Addressing symptoms that affect patients' eating according to the Head and Neck Patient Symptom Checklist©

Brith Granström, Thorbjörn Holmlund, Göran Laurell, Per Fransson, Ylva Tiblom Ehrsson, Brith Granström, Thorbjörn Holmlund, Göran Laurell, Per Fransson, Ylva Tiblom Ehrsson

Abstract

Purpose: The purpose of this prospective study was to assess which nutritional impact symptoms (NIS) interfere with oral intake in patients with head and neck cancer (HNC) and how the symptoms interfere with body weight loss, up to 1 year after treatment.

Methods: This was a prospective study of 197 patients with HNC planned for treatment with curative intention. Body weight was measured before the start of treatment, at 7 weeks after the start of treatment, and at 6 and 12 months after completion of treatment. NIS and NIS interfering with oral intake at each follow-up were examined with the Head and Neck Patient Symptom Checklist© (HNSC©).

Results: At 7 weeks of follow-up, patients experienced the greatest symptom and interference burden, and 12 months after treatment the NIS scorings had not returned to baseline. One year after treatment, the highest scored NIS to interfere with oral intake was swallowing problems, chewing difficulties, and loss of appetite. At all 3 follow-ups, the total cumulative NIS and NIS interfering with oral intake were associated with body weight loss. Factors increasing the risk for a body weight loss of ≥ 10% at 12 months after treatment were pain, loss of appetite, feeling full, sore mouth, difficulty swallowing, taste changes, and dry mouth. Women scored higher than men in NIS and NIS interfering with oral intake. Furthermore, during the study period about half of the population had a body weight loss > 5%.

Conclusion: Because both nutritional and clinical factors may affect body weight, this study highlights the importance of a holistic approach when addressing the patients' nutritional issues.

Trial registration: ClinicalTrials.gov NCT03343236, date of registration: November 17, 2017.

Keywords: Body weight loss; Head and Neck Patient Symptom Checklist©; Head and neck cancer; Health-related quality of life; Nutritional impact symptoms.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
a Boxplot of experienced nutritional impact symptom (NIS), sum of total scores 1–5 in 17 items using the Head and Neck Patient Symptom Checklist© (HNSC©), in men and women with different treatment approaches at baseline (0w), 7 weeks after start of treatment and at 6 and 12 months after the completion of treatment in patients with head and neck cancer. RT = radiotherapy; Chemo/pharm = chemotherapy or other pharmacological treatment. b Boxplot of experienced nutritional impact symptom (NIS) interfering with oral intake as the sum of total scores 1–5 on 17 items using the Head and Neck Patient Symptom Checklist© (HNSC©), in men and women with different treatment approaches at baseline (0w), 7 weeks after the start of treatment and at 6 and 12 months after the completion of treatment in patients with head and neck cancer. RT = radiotherapy; Chemo/pharm = chemotherapy or other pharmacological treatment
Fig. 2
Fig. 2
Forest plot showing the slope (β) for the effects of cumulative nutritional impact symptoms (NIS) on percentage weight loss (7 weeks, 6 and 12 months), with 95% confidence intervals. β is the expected percentage change in body weight from baseline when increasing the cumulative NIS with one point. For enabling comparisons to the individual NIS, NIS total score has here been transformed to a scale between 1 and 5 points before analysis

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