A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

Abstract

Background: Concurrent chemotherapy and radiation (CTRT) improves disease-free survival in locally advanced head and neck cancer but is associated with numerous acute and chronic toxicities resulting in substantial alterations in body mass and composition. We aim to summarize the current evidence on body composition changes experienced by patients undergoing CTRT, examine the impact of these changes on clinical outcomes and address potential interventions aimed at mitigating the loss. Main Body: Loss of 20 % of pre-CTRT weight predicts poorer treatment tolerance and 30-day mortality. While clinical practice focuses on body weight, emerging data indicates that CTRT causes profound adverse changes in lean body mass (sarcopenia). Higher prevalence of sarcopenia predicts poorer disease-free survival as well as overall survival, lower quality of life and functional performance. The magnitude of CTRT-induced sarcopenia is the equivalent to that observed in a decade of aging in a healthy adult. Alterations in body composition are only explained, in part, by decreased caloric intake; other significant predictors include body mass index, stage, and dysphagia. Lifestyle interventions aimed at preventing loss of whole-body and especially lean mass include nutritional counseling, nutritional supplements, dietary supplements and exercise training. Personalized nutritional counseling has been associated with improvement in quality of life, while the benefits of feeding tube placement are inconsistent. There are inconsistently reported benefits of resistance training in this population. Conclusion: Patients with head and neck cancer undergoing CTRT therapy experience dramatic shifts in body composition, including sarcopenia, which can negatively impact clinical outcomes. Efforts to understand the magnitude, clinical importance and mechanisms of sarcopenia are needed to inform a more personalized approach to mitigating the body composition changes associated with CTRT.

Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost

“…These findings are consistent with the current literature where sarcopenia is a demonstrated poor prognostic factor regardless of overall BMI or nutritional status ( 2,4 ) . Efforts to understand the magnitude, clinical importance and mechanisms of sarcopenia and myosteatosis are needed to inform a more personalised approach with respect to mitigating the body composition changes associated with HNC treatment ( 17,26,40 ) .…”

“…Assessment of muscle quality and quantity as routine care is a novel and proactive approach for facilitating early identification and intervention that has the potential to impact a broad range of outcomes ( 42 ) . Because the magnitude of chemoradiotherapy‐induced sarcopenia is equivalent to that observed in a decade of ageing in a healthy adult ( 40 ) , clinicians require greater awareness of sarcopenia and/or myosteatosis because it may be present at baseline or develop over the course of care, regardless of weight or nutritional status. CT‐defined sarcopenia evaluation is underutilised in the clinical setting ( 8 ) , probably as a result of cost, accessibility to the required equipment or software, and a lack of trained analysts.…”

Sarcopenia in male patients with head and neck cancer receiving chemoradiotherapy: a longitudinal pilot study

“…As a result of these clinically significant declines in muscle strength, muscle mass and physical performance observed during seven weeks of CRT and the association between sarcopenia and a host of adverse events in HNC patients, oncologists and their allied health care teams, especially those in India, may need to consider a number of alterations to the usual care strategies for these patients. The first may be the implementation of routine monitoring of some of the sarcopenic-related outcomes used in the present study to help identify patients who are at risk of sarcopenia and the associated adverse events (Baxi, Schwitzer & Jones, 2016;Ganju et al, 2019). Such monitoring may be useful to implement on at least an annual basis with advanced HNC patients, especially those considering CRT, as sarcopenia can reduce CRT compliance, and increase their risk of adverse events and early mortality.…”

Investigating adherence to Australian nutritional care guidelines in patients with head and neck cancer

“…Approximately 25–50% of HNC patients have a significant decrease in dietary intake prior to the commencement of anti-cancer therapy, due to the cancer directly affecting function of the upper aero-digestive tract [5]. In addition, most patients lose in excess of 5% body weight prior to the commencement of treatment [6] and are likely to lose at least 10% of their body weight during treatment, contributing to high rates of protein-energy malnutrition (PEM) [5]. PEM is associated with decreased quality of life, decreased effectiveness of treatment (due to treatment disruptions), increased healthcare costs associated with unplanned hospital admissions, and may negatively impact survival in HNC [7, 8].…”