umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Impact of disease and treatment on body weight and eating in patients with head and neck cancer: experiences from a multicenter study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
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 [en]
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: urn:nbn:se:umu:diva-82562ISBN: 978-91-7459-753-0 (print)OAI: oai:DiVA.org:umu-82562DiVA: diva2:661885
Public defence
2013-11-29, Hörsal C, Samhällsvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-11-07 Created: 2013-11-05 Last updated: 2015-11-04Bibliographically approved
List of papers
1. Weight loss in patients with head and neck cancer during and after conventional and accelerated radiotherapy
Open this publication in new window or tab >>Weight loss in patients with head and neck cancer during and after conventional and accelerated radiotherapy
Show others...
2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 4, 711-718 p.Article in journal (Refereed) Published
Abstract [en]

Background. Weight loss is common among patients with squamous cell carcinoma of the head and neck (SCCHN) and is mainly due to tumor and treatment related factors. The aim of the present study was to evaluate weight loss in patients with SCCHN undergoing two different radiotherapy (RT) schedules.

Material and methods. Nutritional data were analyzed from the ARTSCAN study, a controlled randomized prospective Swedish multicenter study conducted with the aim of comparing conventional fractionation (2.0 Gy per day, total 68 Gy during 7 weeks) and accelerated fractionation (1.1 + 2.0 Gy per day, total 68 Gy during 4.5 weeks). Seven hundred and fifty patients were randomized and 712 patients were followed from the start of RT in the present nutritional study.

Results. The patients had a weight loss of 11.3% (± 8.6%) during the acute phase (start of RT up to five months after the termination of RT). No difference in weight loss was seen between the two RT fractionation schedules (p = 0.839). Three factors were significantly predictive for weight loss during the acute phase, i.e. tumor site, overweight/obesity or lack of tube feeding at the start of RT. Moreover, the nadir point of weight loss occurred at five months after the termination of RT.

Conclusion. The results of the present study showed no difference in weight loss between the two RT fractionation schedules and also highlight that weight loss in SCCHN is a multifactorial problem. Moreover, the nadir of weight loss occurred at five months after the termination of treatment which calls for more intense nutritional interventions during the period after treatment.

Keyword
Nutrition, head and neck cancer
National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-63737 (URN)10.3109/0284186X.2012.731524 (DOI)23106176 (PubMedID)
Projects
ARTSCAN
Available from: 2013-01-08 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
2. Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study
Open this publication in new window or tab >>Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study
Show others...
2014 (English)In: Radiation Oncology, ISSN 1748-717X, E-ISSN 1748-717X, Vol. 9, 160- p.Article in journal (Refereed) Published
Abstract [en]

Background: Weight loss is a common problem in patients with Squamous Cell Carcinoma of the Head and Neck (SCCHN) treated with radiotherapy (RT). The aims of the present study were to determine if treated volume (TV), as a measure of the radiation dose burden, can predict weight loss in patients with oropharyngeal cancer and to analyze weight loss and body mass index (BMI) in the same patient group in relation to 5-year overall survival. Methods: The ARTSCAN trial is a prospective, randomized, multicenter trial in patients with SCCHN. Nutritional data from the ARTSCAN trial were analyzed retrospectively using univariate and multivariate statistical methods based on information on percentage weight loss from the start of RT up to five months after the termination of RT (study cohort 1, n = 232) and information on patients' BMI at the start of RT (study cohort 2, n = 203). TV was defined as the volume of the patient receiving at least 95% of the prescribed dose. TV64.6 (Gy) encompasses macroscopic tumor and TV43.7 (Gy) elective lymph nodes of the neck. Results: TV64.6 Gy and TV43.7 Gy were both significantly correlated with higher weight loss up to five months after the termination of RT in study cohort 1 (p < 0.001 for both). BMI at the start of RT was shown to be a prognostic factor for 5-year overall survival in study cohort 2 but weight loss was not. The hazard ratios and 95% confidence intervals were 3.78 (1.46-9.75) and 2.57 (1.43-4.62) in patients with underweight and normal weight, respectively. Conclusions: TV can predict weight loss during RT in patients with oropharyngeal cancer regardless of clinical stage. A high BMI (>25 kg/m(2)) at the start of RT is positively associated with survival in patients with oropharyngeal cancer.

