Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo‐radiotherapy

Oh, Justin; Liu, Alvin; Tran, Eric; Berthelet, Eric; Wu, Jonn; Olson, Robert; Chau, Nicole G.; Bowman, Angie; Hamilton, Sarah

doi:10.1002/hed.26315

Cited by 15 publications

(10 citation statements)

References 28 publications

(75 reference statements)

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“…20 Many recent studies have found that the NRI serves not only as a nutritional screening tool but also as an independent prognostic factor for malignancies. [6][7][8]21 Meanwhile, cancer treatments such as radiotherapy and chemotherapy can contribute treatment-related toxicities and have detrimental effects of body compositions (such as skeletal muscle loss). Notably, skeletal muscle loss has been identified as an important factor affecting the prognosis of patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

Combination of Nutritional Risk Index and Handgrip Strength on the Survival of Patients with Cancer Cachexia: A Multi- Center Cohort Study

Xie

Ruan

Zhang

et al. 2022

JIR

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The nutritional risk index (NRI) and handgrip strength (HGS) are useful indicators of nutritional and physical status, respectively, both of them can predict the prognosis of many cancers; however, the predictive accuracy of a single indicator is unsatisfactory. Whether the combination of NRI and HGS could enhance the stratification of the prognosis of patients with cancer cachexia. Patients and Methods:The study population was randomly divided into training and validation cohorts. We combined NRI and HGS and constructed the NRI-HGS score. Restricted cubic splines were used to assess the associations between NRI, HGS, and allcause mortality. The Kaplan-Meier method was used to calculate the survival probability of the patients. The Cox proportional hazards risk model was used to analyze survival and prognostic factors. Results: Low NRI and low HGS were independent predictors of poor prognosis in patients with cancer cachexia. The NRI-HGS score showed a better prognostic stratification than either NRI or HGS. The co-occurrence of low NRI and low HGS was associated with an approximately 1.8-fold increased risk of mortality. The NRI-HGS score could effectively distinguish patients with a poor prognosis at different pathological stages. Furthermore, we constructed a novel prognostic nomogram based on NRI and HGS. The concordance index and calibration plot confirmed that the nomogram had good prognostic accuracy. The area under the receiver operating characteristic curve of the nomogram reached >0.8, which was much higher than that of the traditional tumor-node-metastasis staging system. The nomogram provided better prognostic stratification for patients with cancer cachexia. Conclusion: Low NRI and low HGS are independent prognostic indicators in cancer cachexia. The combination of NRI and HGS improve prognostic stratification for patients with cancer cachexia. Our study suggests combining nutritional and physical status in future cachexia research.

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Section: Discussionmentioning

confidence: 99%

Combination of Nutritional Risk Index and Handgrip Strength on the Survival of Patients with Cancer Cachexia: A Multi- Center Cohort Study

Xie

Ruan

Zhang

et al. 2022

JIR

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“…Chemotherapy side effects can also lead to gastrointestinal symptoms, loss of appetite, and exacerbate radiotherapy side effects. Previous literature reported that HNC patients are at exceptionally high risk of malnutrition before initiation of radiotherapy and chemotherapy, and their nutrition status deteriorate further as the treatment progresses (6,(40)(41)(42)(43).…”

Section: Discussionmentioning

confidence: 99%

Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review

2022

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Background and AimsMalnutrition is prevalent among head and neck cancer (HNC) patients and leads to undesirable outcomes such as reduced treatment response and increased treatment-related side effects. This systematic review summarizes the recent evidence regarding the effect of immunonutrition in HNC patients undergoing radiotherapy and chemotherapy.MethodsA literature search was conducted of the CENTRAL, ProQuest, MEDLINE, EBSCOhost, Web of Science and CINAHL databases; and further supplemented with internet and manual searches. Studies published between January 2011 and May 2011 were identified, screened, retrieved, and data extraction was performed.ResultsTwenty studies involving 1535 patients were included, 15 were randomized controlled trials (RCTs), three were retrospective study and two were comparative cohort studies. Five out of seven studies reported improvement or maintenance of nutrition status with continuous supplementation using immunonutrient-enriched formula. Three studies reported functional status as an outcome, with one study reporting significant improvement, one study reporting maintenance, and another study reporting no difference in the functional status of patients supplemented with immunonutrient-enriched formulas. Supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis and had significantly less incidence of severe oral mucositis.ConclusionSupplementation with immunonutrient-enriched formulas in HNC patients during radiotherapy and chemotherapy may improve or maintain nutrition status. Supplementation with glutamine during HNC radiotherapy and chemotherapy may delay the onset of oral mucositis and reduce incidences of severe oral mucositis. Further investigations are required, focusing on the timing, dosage, and duration of immunonutrition.Systematic Review Registration: PROSPERO, identifier CRD42021241817.

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“…However, they only examined the sociodemographic and clinical variables, which are non‐modifiable factors. Previous studies have indicated that pretreatment nutritional risk and nutritional status, as modifiable factors, may be associated with the severity of symptoms during cancer treatment 12,13 . However, at present, there is a lack of evidence supporting the predictive effect of nutritional risk and nutritional status on symptom clusters in patients with HNC receiving RT.…”

Section: Introductionmentioning

confidence: 99%

Predictive effect of pretreatment nutritional risk and GLIM‐defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy

Wang

Zhang

et al. 2022

Head & Neck

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Background Evidence supporting predictive effects of pretreatment nutritional risk and nutritional status on nutrition impact symptom (NIS) clusters during radiotherapy in patients with head and neck cancer (HNC) is insufficient. Methods At baseline (T1), we collected severity and interference of NIS (Head and Neck Patient Symptom Checklist), nutritional risk, and nutritional status. During (T2) and at the end of radiotherapy (T3), we re‐evaluated NIS. Symptom clusters were identified by exploratory factor analysis using mean scores of NIS severity at T2 and T3. Predictive effects were explored by generalized estimating equations. Results Five hundred thirty‐seven patients were recruited and 334 of them completed. Four clusters were identified; the oropharyngeal symptom cluster was the most severe and had the greatest interference with diet. Patients with pretreatment nutritional risk or malnutrition experienced more severe oropharyngeal symptom cluster. Conclusions Pretreatment nutritional risk or malnutrition could predict the oropharyngeal symptom cluster in patients with HNC undergoing radiotherapy.

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Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo‐radiotherapy

Cited by 15 publications

References 28 publications

Combination of Nutritional Risk Index and Handgrip Strength on the Survival of Patients with Cancer Cachexia: A Multi- Center Cohort Study

Combination of Nutritional Risk Index and Handgrip Strength on the Survival of Patients with Cancer Cachexia: A Multi- Center Cohort Study

Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review

Predictive effect of pretreatment nutritional risk and GLIM‐defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy

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