To the Editor,
We read the article regarding body composition changes in patients with head and neck cancer undergoing treatment by Ferrão et al. [1]. We appreciate very much this review and their effort in clarifying the importance of weight loss (especially when associated to skeletal muscle mass loss) in this patient population. Nevertheless, we would like to mention one concern regarding this study.
Several studies [2,3,4,5] have been published addressing the impact of progressive resistance training on weight loss and lean body mass, in patients with head and neck carcinoma undergoing radiotherapy. We understand these studies have not been incorporated in this review because according to the inclusion criteria studies including head and neck patients submitted to any training or dietary program were not considered.
However, we consider these studies might also be relevant because they show possible alternatives to mitigate the weight loss. Radiation therapy (with or without chemotherapy) is a standard treatment, administered to patients with head and neck carcinoma with curative intent. The weight loss (and subsequent skeletal muscle mass loss) is caused by the cancer disease itself and can gradually get worse due to the side effects of radiotherapy, impeding sufficient energy intake. This weight loss has been reported to persist more than 2 years after treatment [6] with a negative impact on toxicity, survival, and quality of life [7].
In this context, we would like to emphasize that strategies to manage treatment-related secondary effects are important to the preservation of patient function and quality of life. Common interventions to manage these secondary effects are mainly focused on nutrition counseling, although nutrition counseling alone does not significantly mitigate muscle and functional loss [6]. Furthermore, physical activity (progressive resistance training program) has also been recognized as relevant intervention for general cancer populations, helping patients to manage side effects throughout treatment and improving function and psychosocial outcomes during and after treatment [2, 5, 8].
This is clinically important, because weight and muscle loss is a primary concern for these patients and directly impacts their physical functioning and quality of life [4, 9].
To date, the majority of studies have investigated physical activity interventions that occur after head and neck cancer treatment [2, 4, 5]. Although current evidence supports the use of physical activity interventions to improve the preservations of lean body mass, and head and neck cancer disease management and recovery, the specific question of the optimal timing for an exercise intervention remains unanswered. Therefore, clinicians have no information about when to start interventions. Moreover, exercise interventions are not routinely provided to patients with head and neck cancer.
Regarding the methods for addressing body composition assessment, Ferrão et al. [1] also propose in their review the use of bioelectrical impedance analysis (on a regular basis) as one of the body composition assessment tools for body composition assessment.
Taking these considerations together, a future avenue of research should probably be focused on evaluating the impact of physical activity on body composition measured by bioelectrical impedance analysis. Additionally, answering questions regarding the optimal timing of an exercise program intervention (immediately before, during, or after radiation therapy) is an important next step in optimizing head and neck cancer care.
References
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Cacicedo, J., Mendizabal, N. & Arietaleanizbeaskoa, M.S. Letter to the editor referencing “Body composition changes in patients with head and neck cancer under active treatment: a scoping review”. Support Care Cancer 30, 1–2 (2022). https://doi.org/10.1007/s00520-021-05999-z
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DOI: https://doi.org/10.1007/s00520-021-05999-z