Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia

Sorina R Simon; Walmari Pilz; Frank J P Hoebers; Irene P M Leeters; Annemie M W J Schols; Anna C H Willemsen; Bjorn Winkens; Laura W J Baijens

doi:10.1016/j.clnesp.2021.05.019

Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia

Clin Nutr ESPEN. 2021 Aug:44:348-355. doi: 10.1016/j.clnesp.2021.05.019. Epub 2021 May 31.

Authors

Sorina R Simon¹, Walmari Pilz², Frank J P Hoebers³, Irene P M Leeters⁴, Annemie M W J Schols⁵, Anna C H Willemsen⁶, Bjorn Winkens⁷, Laura W J Baijens⁸

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address: sr.simon@alumni.maastrichtuniversity.nl.
² Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands; School for Mental Health and Neuroscience - MHeNs, Maastricht University Medical Center, Maastricht, the Netherlands.
³ School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands.
⁵ Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism - NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands.
⁶ School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism - NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands; Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
⁷ Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute - CAPHRI, Maastricht University Medical Center, Maastricht, the Netherlands.
⁸ Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands; School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, the Netherlands.

PMID: 34330489
DOI: 10.1016/j.clnesp.2021.05.019

Abstract

Background & aims: Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. The purpose of this study is two-fold: to identify the risk of malnutrition in patients with oropharyngeal dysphagia (OD) secondary to HNC, and to determine the relationship between the risk of malnutrition versus tumor characteristics, treatment modality, time interval (between the end of oncological treatment and swallowing assessment date), level of oral intake, body mass index (BMI), aspiration, pharyngeal pooling, and OD-related quality of life (QoL).

Methods: The Short Nutritional Assessment Questionnaire (SNAQ) was used to screen patients for the risk of malnutrition. Patients underwent a standardized swallowing examination protocol including an endoscopic evaluation of swallowing.

Results: Seventy-five dysphagic HNC patients were included. Forty-eight percent of the patients presented a high risk of malnutrition using SNAQ. The majority of the patients (81.3%) was on a total oral diet. Moreover, BMI did not appear to be a reliable measure to screen for malnutrition as a normal BMI was often associated with an increased risk of malnutrition on the SNAQ. In contrast, patients who were underweight or overweight did not show an association with a high risk of malnutrition. With the exception of BMI, no other patient and tumor characteristics were found to be associated with the risk of malnutrition.

Conclusions: This study emphasizes the importance of early nutritional screening in dysphagic HNC patients, as almost half of these patients presented a high risk of malnutrition. Malnutrition screening using SNAQ can identify HNC patients with OD who are at risk of malnutrition and subsequently need to be referred to a dietician for additional nutritional assessment, diagnosis of malnutrition, and nutritional support, even when their BMI is within normal range.

Keywords: Deglutition; Dysphagia; Head and neck cancer; Malnutrition.

MeSH terms

Deglutition Disorders* / diagnosis
Deglutition Disorders* / etiology
Early Detection of Cancer
Head and Neck Neoplasms* / complications
Humans
Malnutrition* / diagnosis
Malnutrition* / etiology
Nutrition Assessment
Nutritional Status
Quality of Life