Head and Neck Cancer Early Identification of Malnutrition High Risk Patients and Quality of Life Optimization

Abstract

Malnutrition in Head and neck cancer (HNC) patients can be present at the moment of diagnosis. The nutritional status is determinant for the treatment success and quality of life of the patients. The nutritional status gradually declines during treatment and the majority of patients undergoing treatment will need nutritional therapy. On the other hand, HNC, like other cancers, can induce a paraneoplastic syndrome that leads to cachexia. This cachexia status is most of the times the cause of death or the cause of treatment failure. So, early identification of malnutrition high risk patients is crucial to start an adequate nutrition support intervention in HNC patients. This study aims to identify HNC patients who present malnutrition or higher risk of malnutrition; to signalize variables that support early identification of high-risk patients of becoming malnourished and to establish a dynamic relationship between malnutrition risk in these patients and Quality of Life (QoL) impacts. For six months consecutive outpatients with HNC admitted at the Head & Neck Unity of Oncology Portuguese Institute-Porto were asked to participate in the research (n = 114). The European Organisation for Research and Treatment of Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30 and Malnutrition Universal Screening Tool, MUST were used. At the moment of first presentation, 32 patients (28.1%) presented high-risk of malnutrition. HNC patients with oral cavity and oropharynx tumour locations, older, with low literacy or with BMI under 18.5 at the moment of diagnosis, represent a high-risk group. When HNC is considered, a dynamic and bi-directional connection between malnutrition and QoL is observed. A significant (p < 0.001) difference in the scores of Global health status/QoL according to the malnutrition risk group was found: 62.96, 53.33, 42.

Patient reported outcomes in oncology: changing perspectives—a systematic review

“…Five main advantages related with cancer patients are consistently and actually presented in literature regarding PRO incorporation in daily clinical practice. They are: (1) stepped care models design reflecting patient’s disease pathway [ 4 , 5 , 31 , 32 , 34 , 36 – 57 ] (2) prognosis value [ 2 – 4 , 22 , 31 , 34 , 37 – 43 , 47 , 50 , 53 , 57 – 74 ] (3) communication improvements [ 4 , 5 , 10 , 22 , 31 , 32 , 34 , 36 , 38 , 40 – 43 , 46 – 50 , 53 , 55 , 65 – 69 , 71 – 82 ], (4) patient safety optimization [ 4 , 5 , 10 , 30 , 31 , 34 , 36 , 39 – 43 , 47 , 48 , 52 , 53 , 55 , 56 , 60 – 62 , 64 – 66 , 68 , 70 , 72 – 74 , 77 – 87 ] and (5) healthcare risk identification, i.e., unmet problems identification, symptom detection and symptom control [ 2 ,…”

“…Indeed, most studies reviewed the evidence that the communication processes in health systems are complex. PROs incorporation in oncology improves clinical practice [ 42 , 47 , 92 ], structures the communication, develops effective communication tools and communication skills training [ 93 – 95 ], and contributes to the delivery of effective oncology high-quality care [ 34 , 39 , 76 ], improved patient-safety and patient satisfaction, and reduces patient anxiety [ 39 , 42 , 48 , 49 , 65 – 67 , 77 , 88 ].…”

“…identified key areas of improvement and confirmed that well-conducted and reported prognostic model studies with a PRO predictor have great potential to improve healthcare delivery [ 38 ]. The physical functioning, global health and QoL domains were consider significant prognostic factors (prognosticators) and several domains have been evidenced [ 39 , 40 , 43 ] including patient-reported functional scores [ 37 , 42 , 60 , 61 , 63 , 68 ], patient-reported symptom interference [ 38 , 49 , 59 , 62 , 65 , 66 ], patient-reported depression [ 96 ], or patient-reported fatigue [ 67 , 69 ].…”

The Effect of Hospital-Based Liquid Diet and Commercial Formulas on Laboratory Parameters and Postoperative Complications in Patients with Head and Neck Cancer

“…Finally, some social factors can also worsen the patient's nutritional status, including poor dietary habits at baseline, restrictions on dietary choices, lack of social support, depression, and high alcohol consumption [9]. Silva et al [11] reported that risk factors for malnutrition in patients with HNC included the tumor's location in the oral cavity and oropharynx, younger age, lower education status, and a BMI lower than 18.5 at diagnosis.…”

Quality of life and its correlates in pretreatment patients with locally advanced head and neck cancer: A cross-sectional study in Thailand

“…In the context of head and neck cancer, BMI has been identified as a predictive factor for malnutrition at the time of diagnosis (Arribas et al, 2013 ). Furthermore, previous research has indicated that patients classified as being at high risk of malnutrition experience persistent and significantly impaired quality of life across various domains (Silva et al, 2019 ).…”