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01.09.2014 | Original Article

Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up

verfasst von: Sandra Ottosson, Ulrika Lindblom, Peter Wahlberg, Per Nilsson, Elisabeth Kjellén, Björn Zackrisson, Eva Levring Jäghagen, Göran Laurell

Erschienen in: Supportive Care in Cancer | Ausgabe 9/2014

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Abstract

Purpose

Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

Methods

Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

Results

Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (−10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (−2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

Conclusions

Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

Platteaux N, Dirix P, Dejaeger E, Nuyts S (2010) Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia 25:139–152PubMedCrossRef

Argiris A, Karamouzis MV, Raben D, Ferris RL (2008) Head and neck cancer. Lancet 371:1695–1709PubMedCrossRef

Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, Rademaker A, Logemann JA (2003) Swallowing dysfunction—preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol, Biol, Phys 57:1219–1230CrossRef

Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, Magnuson JS, Spencer SA, Bonner JA (2009) Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol, Biol, Phys 73:410–415CrossRef

Langendijk JA, Doornaert P, Rietveld DHF, Verdonck-de Leeuw IM, René Leemans C, Slotman BJ (2009) A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 90:189–195PubMedCrossRef

Rosenthal DI, Lewin JS, Eisbruch A (2006) Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 24:2636–2643PubMedCrossRef

Hughes PJ, Scott PMJ, Kew J, Cheung D, Leung SF, Ahuja AT, van Hasselt CA (2000) Dysphagia in treated nasopharyngeal cancer. Head Neck 22:393–397PubMedCrossRef

Chang YC, Chen SY, Tak Lui L, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN (2003) Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia 18:135–143PubMedCrossRef

Zackrisson B, Nilsson P, Kjellén E, Johansson KA, Modig H, Brun E, Nyman J, Friesland S, Reizenstein J, Sjödin H (2011) Two-year results from a Swedish study on conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma—the ARTSCAN study. Radiother Oncol 100:41–48PubMedCrossRef

10.

Johansson KA, Nilsson P, Zackrisson B, Ohlson B, Kjellen E, Mercke C, Alvarez-Fonseca M, Billstrom A, Bjork-Eriksson T, Bjor O, Ekberg L, Friesland S, Karlsson M, Lagerlund M, Lundkvist L, Lofroth PO, Lofvander-Thapper K, Nilsson A, Nyman J, Persson E, Reizenstein J, Rosenbrand HO, Wiklund F, Wittgren L (2008) The quality assurance process for the ARTSCAN head and neck study—a practical interactive approach for QA in 3DCRT and IMRT. Radiother Oncol 87:290–299PubMedCrossRef

11.

Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, Chepeha DB, Hogikyan ND, Terrell JE (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol, Biol, Phys 53:23–28CrossRef

12.

Nguyen N, Frank C, Moltz C, Vos P, Smith H, Bhamidipati P, Karlsson U, Nguyen P, Alfieri A, Nguyen L (2006) Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol 80:302–306PubMedCrossRef

13.

Nguyen N, Moltz C, Frank C, Vos P, Smith H, Karlsson U, Dutta S, Midyett F, Barloon J, Sallah S (2004) Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol 15:383–388PubMedCrossRef

14.

Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, MacCracken E, Gaziano J, Stachowiak L (2002) Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24:555–565PubMedCrossRef

15.

Chasen MR, Bhargava R (2009) A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer. Support Care Cancer 17:1345–1351PubMedCrossRef

16.

Jager-Wittenaar H, Dijkstra PU, Vissink A, van Oort RP, van der Laan BFAM, Roodenburg JLN (2011) Malnutrition in patients treated for oral or oropharyngeal cancer—prevalence and relationship with oral symptoms: an explorative study. Support Care Cancer 19:1675–1683PubMedCentralPubMedCrossRef

17.

Sobin LH, Fleming ID (1997) TNM classification of malignant tumors. Cancer 80:1803–1804PubMedCrossRef

18.

Palmer JB, Kuhlemeier KV, Tippett DC, Lynch C (1993) A protocol for the videofluorographic swallowing study. Dysphagia 8:209–214PubMedCrossRef

19.

