Nutrition Assessment in Head and Neck Cancer Patients Pre and Post Chemoradiotherapy

Abstract

Introduction: Head and neck cancer patients are frequently
malnourished at the time of diagnosis and prior to the beginning
of treatment. Deterioration of the nutritional status results in an
increase in chemo-radiotherapy (CRT) related toxicity, and this
may increase the prolonged treatment time, which has been
associated with poor clinical outcome. The present study aims
to do a nutritional assessment before and after CRT in head
and neck cancer patients.
Material and Methods: The present study was undertaken at
the Department of Radiation Oncology, Shri Ram Murti Smarak
Institute of Medical Sciences, Bareilly. In this study, 50 patients
of head and neck tumors were enrolled, and their nutrition was
assessed before and after CRT. Nutrition assessment was
done using different laboratory parameters like hemoglobin,
total leukocyte count, blood urea, serum creatinine, and
serum bilirubin. Anthropometric parameters used are body
mass index, skinfold thickness, and mid-arm circumference.
Nutritional risk indicator and patient-generated subjective global
assessment (PG-SGA) score are measured before and after
CRT. All the parameters were assessed and analyzed using
different statistical tests – Chi-square test, Fisher exact test,
and paired t-test.
Results: Hemoglobin decrease was statistically significant
during treatment (p less than 0.001), and the decrease in total
leukocyte count during treatment was showing a trend towards
significance (p-value -0.056). There was deterioration in other
parameters like blood urea, serum creatinine, and serum
bilirubin but was not statistically significant. Anthropometric
parameters–body mass index (BMI), mid-arm circumference
(MAC), skinfold thickness, and percent body fat showed a
significant change (p less than 0.00001).
Nutritional risk indicator and PG-SGA class have decreased
for the majority of patients during treatment, and the change
is statistically significant (p less than 0.00001 and p = 0.0251),
respectively.
Conclusion: Nutrition has an important role to play in the
management of head and neck cancers by CRT. It helps to
reduce the complications and improve the tolerance of CRT,
thus avoiding treatment breaks, which may lead to failure of
treatment.