Author(s)

Joaquim Castro Silva¹, Augusta Silveira^2,3, Ana Sacau², Eurico Monteiro^1,2, Teresa Sequeira^2,3

¹Portuguese Institute for Oncology (IPOP), Porto, Portugal.
²Fernando Pessoa University (UFP), Porto, Portugal.
³Centre of Health Studies and Research of the University of Coimbra (CEISUC), Coimbra, Portugal.

Malnutrition in Head and neck cancer (HNC) patients can be present at the moment of diagnosis. The nutritional status is determinant for the treatment success and quality of life of the patients. The nutritional status gradually declines during treatment and the majority of patients undergoing treatment will need nutritional therapy. On the other hand, HNC, like other cancers, can induce a paraneoplastic syndrome that leads to cachexia. This cachexia status is most of the times the cause of death or the cause of treatment failure. So, early identification of malnutrition high risk patients is crucial to start an adequate nutrition support intervention in HNC patients. This study aims to identify HNC patients who present malnutrition or higher risk of malnutrition; to signalize variables that support early identification of high-risk patients of becoming malnourished and to establish a dynamic relationship between malnutrition risk in these patients and Quality of Life (QoL) impacts. For six months consecutive outpatients with HNC admitted at the Head & Neck Unity of Oncology Portuguese Institute—Porto were asked to participate in the research (n = 114). The European Organisation for Research and Treatment of Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30 and Malnutrition Universal Screening Tool, MUST were used. At the moment of first presentation, 32 patients (28.1%) presented high-risk of malnutrition. HNC patients with oral cavity and oropharynx tumour locations, older, with low literacy or with BMI under 18.5 at the moment of diagnosis, represent a high-risk group. When HNC is considered, a dynamic and bi-directional connection between malnutrition and QoL is observed. A significant (p < 0.001) difference in the scores of Global health status/QoL according to the malnutrition risk group was found: 62.96, 53.33, 42.71 for low, medium and high malnutrition risk respectively. Also, Emotional and social functional scales and all symptom scales—including pain, presented significant differences between high and medium risk of malnutrition patients. Fatigue, pain, insomnia, appetite loss and financial difficulties were domains directly related to high risk of malnutrition patients. Pain scores were significantly higher (43.23) in the high-risk patients when compared to medium risk patients (11.67). Nutrition support should be considered at any stage of the pathway —especially in high risk group—in order to optimize tumour treatment results, reduction of adverse effects of therapy and improving both QoL and survival.

Oncology, Head and Neck Cancer, Body Mass Index Malnutrition, Nutritional Support, Quality of Life, Malnutrition Universal Screening Tool

Silva, J. , Silveira, A. , Sacau, A. , Monteiro, E. and Sequeira, T. (2019) Head and Neck Cancer Early Identification of Malnutrition High Risk Patients and Quality of Life Optimization. International Journal of Otolaryngology and Head & Neck Surgery, 8, 204-216. doi: 10.4236/ijohns.2019.86023.