Nutritional prehabilitation in head and neck cancer: a systematic review

Cantwell, Linda A.; Fahy, Emer; Walters, Emily; Patterson, Joanne

doi:10.1007/s00520-022-07239-4

Cited by 12 publications

(8 citation statements)

References 52 publications

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“…Pre-emptive management of treatment side effects, such as mucositis, nausea and dysphagia, should be prioritised, particularly in vulnerable groups. Nutritional prehabilitation delivered before and during treatment may help to prevent deterioration, although evidence to support its effectiveness in HNC is lacking [ 25 ]. Regional data is also important in order to appropriately consent patients when discussing treatment plans.…”

Section: Discussionmentioning

confidence: 99%

A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment

Fahy

Brooker

Fleming

et al. 2023

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Aim Non-surgical treatment for head and neck cancer (HNC) often results in severe toxicities, which are detrimental to a patient’s health and quality of life. There is limited published UK data on unplanned hospital admissions and reasons associated with admission. We aim to identify frequencies and reasons for unplanned hospital admissions, highlighting those patient groups who are most vulnerable. Methods A retrospective study of unplanned hospital admissions of HNC patients receiving non-surgical treatment was completed. An inpatient admission was defined as ≥ 1 night spent in the hospital. To test potential demographic and treatment predictors of inpatient admission, a multiple regression model was constructed using the endpoint measure (unplanned admission), as the dependent variable. Results A cohort of 216 patients was identified over a 7-month period, and 38 of these patients (17%) required an unplanned admission. Treatment type was the only statistically significant predictor of in-patient admission. The majority of admissions were patients receiving chemoradiotherapy (CRT) (58%) with predominant reasons for admission being nausea and vomiting (25.5%) and decreased oral intake/dehydration (30%). Of the patients admitted, 12 had a prophylactic PEG placed pre-treatment, and 18 of 26 admitted without prophylactic PEG required nasogastric tube feeding during their admission. Discussion Almost one-fifth of HNC patients over this time period required hospital admission; the majority of which can be attributed to treatment toxicities when receiving CRT. This is concurrent with other studies which review the impact of radiotherapy versus CRT. Increased support and monitoring, particularly focused on nutrition, are required for patients with HNC who receive CRT. Key message This article describes a retrospective review of a patient undergoing non-surgical treatment for head and neck cancer. These patients frequently require unplanned hospital admission. The results indicate that patients undergoing (chemo)radiotherapy are most vulnerable to deterioration and additional support focused on nutrition for these patients is indicated.

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Section: Discussionmentioning

confidence: 99%

A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment

Fahy

Brooker

Fleming

et al. 2023

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“…The introduction and use of prehabilitation could also help achieve long-term MNT in patients with HNC. This would allow for the identification of patients at risk before surgery and other anti-cancer treatments and the early introduction of MNT, thus prolonging the time to therapy [29][30][31][32]. Prehabilitation could also allow for intervention before the signs of malnutrition are present and prevent deterioration in nutritional status.…”

Section: Discussionmentioning

confidence: 99%

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Molnár,

Pálfi,

Belák

et al. 2024

Pathol. Oncol. Res.

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Background: Several factors can affect overall survival of head and neck cancer (HNC) patients, including characteristics of the cancer disease and response to treatments. However, patients’ nutritional status and the effectiveness of medical nutrition therapy (MNT) can also impact overall survival. The primary goal of our research was to collect real-life data on the use of MNT in HNC patients and to specifically investigate the correlation between survival and the duration of uninterrupted (persistent) nutrition.Method: The data of this retrospective, analytical, cohort study was collected from electronic healthcare records from the Hungarian National Health Insurance Fund Management. Overall, 38,675 HNC patients’ data of the period between 2012 and 2021 was used. We applied multi-step exclusions to identify patient groups accurately and to avoid biasing factors. Statistical analysis was done by the Kaplan-Meier method, log-rank test, and Cox regression analysis.Results: Throughout the investigated period 16,871 (64%) patients received MNT therapy out of 26,253 newly diagnosed patients (≥18 years). In terms of the persistence of MNT, we divided the patients into three groups (1–3; 4–6; ≥7-month duration of MNT). When comparing these groups, we found that patients receiving long-term (≥7 months) MNT had a significantly longer overall survival (p < 0.0001) than those who received MNT for a shorter duration, both in locally advanced and recurrent/metastatic cases.Conclusion: The main outcome of the study is that there is a positive correlation between the persistence of MNT and the overall survival in HNC patients when nutritional intervention lasts several months. It highlights the responsibility of the specialists during the patient journey to use MNT early and to continue its use for as long as it is beneficial to the patients.

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“…These pre-operative interventions alongside other multimodal and multidisciplinary approaches to optimize patient’s physical, nutritional and mental status prior to surgery has been termed prehabilitation and can also include exercise programs and dysphagia rehabilitation [ 35 , 36 ]. A systematic review of nutrition interventions undertaken in the HNC prehabilitation setting identified only two studies which examined the use of an enriched formula versus standard nutrition support in malnourished patients and found no additional benefit of the enriched formula in mitigating weight loss [ 37 ]. The authors concluded, however, that due to the malnutrition risks on diagnosis and the negative impact of poor nutritional status on clinical outcomes, further robust nutritional prehabilitation research is required to inform clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

Brown

Edwards

Pashley

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer. Methods Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications. Results Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days). Conclusion Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

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Nutritional prehabilitation in head and neck cancer: a systematic review

Cited by 12 publications

References 52 publications

A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment

A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

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