1. Impact of nutritional status on quality of life in head and neck cancer patients Marie-Renée ATALLAH1, Sami-Pierre MOUBAYED1, Tareck AYAD1, Louis GUERTIN1, Apostolos CHRISTOPOULOS1, Eric BISSADA1 Centre de recherche du Centre hospitalier de l’Université de Montréal (CHUM)1
Abstract
Methods
Results
Background: Head and neck cancer and the side effets related to its treatment predispose patients to malnutrition, which is an important cause of morbidity and mortality. However, uncertainties persist as to its impact on quality of life. Objective: The objective of this study is to evaluate the nutritional status of patients treated for head and neck squamous cell carcinoma and its impact on their quality of life at four months and one year after diagnosis. Methods: Data regarding nutritional status, as measured with BMI, weight loss, albumin and prealbumin, was collected before the beginning of treatment. Quality of life was evaluated prospectively, using the University of Washington Quality of Life Questionnaire, on three occasions: before the beginning of treatment, four months after diagnosis and one year later. A total of 155 consecutive patients treated for head and neck squamous cell carcinoma were reviewed from this prospective databank. Multiple linear regression was used for statistical analysis. Results: With adjustment for age, sex, cancer stage, type of treatment and progression of the disease, a lower BMI is associated with a poorer overall quality of life at one year post-diagnosis (p=0,017). No association was demonstrated between the nutritional markers and quality of life at four months after diagnostic. Conclusion: Evaluation of nutritional status is an essential component in the care of head and neck cancer patients, as malnutrition is correlated with poorer long-term quality of life.
Creation of the DICO database
Sociodemographic and clinical characteristics : SARDO database
Inclusion criteria:
Diagnosis between January 2014th and January 2016th
Oral cavity, oropharyngeal, hypopharyngeal, laryngeal, nasopharyngeal, sinonasal, unknown primary SCC
No previous head and neck SCC
Follow-up at Notre-Dame Hospital
Diagnosis ≥ 1 year
Exclusion criteria:
Inability to speak either French or English
Skin and salivary gland cancer
Recurrent cancer
Missing pre-treatment questionnaire
Statistical Analysis: SPSS V. 21,0
Simple linear regression
Multiple linear regression with adjustment for age, sex, staging, type of treatment and evolution of disease
Physical Function
Social-Emotive Function
Nutritional status predicting QoL at 4 months : No association was demonstrated between the nutritional markers and quality of life at four months after diagnostic
Nutritional status predicting QoL at 12 months – univariate analysis
Nutritional status predicting QoL at 12 months – multivariate analysis
Results
DICO Database
End of January 2016: 401 patients
246 patients excluded
155 patients included
Baseline Characteristics
Men: 106 (68,7%) / Women 49 (31,6% )
Age : 61,5 ± 9,49 year old
Cancer Site
Oral Cavity: 17 (11,0%)
Orophayngeal: 85 (54,8%)
Hypopharyngeal: 8 (5,2%)
Laryngeal: 26 (16,8%)
Nasopharyngeal: 8 (5,2%)
Nasosinusal: 6 (3,9%)
Unknown primary: 5 (3,2%)
Staging
I: 11 (7,1%)
II: 21 (13,5%)
III: 24 (15,5%)
IV: 99 (63,9%)
Treatment
Surgery only: 8 (5,2%)
Radiotherapy only: 32 (20,6%)
Chemotherapy only: 5 (3,0%)
CRT: 780 (51,6%)
Surgery + Radiotherapy: 19 (12,3%)
Surgery + CRT: 9 (5,8%)
Palliative: 2 (1,3%)
Weight loss
month prior baseline:1,69 ± 2,60 kg
BMI
<18,5 : 3 (1,9%)
18,5-24,99: 54 (34,8%)
25-29,99: 63 (40,6%)
>30: 32 (20,6%)
Background
Head and neck cancer and treatment side effects predispose patients to malnutrition1
Malnutrition is known to correlate with poor health outcome2 and can worsen functional status
Does malnutrition predict poor quality of life in these patients?
Discussion
Low BMI is correlated with poor emotional and overall quality of life at 12 months. Other studies show similar results3.
Inconclusive data for other markers: Malnutrition in our population is less prevalent than current literature suggests4
Objective
Nutritional status at diagnosis can be used as a predictor of quality of life at four and twelve months post-treatment
Conclusion
Evaluation of nutritional status is an essential component in the care of head and neck cancer patients, as malnutrition is correlated with poorer long-term quality of life.
Methods
Prospective data collection :
At time of diagnosis
Four months after diagnosis
One year after diagnosis
Evaluation of nutritional status: Weight loss in the past month; BMI; Serum markers: albumin, prealbumin, hemoglobin
Evaluation of Quality of Life: UW-QOL
References
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Cancer: disease and nutrition are key determinants of patients' quality of life. Support Care Cancer Apr;12(4):246-5
Lees J. Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) Sep;8(3):
Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer--a systematic review of the epidemiological literature. Nutr J Apr 24;11:27
Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y. Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol Apr;29(2):183-8
Acknowledgement