A prospective study on malnutrition and quality of life in patients with head and neck cancer
Introduction
Patients with squamous cell carcinoma (SCC) of the head and neck area are particularly at risk of developing malnutrition, due to the location of the tumour and their treatment. The incidence of malnutrition is high and affects 30–50% patients with a large tumour (T2–T4) located in the oropharynx and hypopharynx are particularly susceptible.1, 2, 3, 4 Unintended weight loss of more ⩾10% in six months or ⩾5% in one month is related to risk malnutrition.3, 4, 5
In addition to the traditional clinical outcomes in tumour response and survival, health related quality of life (QoL) has been recognized to be important in clinical research and practice.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Treatment of head and neck cancer patients should therefore not only aim at the improvement of clinical outcome but also maintain or improve QoL.18, 19
The QoL depends on physical and psychological well-being and both may influence or be affected by nutritional status.17 The relation between unintended weight loss and QoL in cancer patients in general and patients with head and neck cancer in particular has been studied prospectively. These studies suggest a relation between unintended weight loss and impaired QoL from diagnoses until and/or during treatment/revalidation.8, 10, 12, 14, 16, 19, 20
A logical conclusion would be that unintended weight loss and a subsequent decline in QoL may be prevented with adequate nutritional support.17, 21, 22
QoL is an overall expression made up of various parameters. If the QoL score or a certain profile of parameters could show a relation with or predict the onset of unintended weight loss it would be beneficial to initiate adequate nutritional intervention. It is unknown which parameters in head and neck oncology patients are affected by unintended weight loss and a subsequent decline in overall QoL especially before diagnoses until the end of treatment and six months after treatment. Clarification of this subject is important to support guidelines for nutritional support in head and neck oncology patients. Therefore an observational, prospective study in patients with SCC of the oral, oropharyngeal and hypopharyngeal cavity to look into the relation between unintended weight loss and QoL at diagnosis, treatment and revalidation was set up. In addition, the relationship between other variables as age, gender, tumour stage, treatment, and QoL were evaluated.
Section snippets
Design
This observational, prospective non-randomized study was carried out between May 2002 and May 2004. Patients with primary untreated head and neck cancer and without other malignancies in their history were asked to take part.
Medical treatment i.e. surgery and/or radiotherapy and/or chemotherapy was in accordance with the guidelines of the Dutch Cooperative Working Group for Head and Neck Oncology.23 Nutritional support during the study was in accordance with the common clinical practice at the
Compliance
Sixty-eight patients who met the inclusion criteria signed the form of consent. Twenty-one patients were subsequently excluded either because they died during the study (n = 12), were too ill to take part (n = 6) or their data were incomplete (n = 3). Finally 47 patients completed the study. Standard descriptive demographic information, tumour stage, location and medical treatment are presented in Table 1.
Unintended weight loss
Correspondence was found between self reported weight at baseline and measured weight in the
Discussion
In this prospective observational study the relation between malnutrition (unintended weight loss ⩾10% weight loss in 6 months) and QoL parameters in patients with SSC of the oral cavity, oropharynx and hypopharynx during diagnosis, treatment and revalidation was explored. Correlation between QoL scores and characteristics as unintended weight loss, age, gender, tumour stage and treatment modality was also evaluated.
Nineteen percent of the patients were considered to be malnourished at
Conflict of Interest Statement
This study was supported by a grant from the College of Health Care Insurance (CVZ). Association of Academic Efficacy Programs (VAZ). Herewith all authors declare no financial or personal interest is involved that may bias or influence this study.
Acknowledgements
This study was supported by a grant from the College of Health Care Insurance (CVZ) Association of Academic Efficacy Programs (VAZ). We thank Nienke van der Veer, RN and Maurice van Dongen, RN and Marianne Arts, clinical nurse specialist of the Oral and Maxillofacial Surgery and Otorninolaryngology Department RUNMC for their assistance in entering patients into the study. Thanks are also due to Jacqueline Arnts, RN and Heleen Lintz-Luidens nurse specialist of the Radiotherapy Department RUNMC
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