Download Impact of nutritional status on quality of life in head and neck cancer

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
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 postdiagnosis (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.
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?
Objective
Nutritional status at diagnosis can be
used as a predictor of quality of life at
four and twelve months post-treatment
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
Methods
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
Results
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
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%)
Nutritional status predicting QoL at
12 months – multivariate analysis
Discussion
•
•
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.
References
1.
2.
Acknowledgement
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
3.
4.
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Cancer: disease and nutrition
are key determinants of patients' quality of life. Support Care Cancer. 2004
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).
1999 Sep;8(3):133-6 .
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. 2012 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. 2006 Apr;29(2):183-8