National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-82489 (URN)10.1186/1748-717X-9-160 (DOI)000339593400001 ()
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2017-12-06Bibliographically approved
3. Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up
Open this publication in new window or tab >>Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up
Show others...
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
Keyword
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:nbn:se:umu:diva-82488 (URN)10.1007/s00520-014-2211-6 (DOI)000339976900009 ()24687537 (PubMedID)
Note

Included in thesis in manuscript form.

Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2017-12-06Bibliographically approved
4. The experience of food, eating and meals following radiotherapy for head and neck cancer: a qualitative study
Open this publication in new window or tab >>The experience of food, eating and meals following radiotherapy for head and neck cancer: a qualitative study
2013 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 7-8, 1034-1043 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe the experience of food, eating and meals following radiotherapy in patients with head and neck cancer.

Background. Eating problems are common in patients with head and neck cancer and may remain for a long period of time after treatment.

Design. A qualitative study design using in-depth semi-structured interviews.

Methods. Interviews were conducted nine months after the termination of radiotherapy. A purposive sample of thirteen patients with head and neck cancer participated in the study. The interviews were tape-recorded, transcribed verbatim and analysed using content analysis.

Results. The experience of food, eating and meals up to nine months after radiotherapy was captured in six categories: ‘Along journey – taking small steps to an uncertain future’, ‘A new way of eating’, ‘Eating without satisfaction’, ‘Challenging meals outside the family’, ‘Support and information – the key to a successful journey’ and ‘The creation and acceptance of a new normal’.

Conclusion. This study provides new information on the long-term aspects of food, eating and meals in patients with head and neck cancer. Head and neck cancer signifies a long journey with problems affecting physical, psychological and social aspects of food. Information and support and the use of strategies are important for patients with head and neck cancer to adapt to new possibilities for living after cancer treatment. Relevance to clinical practice. All members of the multiprofessional team need to be aware of the struggles with food and eating experienced by patients with head and neck cancer during the convalescent period. It is therefore important that the follow-up focuses on all aspects of food, eating and meals as a part of a holistic approach.

Keyword
content analysis, eating; food, head and neck cancer, lived experience, meals, radiotherapy
National Category
Cancer and Oncology Nursing
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-67118 (URN)10.1111/jocn.12151 (DOI)000316148500015 ()
Available from: 2013-03-13 Created: 2013-03-13 Last updated: 2017-12-06Bibliographically approved

Open Access in DiVA

Kappa(1111 kB)694 downloads
File information
File name FULLTEXT01.pdfFile size 1111 kBChecksum SHA-512
a057d3f79baa63a4cc351eba04b6ef93a74b6cb4fe11427bb506bb4b103553afe5dbbeeeea989dade4d9a34d5bef19c8282a3d466436c097d63052fd3646b15d
Type fulltextMimetype application/pdf
Omslag(2441 kB)26 downloads
File information
File name COVER01.pdfFile size 2441 kBChecksum SHA-512
78cb053450902d6376832177f52d62392574c959dea9144309a455b5627d693473d4f80d1c59ac6db98121ba18808c0b86e154bbf5dc7e59f4d687c9bdd53ec6
Type coverMimetype application/pdf
Spikblad(97 kB)14 downloads
File information
File name SPIKBLAD01.pdfFile size 97 kBChecksum SHA-512
dbf5341f4a0aca1732e77b2a5766c5f7e3635f04985a58a4aac3b1d8b53e19db0757a2eebecec0286d469455630d79c14da5f30c5215ecdd4b69f4feb56b4742
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Ottosson, Sandra
By organisation
Otorhinolaryngology
Cancer and OncologyOtorhinolaryngology

Search outside of DiVA

GoogleGoogle Scholar
Total: 694 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 872 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf