Comorbidities of head and neck cancer may drive malnutrition

1. The following independent factors were associated with malnutrition in head and neck cancer: gastrointestinal disease, pulmonary disease, collagen disease, metachronous cancer and advanced T classification. 

2. Second primary cancer, diabetes mellitus, and cardiovascular disease were the most prevalent underlying comorbidities in head and neck cancer patients. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Malnutrition is a common clinical concern that affects up to 60% of patients with head and neck squamous cell carcinoma (HNSCC). Early interventions with the aim to improve nutritional status are important since malnutrition is associated with postoperative complications, adverse events during chemoradiation, and poorer prognosis. In this study, the authors reviewed the clinical characteristics of patients with HNSCC to elucidate factors that may be associated with malnutrition. They found that several comorbidities, namely second primary cancer, diabetes mellitus, and cardiovascular disease, were quite prevalent in HNSCC patients. In addition, they demonstrated that advanced T classification and comorbidities such as metachronous cancer, collagen disease, gastrointestinal disease, and pulmonary disease were re independently associated with malnutrition. An important strength of this study is its large sample size. However, a key limitation is that it is a retrospective review at a single institution. Although this study is not the first to delineate the factors associated with malnutrition in HNSCC patients, it solidifies the importance of recognizing these factors for effective treatment in this patient population.

Click to read the study in Acta Otolaryngologica

Relevant Reading: The diversity of nutritional status in cancer: new insights

In-Depth [retrospective cohort]: This was a retrospective study involving 726 patients from a single institution. All included patients were newly diagnosed and histologically confirmed to have HNSCC. Associations were assessed using the chi-squared or Fisher’s exact test and a logistic regression analysis was then performed to control for confounding variables. In this study, the authors found that comorbidities were present in 290 patients (40%) and among them, second primary cancer (13%), diabetes mellitus (13%), and cardiovascular disease (10%) were the most prevalent. Among the factors associated, advanced T classification, metachronous cancer, collagen disease, gastrointestinal disease, and pulmonary disease were shown to be significantly associated with malnutrition (p<0.05).

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