Chronic Nutrition Impact Symptoms Are Associated with Decreased Functional Status, Quality of Life, and Diet Quality in a Pilot Study of Long-Term Post-Radiation Head and Neck Cancer Survivors

Abstract

Background: As a result of tumor location and treatment that is aggressive, head and neck cancer (HNC) survivors experience an array of symptoms impacting the ability and desire to eat termed nutrition impact symptoms (NISs). Despite increasing cancer survival time, the majority of research studies examining the impact of NISs have been based on clinical samples of HNC patients during the acute phase of treatment. NISs are often chronic and persist beyond the completion of treatment or may develop as late side effects. Therefore, our research team examined chronic NIS complications on HNC survivors’ functional status, quality of life, and diet quality. Methods: This was a cross-sectional study of 42 HNC survivors who were at least 6 months post-radiation. Self-reported data on demographics, NISs, quality of life, and usual diet over the past year were obtained. Objective measures of functional status included the short physical performance battery and InBody© 270 body composition testing. NISs were coded so a lower score indicated lower symptom burden, (range 4–17) and dichotomized as ≤10 vs. >10, the median in the dataset. Wilcoxon rank sum tests were performed between the dichotomized NIS summary score and continuous quality of life and functional status outcomes. Diet quality for HNC survivors was calculated using the Healthy Eating Index 2015 (HEI-2015). Wilcoxon rank sum tests examined the difference between the HNC HEI-2015 as compared to the National Health and Nutrition Examination Survey (NHANES) data calculated using the population ratio method. Results: A lower NIS score was statistically associated with higher posttreatment lean muscle mass (p = 0.002). A lower NIS score was associated with higher functional (p = 0.0006), physical (p = 0.0007), emotional (p = 0.007), and total (p < 0.0001) quality of life. Compared to NHANES controls, HNC survivors reported a significantly lower HEI-2015 diet quality score (p = 0.0001). Conclusions: Lower NIS burden was associated with higher lean muscle mass and functional, physical, emotional, and total quality of life in post-radiation HNC survivors. HNC survivors reported a significantly lower total HEI-2015 as compared to healthy NHANES controls, providing support for the hypothesis that chronic NIS burden impacts the desire and ability to eat. The effects of this pilot study were strong enough to be detected by straight forward statistical approaches and warrant a larger longitudinal study. For survivors most impacted by NIS burden, multidisciplinary post-radiation exercise and nutrition-based interventions to manage NISs and improve functional status, quality of life, and diet quality in this survivor population are needed.

Symptom Patterning Across the Cancer Care Trajectory for Patients Receiving Chemoradiation for Head and Neck Cancer

“…Persistent nutritional impact symptoms (dysphagia and xerostomia) can decrease functional status and quality of life in HNC survivors. 31 Strategies for improving utilization of nutritional support for patients with HNC include implementation of multidisciplinary clinics for this population. 32 Although this study focused on the trends for the most commonly reported symptoms among patients with HNC, noteworthy results emerged among the lesser-reported symptoms of anxiety and depression.…”

“…Examination and management of frequently reported symptoms during treatment and into survivorship have implications for patient quality of life. Persistent nutritional impact symptoms (dysphagia and xerostomia) can decrease functional status and quality of life in HNC survivors 31 . Strategies for improving utilization of nutritional support for patients with HNC include implementation of multidisciplinary clinics for this population 32 …”

Dietary Carotenoids in Head and Neck Cancer—Molecular and Clinical Implications

“…It is also worth emphasizing that a range of professional validated food–frequency questionnaires (FFQ) (e.g., the semi-quantitative Harvard FFQ) and/or index-based dietary patterns (e.g., the Healthy Eating Index-2005, HEI-2005; the Healthy Eating Index 2015, HEI-2015; and alternate Mediterranean Diet Score, aMED) or the National Health and Nutrition Examination Survey (NHANES) results are used in the studies. These tools allow the most objective analysis of the role of diet and nutrition compounds, including carotenoids, on the risk, onset, and progression of cancer and the estimation of circulating nutrient levels [ 175 , 176 , 177 ].…”

“…Elsewhere, the diet quality of 42 HNC survivors, at least six months postradiation, was evaluated in a cross-sectional study by Crowder et al [ 177 ]. The score was calculated using the HEI-2015 index and compared with NHANES data.…”

The experience of nutrition impact symptoms during chemotherapy for lung cancer patients : A qualitative study

“…NIS were initially studied in patients with head and neck cancer, its occurrence is linked to the location of the tumor, surgery, and radiotherapy [8]. It is also closely linked to patients' weight loss and deterioration of quality of life [9][10][11]. Recent research has demonstrated that nutritional in uence symptoms in lung cancer patients are a prognostic sign worth paying attention [5].…”