Assessing the acceptability and feasibility of using a computerized food frequency questionnaire (FFQ) to determine dietary patterns in survivors of head and neck cancer (HNC).
Authors: Senchak Jordan , Albert Madeline , Egleston Brian L. , Galloway Thomas James , Giri Anshu , Stromberg Kara , Costa Jacquelyn , Liu Jeffrey , Schmalbach Cecelia , Vendra Varun , Fang Carolyn Y , Jain Rishi , Bauman Jessica R 
Published: June 2023

e24103

Background: Malnutrition and poor dietary habits are associated with worse outcomes and decreased quality of life (QOL) in patients with HNC. Given the lack of standardized assessment of diet in survivors of HNC but the concern for long term malnutrition risk, we piloted a recently developed computerized FFQ that provides individualized dietary feedback (Vioscreen) in survivors of HNC. We sought to assess its feasibility and acceptability and explore associations between diet quality, QOL, and patient/treatment characteristics. Methods: We recruited HNC patients who had completed cancer treatment (radiation alone, chemoradiation, surgery/radiation, surgery/chemoradiation) at least 6 months prior to study enrollment who did not have a feeding tube. Dietary assessment was conducted using Vioscreen. Dietary quality was defined by Healthy Eating Index (HEI) and calculated by the participant’s response. All patients received an individualized feedback report. Patients also completed the EORTC QLQ-C30 and H&N35. At 6 weeks, we administered an acceptability questionnaire on usability of Vioscreen and perceived dietary changes. Results: 50 patients consented to participate. Of these, 34 (68%) completed all initial questionnaires. Of the 34 participants, majority were white/non-Hispanic, male, with oropharynx primaries, and median time from treatment was 68.4 months. Of the 27 who completed acceptability, 15 (56%) considered the Vioscreen tool to be useful, 9 (36%) reported they made changes to diet, and 16 (59%) would recommend to others. Mean HEI score was 63.2 (SD 11.3). There were no statistically significant differences in HEI scores between participants who were male vs female or based on time from treatment. There was a numeric difference in HEI scores for those with oral cavity/larynx cancers vs. oropharynx (58.3 vs 65.6; p = 0.06), and those with bimodality vs. trimodality treatment (66.1 vs 57.3; p = 0.07), but this did not reach statistical significance. There was a significant positive correlation with higher HEI scores and less trismus as reported on the EORTC H&N35 questionnaire (r = .49, p < .01). Additionally, the participants who found the Vioscreen useful were less likely to report swallowing difficulties on the EORTC H&N35 (p = 0.046) and less likely to have had surgery as part of treatment (p = 0.046). Conclusions: For survivors of HNC, Vioscreen was useful to > 50% of participants. Diet quality and swallowing issues were worse in patients receiving trimodality treatment; those reporting more swallowing complaints also reported the Vioscreen tool was less useful. Thus, using Vioscreen as a stand-alone intervention may be insufficient for these populations. Future studies will couple the Vioscreen FFQ with a nutrition counseling intervention.