Nutrition plays a vital role during all phases of treatment for many cancer types, but it is particularly important for individuals with head and neck cancer.
An estimated 30% to 50% of patients with head and neck cancer experience malnutrition before treatment begins. Even those who are not malnourished at the time of diagnosis remain highly susceptible to malnutrition.
Significant weight loss in 75% to 80% of those with head and neck cancer has been widely reported.
Malnutrition and poor food intake are associated with more frequent and severe radiation therapy–induced toxicities, more frequent and longer radiation therapy interruptions, greater hospital readmission rates, impaired quality of life and increased mortality. Many studies showed malnourished patients experience worse physical functioning and fatigue than well-nourished patients.
Therefore, nutritional needs — often elevated among those with cancer due to hypermetabolism and increased stress — must be met to avoid catabolism and weight loss.
This overview — presented in conjunction with National Oral, Head and Neck Cancer Awareness Week, observed this year from April 2-9 — examines the nutrition-related challenges faced by patients with head and neck cancer, as well as nutrition strategies and other suggestions that may help patients overcome these challenges and maintain good nutritional status.
Challenges during treatment
Adequate nutritional status has been shown to benefit patients with cancer in multiple ways, including higher therapy completion rates, longer survival and improved quality of life. However, patients with head and neck cancer face unique challenges that interfere with their ability to eat due to the location of their disease.
Many patients require significant dental work prior to starting treatment. As a result, they may require diets of modified textures.
Large tumors may cause dysphagia, odynophagia and trouble chewing.
Dysphagia — the most common side effect of head and neck cancer — often results from obstruction of the tumor, odynophagia or other factors. A speech language pathologist should be part of the care team to conduct swallowing studies and determine appropriate diet consistencies.
The multimodality nature of treatment — which includes surgery, chemotherapy or radiation therapy — also creates challenges for patients.
Surgery may impact anatomy, and this could affect a person’s ability to chew and swallow. Radiation therapy to the head and neck often damages tissues, causing dysgeusia, oral mucositis, stomatitis, xerostomia and thick salvia. Chemotherapy enhances the side effects of radiation therapy, and it also may cause nausea, vomiting and decreased desire to eat.