Abstract
Purpose
Poor nutritional status is common and associated with mortality and morbidity in patients with head and neck cancer (HNC). While there are several established clinical risk factors for poor nutritional status during HNC radiotherapy, the complete aetiology is not known. The association of malnutrition with psychological factors has been recognised in other chronic illnesses but has not been studied in HNC patients who have higher levels of malnutrition and psychological disorder than many other patient populations.
Method
Patients with HNC were assessed at three time points: week 1 of radiotherapy treatment (T1, n = 72), end of radiotherapy treatment (T2, n = 64) and 4 weeks post-radiotherapy treatment (T3, n = 58). Nutritional outcome was measured using the Patient-Generated Subjective Global Assessment, and psychological factors measured were depression, anxiety and adjustment style.
Results
Linear mixed models indicated that a model containing the variables time, tumour site and baseline depression best explained malnutrition at T2 and T3 (−2 restricted log likelihood = 695.42). The clinical risk factors: cancer stage, number of radiotherapy fractionations, a PEG feeding tube, availability of a care giver and dietitian's informal clinical assessment did not predict later nutritional status.
Conclusions
Depression is a modifiable risk factor for malnutrition among HNC patients undergoing radiation therapy, offering the potential to ameliorate malnutrition in this group. While the nature of any causal relationship between depression and malnutrition in HNC is yet to be understood, the utility of a short depression screen in predicting malnutrition has been demonstrated and could be adopted in clinical practice.
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References
Rose BR, Li W, O’Brien CJ (2004) Human papillomavirus: a cause of some head and neck cancers? Med J Aust 181:415–416
Australian Institute of Health and Welfare (AIHW) (2007) Head and neck for NSW
Larsson M, Hedelin B, Johansson I, Athlin E (2005) Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment. Cancer Nurs 28:425–435
van Bokhorst-de van Der Schueren MA, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527
Piquet MA, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M, Monnier P, Mirimanoff RO, Roulet M (2002) Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer 10:502–504
Cady J (2007) Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement. Clin J Oncol Nurs 11:875–880
Konski AA, Pajak TF, Movsas B, Coyne J, Harris J, Gwede C, Garden A, Spencer S, Jones C, Watkins-Bruner D (2006) Disadvantage of men living alone participating in radiation therapy oncology group head and neck trials. J Clin Oncol 24:4177
Adolorato G, Capristo E, Stefanini G, Gasbarrini G (1997) Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol 32:1013–1021
Koo JR, Yoon JW, Kim SG, Lee YK, Oh KH, Kim GH, Kim HJ, Chae DW, Noh JW, Lee SK, Son BK (2003) Association of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis 41:1037–1042
Egede LE, Nietert PJ, Zheng D (2005) Depression and all-cause and coronary heart disease mortality among adults with and without diabetes. Diab Care 28:1339–1345
Onyike C, Crum R, Lee H, Lyketsos C, Eaton W (2003) Is obesitry association with major depression? Results from the third national health and nutrition examination survey. Am J Epidemiol 158:1139–1147
Musselman DL, Betan E, Larsen H, Phillips LS (2003) Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry 54:317–329 [Review; 141 refs]
Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, Blais MA, Meigs JB, Grant RW (2007) Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diab Care 30:2222–2227
Valente SM (2003) Depression and HIV disease. J Assoc Nurses AIDS Care 14:41–51 [Review; 37 refs]
Samuel-Hodge CD, Watkins DC, Rowell KL, Hooten EG (2008) Coping styles, well-being, and self-care behaviors among African Americans with type 2 diabetes. Diab Educ 34:501–510
Duffy SA, Ronis DL, Valenstein M, Fowler KE, Lambert MT, Bishop C, Terrell JE (2007) Depressive symptoms, smoking, drinking, and quality of life among head and neck cancer patients. Psychosomatics 48:142–148
Dropkin MJ (2001) Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery. Cancer Nurs 24:143–148
Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785
Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9. J Gen Intern Med 16:606–613
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52:69–77
Watson M, Law M, dos Santos M, Greer S (1994) The Mini-MAC: further development of the mental adjustment to cancer scale. J Psychosoc Oncol 12:33–46
Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:15–19
(2008) SPSS for Windows
Shike M (1996) Nutrition therapy for the cancer patient. Hematol Oncol Clin North Am 10:221–234 [Review; 77 refs]
Bomford C, Kunkler I (2003) Walter and Miller’s Tectbook of Radiotherapy, sixth edition. Churchill and Livingstone: Sydney. Chapters 17, 18 & 19
de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA (2000) Pretreatment factors predicting quality of life after treatment for head and neck cancer. Head Neck 22:398–407
Kugaya A, Akechi T, Okuyama T, Okamura H, Uchitomi Y (1998) Screening for psychological distress in Japanese cancer patients. Jpn J Clin Oncol 28:333–338
Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G (2004) Screening for depression in head and neck cancer. Psycho-Oncology 13:269–280
Chen AM, Jennelle RLS, Grady V, Tovar A, Bowen K, Simonin P, Tracy J, McCrudden D, Stella JR, Vijayakumar S (2009) Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 73:187–193
Gillespie MB, Brodsky MB, Day TA, Lee FS, Martin-Harris B (2004) Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope 114:1362–1367
Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care 8:133–136
Inouye J, Flannelly L, Flannelly KJ (2001) The effectiveness of self-management training for individuals with HIV/AIDS. J Assoc Nurses AIDS Care 12:71–82 [Republished from J Assoc Nurses AIDS Care. 2001 Mar–Apr;12(2):73–84; PMID: 11296732]
Britton B, Clover K, Carter G, Baker A (2009) The Innovation in the Intervention: Design, Recruitment and Treatment Innovations in Head and Neck Cancer Psycho-Oncology Trials. Asia-Pacific Journal of Clinical Oncology. Vol 5 S2
Rose P, Yates P (2001) Quality of life experienced by patients receiving radiation treatment for cancers of the head and neck. Cancer Nurs 24:255
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Britton, B., Clover, K., Bateman, L. et al. Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 20, 335–342 (2012). https://doi.org/10.1007/s00520-011-1087-y
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DOI: https://doi.org/10.1007/s00520-011-1087-y