Importance of Nutrition for Head and Neck Cancer Patients

Importance of Nutrition for Head and Neck Cancer Patients
Zeinab Elsayed
Prof. Department of Clinical Oncology and Nuclear Medicine Ain Shams University
Head and neck cancer is the sixth most common cancer type. At present, more than 650,000 new cases are diagnosed each year worldwide. More than 90% of head and neck cancers are of squamous cell histology and originate in the lip/oral cavity, nasopharynx, oropharynx, hypopharynx and the larynx (1). Malnutrition is a subacute or chronic state in which a combination of varying degrees of undernutrition and inflammatory activity has led to a change in body composition and diminishedfunction (2). Malnutrition in cancer patients ranges between 40 % -80% and most commonly occurs in those with gastrointestinal or head and neck cancer (HNC) (3). Patients with HNC arefrequently malnourished at the time of diagnosis and even before beginning their treatment as tumors of the HN can mechanically hinder the intake of food or cause trismus and odynophagia that limit oral intake (4). Surgery, depending on the tumor site, technique, and approach, may extensively alter the anatomy and lead to sacarring that negatively impacts chewing and swallowing functions (4). Radiotherapy and chemotherapy commonly result mucositis, xerostomia, alteration or loss of taste, nausea, and vomiting, with consequent decline in nourishment (6-8). Other factors that contribute to metabolic complications include tumor-induced metabolic dysfunction or cancer cachexia orimmune alterations (9). The impact of malnutrition on HNC patients is profound and directly affects outcomes. In addition to survival, quality of life (QOL), and functional outcomes are of prime importance (5). Weight loss is one of the main symptoms of
malnutrition and is a frequently observed problem among patients with HNC (10). It has been shown that, during radiotherapy or chemoradiation, many patients may lose ≥ 10% of body weight (7). In patients with stage III and IV HNC, treated with different modalities, the strongest independent predictor of survival is pretreatment weight loss (11). Bertrand et al showed that 7 to 10 days of preoperative nutrition resulted in a significant improvement in postoperative quality of life and led to a 10% decrease in postoperative infectiouscomplications (12). Malnourished patients are immunocompromised, with a particular decrease in cell-mediated immunity. It has been found that the immune suppression observed in malnourished patients is associated with unimpeded tumor growth (9). Moreover, the deterioration of the nutritional status of HNC patients results in an increase in chemoradiation related toxicities and this may prolong the overall treatment time, which has been associated with poor clinical outcome (13-14). Because of the risks associated with malnutrition, it is important to be able to identify before treatment begins those patients with HNC who are at risk for malnutrition. Regardless of the method used to assess, diagnose, or monitor, once high-risk patients are identified, immediate intervention is mandated to result in a much improved outcome (9).In HNC patients, enteral nutrition is often preferred. However, it is almost always inadequate to give nutrition via routine oral route and some form of tube feeding is required (15). Parenteral nutrition is the feeding option of last resort and should be used only when enteral feeding is not possible or is contraindicated(9). Nutritional assessment and support of HNC patients before initiating treatment and frequent reevaluation during and after therapy are of paramount importance. A multidisciplinary approach with a medical team, in which a clinical nutritionist is involved would give the best outcome in this group ofpatients.