hyperthermia has shown to be a potent sensitizer of radiotherapy in clinical studies in the primary treatment of HNC. At our institution, we developed the Hypercollar3D, as the successor to the Hypercollar, to enable improved application of hyperthermia for deeply located HNC. In this study, we report on the feasibility and clinical outcome of patients treated with the Hypercollar3D as an adjuvant to reirradiation in recurrent or SP HNC patients; (2) Methods: We retrospectively analyzed all patients with a recurrent or SP HNC treated with reirradiation combined with hyperthermia using the Hypercollar3D between 2014 and 2018. Data on patients, tumors, and treatments were collected. Follow-up data on disease specific outcomes as well as acute and late toxicity were collected. Data were analyzed using Kaplan Meier analyses; (3) Results: Twenty-two patients with recurrent or SP HNC were included. The average mean estimated applied cfSAR to the tumor volume for the last 17 patients was 80.5 W/kg. Therefore, the novel Hypercollar3D deposits 55% more energy at the target than our previous Hypercollar applicator. In patients treated with definitive thermoradiotherapy a complete response rate of 81.8% (9/11) was observed at 12 weeks following radiotherapy. Two-year local control (LC) and overall survival (OS) were 36.4% (95% CI 17.4–55.7%) and 54.6% (95% CI 32.1–72.4%), respectively. Patients with an interval longer than 24 months from their previous radiotherapy course had an LC of 66.7% (95% CI 37.5–84.6%), whereas patients with a time interval shorter than 24 months had an LC of 14.3% (95% CI 0.7–46.5%) at 18 months (p = 0.01). Cumulative grade 3 or higher toxicity was 39.2% (95% CI 16.0–61.9%); (4) Conclusions: Reirradiation combined with deep hyperthermia in HNC patients using the novel Hypercollar3D is feasible and deposits an average cfSAR of 80.5 W/kg in the tumor volume. The treatment results in high complete response rates at 12 weeks post-treatment. Local control and local toxicity rates were comparable to those reported for recurrent or SP HNC. To further optimize the hyperthermia treatment in the future, temperature feedback is warranted to apply heat at the maximum tolerable dose without toxicity. These data support further research in hyperthermia as an adjuvant to radiotherapy, both in the recurrent as well as in the primary treatment of HNC patients.

Despite well-documented benefits of physical activity (PA), adherence remains poor among head and neck cancer (HNC) patients. Emotional factors significantly influence PA behaviors in this population, yet their underlying interaction pathways are poorly understood. This study aimed to identify the influence of emotional factors on PA behavior in HNC patients using an extended theory of planned behavior (TPB). Adhering to the STROBE checklist, we conducted a cross-sectional survey of 304 HNC patients. Path analysis and mediation analysis were employed to examine factors associated with PA behavior and their interrelationships. A high percentage of HNC patients (53.90%) were physically inactive. The path model demonstrated good fit: χ2/df = 1.644, NFI = 0.968, TLI = 0.969, CFI = 0.987, IFI = 0.987, RMSEA = 0.047. The model explained 44.50% of the variance in PA behaviors (R2 = 0.445). Path analysis revealed that perceived behavioral control exerted the strongest influence on PA behavior, followed by intention, planning, perceived benefits and barriers, subjective norms, and attitudes. Enhancing PA behaviors in HNC patients is imperative. The extended TPB model was useful for understanding PA intentions and behaviors among HNC patients in China. Interventions that incorporate the emotional factors identified in our study may provide an effective framework for supporting PA in this population.

The effects of continued smoking in head and neck cancer patients treated with radiotherapy: A systematic review and meta-analysis