Nutritional Status Impacts Quality of Life in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy: Results from the Prospective HEADNUT Trial

Abstract

Malnutrition negatively impacts quality of life (QoL) in patients with head and neck cancer (HNC). This is the first prospective study to assess the impact of malnutrition (defined by the bioelectrical impedance analysis (BIA)-derived fat-free mass index) on QoL in patients with HNC undergoing (chemo)radiotherapy. Between October 2018 and October 2020, 58 HNC patients prospectively completed the QoL-questionnaires EORTC-QLQ-C30 and EORTC-QLQ-H&N35 at the beginning (t_b) and at the end of (chemo)radiotherapy (t_e) as well as during follow-up (t_f). At these time points, nutritional risk assessment (MUST, NRS-2002, Nutriscore), BIA measurement and laboratory testing was performed by a permanent study team. Differences between malnourished (n = 14) and well-nourished patients (n = 44) were observed in UICC classification (P < 0.001) and HPV status (P = 0.03). Well-nourished patients showed higher baseline hemoglobin (P = 0.025) and albumin (P = 0.005), but lower c-reactive protein levels (P < 0.001). At t_b, mostly malnourished patients presented with worse QoL. Multivariable analysis showed that MUST, NRS-2002, HPV status, and UICC classification were related to QoL. Nutritional status has a crucial impact on QoL. The nutritional screening protocols MUST and NRS-2002 are suitable for identifying patients at risk and predicting QoL in patients with HNC undergoing (chemo)radiotherapy.

Acknowledgment

We thank all patients and our dieticians who participated in this study.

Disclosure Statement

We state that this manuscript has not been published elsewhere and that it has not been submitted simultaneously for publication elsewhere. There is no copyright material taken from other sources. No potential conflict of interest was reported by the authors.

Author’s Contributions

Anastassia Loeser: writing the manuscript, conception, study design, execution, acquisition of data, analysis, and interpretation; Maxim Avanesov: data interpretation, revising the work; Alexander Thieme: data interpretation, revising the work; Andrea Baehr: data interpretation, revising the work; Elisabetta Gargioni: data interpretation, revising the work; Katharina Hintelmann: acquisition of data; Silke Tribius: revising the work; Andreas Krüll: revising the work; Cordula Petersen: conception, revising the work, final approval of the version to be published.

Additional information

Funding

None.