Malnutrition Issues in Patients with Head and Neck Cancer

ISSN: 2573-5462 Since its introduction in the 1950s, the TNM staging system has been regarded as the most important prognostic cancer classification method. Patient health status is considered as a major disadvantage even by the originators of the TNM concept. Coexistent disease (as malnutrition) can strongly affect a patient’s survival and scope for treatment. Progressive weight loss and malnutrition are commonly found in patients with Head And Neck Cancer (HNC) (especially the hospitalized ones), the similar to the lung and gastrointestinal cancer [1,2,3,4]. Weight loss during the treatment for HNC is a major concern. It can result from either the neoplastic process itself or the applied therapies such as surgery, radiotherapy and chemotherapy. They all lead to additional complications e.g. as difficulty in oral intake [1,5]. The incidence of malnutrition in cancer patients ranges between 40 and 80% while the prevalence ranges from 50% to 80% depending on tumor type, tumor location, stage of disease, received treatment and the type of nutritional assessment method used [6]. All these conditions and nutritional deficits have a significant impact on mortality, morbidity, and quality of life in patients with HNC [7-12]. Timely identification of nutrition problems may improve a cancer patient’s prognosis and increasing the patient’s response to therapy with reduction of the rate and stage of the complications. There are many methods of subjective and objective assessment of patient’s nutritional status generally used in patients. Anthropometric Measurements (weight change, arm muscle Circumference (AMC), Triceps Skin-Fold Thickness (TSF)) and biochemical parameters (such as serum albumin, transferrin). Subjective Global Assessment (SGA) [13] and Patient-Generated Subjective Global Assessment (PG-SGA) are designed especially for cancer patients and commonly used also for patient with HNC [14]. European Society for Clinical Nutrition and Metabolism also recommend other tools such as Nutritional Risk Screening (NRS-2002 for hospital admission; the Malnutrition Universal Screening Tool (MUST), the Mini Nutritional Assessment (MNA) [15]. Relatively new tool such as Phase Angle (PA) determined by Bioelectric Impedance Analysis (BIA) is used and allow the objective determination of prognosis [16]. The utility of this nutritional screening tool has been evaluated by its ability to predict relevant clinical outcomes such as complications, treatment response, survival and Quality Of Life (QoL). Different methods have been compared to assess prognosis and ability of prediction of clinical outcome, but only just few assess the impact on overall survival [16]. BIA is the objective diagnostic method and has been established as a valuable tool in the evaluation of body composition and nutritional status in many patients’ conditions including cancer [8-22]. BIA evaluates body components such as Resistance (R) and Reactance (Xc) by recording a voltage drop in applied current [23]. PA is proportional to the ratio of reactance and resistance – it is also proportional to the ratio of body cell mass to fat-free mass. PA reflects the relative contributions of fluid (resistance) and cellular membranes (reactance) of the human body. By definition, PA is positively associated with reactance and negatively associated with resistance [24]. Resistance is the restriction to the flow of an electric current, primarily related to the amount of water present in the tissues. Reactance is the resistive effect produced by the tissue interfaces and cell membranes [25]. Reactance causes the current to lag behind the voltage creating a phase shift, which is quantified geometrically as the angular transformation of the ratio of reactance to resistance, or PA. Thanks to its potential to detect changes in tissue electrical properties PA has been found as a prognostic, nutritional, membrane cell function or health marker in various disease conditions [26-37].