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Nutrition Is Vital for Patients with Head and Neck Cancer

by Nikki Kean •

By the Numbers

In 2023, according to Cancer.net, an estimated 66,920 people (49,190 men and 17,730 women) will be diagnosed with head and neck cancers (HNC).

Here are some statistics based on those numbers:

  • 4% of all cancers in United States are HNC.
  • 90% of HNC cases arise from squamous epithelial cells.
  • 30% of patients with HNC are malnourished before therapy.
  • 90% of survivors of HNC have nutrition impact symptoms (NIS) after therapy.
  • Weight loss of 20% during therapy interrupts treatment and increases infection risk and hospitalization readmission.
  • Weight loss of 5% is associated with increased mortality.

Sources: ASCO Cancer Net. Cancers. 2023;15:822. Nutrients. 2021;13:2886

A Bright Light in HNC Care

Human papilloma virus (HPV)-related oral pharyngeal squamous cell carcinomas are one of the most common mucosal head and neck cancers treated by Allen L. Feng, MD, an assistant professor of otolaryngology–head and neck surgery at Harvard Medical School and surgeon at Massachusetts Eye and Ear Institute, Boston. 

“In terms of head and neck cancers, this subset of patients has very good survival outcomes, with overall survival rates of greater than 90%,” said Dr. Feng. With long-term survival likely, Dr. Feng and his colleagues have turned their attention to improving long-term functional outcomes, which are very important for this patient population. “We’re curing this disease, which is great, but we don’t want to leave these patients debilitated afterward,” Dr. Feng told ENTtoday.

This focus on supportive care has led Dr. Feng and other researchers to examine how to best manage the perioperative nutritional needs of these patients, including factors that affect the placement of feeding tubes. One question posed by the team is whether patients require placement of a feeding tube prior to surgery to make sure that they don’t become nutritionally depleted after surgery or during radiation and chemotherapy.

To investigate this question, Dr. Feng and his colleagues retrospectively examined a series of 138 patients who underwent transoral robotic surgery (TORS) for management of oropharyngeal squamous cell carcinoma. Most patients (82%) had HPV-associated tumors, and 28% were current or former smokers. The team found that only 11 patients (8%) had a nasogastric or gastrostomy tube placed at some point during their treatment: Five patients had feeding tubes (the majority were nasogastric tubes) placed less than four weeks after TORS and six patients had feeding tubes (the majority were gastrostomy tubes) placed in the periadjuvant treatment setting. Only one patient was gastrostomy dependent one year after surgery (Otolaryngol Head Neck Surg. 2022;166:696–703).