Logemann JA (1998) Evaluation and treatment of swallowing disorders. PRO-ED, Incorporated

20.

Kondrup J, Allison S, Elia M, Vellas B, Plauth M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421PubMedCrossRef

21.

Vallén C, Hagell P, Westergren A (2011) Validity and user-friendliness of the minimal eating observation and nutrition form-version II (MEONF-II) for undernutrition risk screening. Food Nutr Res. doi:10.3402/fnr.v55i0.5801

22.

Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM (2004) Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 130:1100–1103PubMedCrossRef

23.

Teitelbaum D, Guenter P, Howell WH, Kochevar ME, Roth J, Seidner DL (2005) Definition of terms, style, and conventions used in ASPEN guidelines and standards. Nutr Clin Pract 20:281–285PubMedCrossRef

24.

Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29:893–900PubMedCrossRef

25.

Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:15–19CrossRef

26.

Dechaphunkul T, Martin L, Alberda C, Olson K, Baracos V, Gramlich L (2013) Malnutrition assessment in patients with cancers of the head and neck: a call to action and consensus. Crit Rev Oncol Hematol 88:459–476PubMedCrossRef

27.

Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr 92:799–808PubMedCrossRef

28.

Berg MG, Rütten H, Rasmussen–Conrad EL, Knuijt S, Takes RP, Herpen CM, Wanten GJ, Kaanders JH, Merkx MA (2013) Nutritional status, food intake, and dysphagia in long–term survivors with head and neck cancer treated with chemoradiotherapy: a cross–sectional study. Head Neck. doi:10.1002/hed.23265 PubMed

29.

McQuestion M, Fitch M, Howell D (2011) The changed meaning of food: physical, social and emotional loss for patients having received radiation treatment for head and neck cancer. Eur J Oncol Nurs 15:145–151PubMedCrossRef

30.

Tiblom Ehrsson YT, Langius-Eklof A, Laurell G (2011) Nutritional surveillance and weight loss in head and neck cancer patients. Support Care Cancer 20:757–765CrossRef

31.

Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT (1998) Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 124:589–592PubMedCrossRef

32.

Ottosson S, Zackrisson B, Kjellén E, Nilsson P, Laurell G (2012) Weight loss in patients with head and neck cancer during and after conventional and accelerated radiotherapy. Acta Oncol 52:711–718PubMedCentralPubMedCrossRef

33.

Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E (2011) Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer—a randomized study. Head Neck 34:1–9PubMedCrossRef

34.

Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, Nguyen LM, Rose S, Dutta S, Sallah S (2006) Evolution of chronic dysphagia following treatment for head and neck cancer. Oral Oncol 42:374–380PubMedCrossRef

35.

Payakachat N, Ounpraseuth S, Suen JY (2012) Late complications and long–term quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck 35:819–825PubMedCrossRef

36.

Bodin I, Jäghagen EL, Isberg A (2004) Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer. Head Neck 26:923–929PubMedCrossRef

37.

Kuhlemeier K, Yates P, Palmer J (1998) Intra-and interrater variation in the evaluation of videofluorographic swallowing studies. Dysphagia 13:142–147PubMedCrossRef

38.

Lango MN, Egleston B, Fang C, Burtness B, Galloway T, Liu J, Mehra R, Ebersole B, Moran K, Ridge JA (2013) Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer. Cancer. doi:10.1002/cncr.28482 PubMed

39.

Semenov YR, Starmer HM, Gourin CG (2012) The effect of pneumonia on short–term outcomes and cost of care after head and neck cancer surgery. Laryngoscope 122:1994–2004PubMedCrossRef

Titel: Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up
verfasst von: Sandra Ottosson
Ulrika Lindblom
Peter Wahlberg
Per Nilsson
Elisabeth Kjellén
Björn Zackrisson
Eva Levring Jäghagen
Göran Laurell
Publikationsdatum: 01.09.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 9/2014
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-014-2211-6

Springer Medizin

Weight loss and body mass index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up