Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival

Objectives: To evaluate the impact of 17 symptoms on reduced dietary intake, weight loss, and survival of patients with Head and Neck Cancer (HNC).

Methods: 635 Consecutive patients were screened (Patient- Generated Subjective Global Assessment©, Head and Neck Symptom Checklist©) before radiation and/or chemotherapy. Multivariate regression analyses were used to relate severity of symptoms to reduced dietary intake and weight loss and identify prognostic individual symptoms impact on dietary intake. Cox proportional hazards model was used to find significant predictors of survival.

Results: Aggregate burden of symptoms was a significant independent predictor of reduced intake, weight loss and survival. Patients with a highest total symptom scores survived significantly less (205days, 95% CI=146-264) compared to patients with lowest total symptom score (577days, CI=429-725), log-rank P<0.001). Loss of appetite, difficulty chewing, dry mouth, thick saliva and pain were individual symptoms that significantly associated with reduced dietary intake in the entire cohort. In subgroup analyses, tumor location, disease stage, performance status, and presence of dysphagia altered the profile of individual symptoms that predict intake. However across all subgroups loss of appetite had the highest impact (OR=4.6; 95% CI=3.1-6.8), followed by difficulty chewing (OR=2.5; 95% CI=2.0-3.9).

Conclusion: HNC patients experience significant symptom burden prior to radiation and chemotherapy. The nutritional impact of these symptoms on dietary intake is revealed by multivariate analysis and support the suggestion that unique individual symptom profiles require management to improve nutritional status.