Quality of life, HPV-status and phase angle predict survival in head and neck cancer patients under (chemo)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial. (January 2022)

• Record Type: Journal Article
• Authors: Kutz, Laura Magdalena; Abel, Jakob; Schweizer, Diana; Tribius, Silke; Krüll, Andreas; Petersen, Cordula; Löser, Anastassia
• Is Part Of: Radiotherapy and oncology. Volume 166(2022)
• Page Start: 145
• Page End: 153
• Publication Date: 2022-01
• Subjects: Head and neck squamous cell cancer -- Survival -- Quality of life -- HPV status -- Phase angle -- Malnutrition; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.11.011
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Quality of life, HPV-status and phase angle predict survival in head and neck cancer patients. Dental problems at the end of (chemo)radiotherapy influence overall survival in head and neck cancer patients. HPV negativity is associated with reduced overall survival in head and neck cancer patients. The baseline phase angle from bioelectric impedance analysis is another predictor of survival. Abstract: Purpose: To analyze the impact of quality of life (QoL), nutritional and clinical indicators on overall survival in patients with head and neck squamous cell cancer (HNSCC) undergoing (chemo)radiotherapy. Materials and methods: At the beginning, at the end of (chemo)radiotherapy and during follow-up, QoL was prospectively assessed using the EORTC-QLQ-C30 and -QLQ-H&N35 questionnaires. Data were analyzed in 58 out of 220 screened patients, who were randomized into a control and intervention group. All patients received a nutritional assessment including bioelectrical impedance analysis (BIA), laboratory testing, and a screening for malnutrition based on the questionnaires MUST, NRS-2002 and Nutriscore at baseline and at the end of therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks. Results: Except for emotional functioning, dyspnea, financial difficulties, dental problems and weight gain, all other scales from the EORTC-QLQ-C30 and -H&N35 deteriorated during (chemo)radiotherapy. At first follow-up, patients of the control group experienced more nausea and vomiting compared to those of the intervention group ( p = 0.02). After performing a multivariable model, dental problems at the end of therapy (HR: 1.03; 95% CI: 1–1.06; p = 0.03), HPV negativity (HR: 18.19, 95% CI: 1.61–204.17; p = 0.02), and baseline phase angle (HR: 0.09; 95% CI: 0.01–0.82; p = 0.03) were identified as predictors for overall survival. Conclusions: Factors influencing overall survival in patients with HNSCC undergoing (chemo)radiotherapy are complex and multifactorial. We were able to identify QoL-related (dental problems), clinical (HPV status) and nutritional (phase angle) factors as negative predictors for survival. This study was registered within the German Clinical Trials Register (DRKS00016862).