|Nutritional status and quality of life in head and neck cancer|
|First Author, Year, Study Place||Data Collection Period||Study Design||Sample Size||Nutritional Assessment||Quality of Life Assessment||Groups being compared||Key results||Conclusion|
|Jager-Wittenaar H, 2011, The Netherlands ||October 2004 and February 2006||Convenience sample, cross-sectional study||115 oral or oropharyngeal cancer||
Percentage weight loss was calculated as: [(normal
body weight - actual body weight)/normal body weight] *100
|EORTC QLQ C-30||Weight loss > =10% in 6 months or > =5% in 1 month||
Median scores of malnourished
patients on physical functioning (p = .007)
and fatigue (p = .034) were significantly lower than those of well-nourished patients.
Malnourished patients treated for oral/oropharyngeal
cancer score lower on quality of life scales related to physical fitness.
|Capuano G, 2010, Italy ||NA||Prospective, consecutive case series||
61 Head & Neck Cancer
Oropharynx: n = 21; Oral cavity: n = 19
Nasopharynx: n = 13; Larynx: n = 5; Maxillary sinus: n = 2
Submandibular gland: n = 1
1. Unintended weight loss (UWL)
|EORTC QLQ C-30||
Unintended weight loss –
Non-malnourished: involuntary loss of < 5% of body weight in the last 3 months (n = 36) & Malnourished: ≥ 5% loss of body weight in the last 3 months (n = 25)
1. Unintended weight loss –
Malnutrition (UWL) and Hb level independently influenced physical (p = 0.002; p = 0.005), role (p = 0.004; p = 0.001), and social functions (p = 0.024; p = 0.009).
2. PG-SGA score –
Mean ± SD = 3 ± 2 & 9 ± 5 respectively for non-malnourished & malnourished patients, p < 0.001.
An early and intensive
nutritional support might reduce weight loss before, during, and after treatment completion, improving outcome, QoL, and PS.
|Morton RP, 2009, New Zealand ||
24-month period, ending in 2005
|Retrospectiveconsecutive case series||36 head and neck cancer||BMI drop over 12 months||UW-QOL||BMI change was taken as a continuous variable||The 12-month BMI drop was inversely correlated with current HRQOL, signifying that weight loss correlated with a poorer subsequent HRQOL score (r = −0.47, P = 0.026). It was significantly related to lower speech and swallowing function scores.||The observed relationship between a drop in BMI and the current HR-QOL may be a function of greater general impact of treatment.|
|van den Berg MGA, 2007, the Netherlands ||May 2002 to May 2004||Observationalprospective non-randomized, longitudinal study||
47 Squamous Cell Carcinoma of the oral cavity, oropharynx,
Oral cavity: n = 23; Oropharynx: n = 18; Hypopharynx: n = 5
Unintended weight loss
Malnutrition was defined as unintended weight loss of 10% or more within the previous 6 months before baseline
|EORTC QLQ C-30and EORTC QLQ – H&N35||≥ 10% & < 10% weight loss at baseline||
1. At baseline: Patients ≥10% weight loss in 6 months before baseline had lower scores for global, physical, role, and emotional functioning. Fatigue, pain, insomnia, appetite loss, swallowing, decreased sexuality, sticky saliva and coughing were worse in the ≥ 10% weight loss group.
2. At the end of treatment: Patients who had lost ≥ 10% weight had lower role and social functioning. Scores significantly differed for global (p = 0.01), fatigue (p = 0.03), pain (p = 0.04), senses problems (0.05), sticky saliva (p = 0.01), coughing (p = 0.02) and feeling ill (p = 0.01) during treatment.
3. Six months after treatment: Patients ≥ 10% weight loss lower on physical, role, emotional and cognitive functioning.
|Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL.|
|Petruson KM, 2005, Sweden ||
February 1996 to
|Prospective, longitudinal study||
49 primary untreated head and neck cancer
Pharyngeal: n = 15; Laryngeal: n = 12; Oral: n = 12; Other: n = 10
* Severe weight loss (malnutrition) defined as loss of more than 10% weight during 6 months
1. EORTC QLQ-C30
2. EORTC QLQ-H&N35
|≥ 10% weight loss (n = 20) & < 10% weight loss (n = 29)||
(A) At different time-points: Patients who lost ≥ 10% in weight during 6 months had worse HRQL at diagnosis than did patients who lost less at all time-points.
(B) HADS: At diagnosis, 37% of the ≥ 10% weight loss group had Possible/probable depression versus 17% of the <10% weight-loss group. This tendency remained after 3 months (38% vs 20%), at 1-year follow-up (44% vs 5%), and after 3 years (27% vs 15%).
|Patients with head and neck cancer who are at risk of severe weight loss developing during treatment may be detected with the aid of HRQL questionnaires at diagnosis.|
|Hammerlid E, 1998, Norway, Sweden ||NA||Prospective, consecutive case series||
48 head and neck cancer
Oral cavity: n = 16
Larynx: n = 11
Sinus: n = 10
Skin: n = 4
Hypopharynx: n = 4
Other: n = 3
1. Weight loss
(a) AMC and (b) TSF
EORTC QLQ-C30 supplemented
by a provisional H&N cancer module constructed
1. Weight loss:
> 5% & ≤ 5% of the body weight
2. Anthropometry: Based on Swedish reference values
3. WI: < 0.80 & ≥ 0.80
4. BMI: ≥ 20 & < 20
5. S-alb: < 33 g/L & ≥ 33 g/L
Groups for analysis
(1) malnutrition (n =25) versus normal (n = 22),
(2) weight loss (n = 20) versus no weight loss (n = 24),
(3) negative energy balance (n = 18) versus positive energy balance (n = 15)
1. Malnutrition versus normal nutritional status: Malnourished patients scored worse for 12 of the 16 functions/symptoms. The greatest differences between the two groups were found for Physical Function, global QoL, and Role Function, NS.
2. Weight loss versus no weight loss: Patients with weight loss scored worse for 11 of 16 functions.
(a) Swallowing difficulties
Mean score = 52 & 18 for those with weight loss and no weight loss respectively, p < 0.01.
(b) Problems swallowing food
Mean score = 62 & 29 for those with weight loss and no weight loss respectively, p < 0.01.
3. Negative and positive energy balance:
The groups of patients with negative energy balance scored better than the group of patients with positive energy balance for 11 of the 16 function/symptoms, NS.
|This study demonstrated few significant differences, depending on nutritional status, in some of the QL scales or item scores.|
Lis et al. Nutrition Journal 2012 11:27 doi:10.1186/1475-2891-11-27