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Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
Lunds universitet.
Lunds universitet.
Lunds universitet.
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2014 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 22, no 9, 2361-2369 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

METHODS: Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

RESULTS: Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (-10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (-2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

CONCLUSIONS: Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

Place, publisher, year, edition, pages
Springer, 2014. Vol. 22, no 9, 2361-2369 p.
Keyword [en]
fluoroscopy, swallowing dysfunction, head and neck cancer, weight loss, Body Mass Index
National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-82488DOI: 10.1007/s00520-014-2211-6ISI: 000339976900009PubMedID: 24687537OAI: oai:DiVA.org:umu-82488DiVA: diva2:661416
Note

Included in thesis in manuscript form.

Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Impact of disease and treatment on body weight and eating in patients with head and neck cancer: experiences from a multicenter study
Open this publication in new window or tab >>Impact of disease and treatment on body weight and eating in patients with head and neck cancer: experiences from a multicenter study
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating.

Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project.

Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating.

Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1608
Keyword
Head and neck cancer, weight loss, body mass index, tube feeding, radiation therapy, survival, treated volume, swallowing dysfunction, patient experience.
National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-82562 (URN)978-91-7459-753-0 (ISBN)
Public defence
2013-11-29, Hörsal C, Samhällsvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
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Available from: 2013-11-07 Created: 2013-11-05 Last updated: 2015-11-04Bibliographically approved

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