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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