Background. Radiotherapy associated toxicities and weight loss is common in patients with head and neck cancer (HNC). Helical-intensity modulated radiotherapy (H-IMRT) is a relatively new technique used in treatment. The aim of this study was to determine the association between nutrition outcomes and toxicities following H-IMRT in patients with HNC.
Methods. A prospective cohort of patients with HNC receiving H-IMRT were recruited over 14 months. The outcomes for patients predicted as low nutritional risk according to local protocol were analysed. Data collected include patient characteristics, toxicities (graded 0, 1, ≥ 2 using the CTCAE version 4.0), weight, diet texture and enteral feeding. Primary outcomes were percentage weight change from start to end of treatment and diet texture at the final week of treatment. One-way ANOVA, Welch ANOVA, Chi-squared and Fisher’s Exact tests were used to examine associations with grades of toxicities at the final week of treatment (P < 0.05).
Results. Final sample (n=84) with 74% male and median age 66 years. Weight loss (mean, 3.9%; 95% CI, 3.1%–4.8%) was associated with histology, treatment modality, diet texture and toxicities (pharyngeal mucositis, dysgeusia, xerostomia, salivary duct inflammation, nausea and dysphagia) but not with tumour site or staging. 35% of patients had clinically significant weight loss ≥ 5% which was associated with grade ≥ 2 nausea, dysgeusia and pharyngeal mucositis. Grade ≥ 2 oral and pharyngeal mucositis, xerostomia, salivary duct inflammation and dysphagia were associated with texture modified diet (minced, pureed or liquids).
Conclusions. For patients predicted as low nutritional risk treated with H-IMRT, grade ≥ 2 nausea, dysgeusia or pharyngeal mucositis can identify patients at risk of weight loss ≥ 5%. Frequent monitoring of toxicities, weight and diet texture is recommended to identify patients requiring dietetic intervention to minimise weight loss and ensure nutritional adequacy of texture modified diets.