Teresa E. Brown, Wiley Online Library, 19 December 2019
This present issue of the Journal of Medical Radiation Sciences features a study by Anderson et al. that reports findings on patients with HPV‐associated head and neck cancer. This subgroup experience increased weight loss compared to other groups of patients who are typically considered a higher nutrition risk.1 Their study highlights the changing landscape of head and neck cancer radiation therapy patients and that patients with HPV‐associated disease may require additional support and interventions to optimise their nutrition outcomes.
The risks of malnutrition, weight loss and dysphagia are well known in this patient population with many patients requiring enteral nutrition. There is a considerable body of evidence to support that malnutrition and weight loss have adverse consequences. This includes the impact of malnutrition on the patient’s well‐being and quality of life, as well as increasing risk of complications, treatment interruptions, unplanned hospital admissions and increased length of stay, thus contributing to increased costs to the health service system.
Weight loss has also been found to be a major prognostic indicator for survival. Patients who presented with >10% weight loss pre‐treatment had worse overall survival and disease‐specific survival. In addition, patients who experienced critical weight loss during radiation therapy also had worse disease‐specific survival.2 As discussed by Anderson et al., the evolution of highly conformal radiation therapy techniques has allowed high dose escalation to tumour volumes whilst sparing dose volumes to surrounding organs at risk and healthy tissue.
Maintaining weight during treatment is thus essential to avoid treatment‐induced anatomical changes. Such changes can result in potential underdosing and/or overdosing of target volumes and organs at risk volumes. This can subsequently impact upon resource utilisation to perform time‐intensive adaptive radiation therapy and re‐planning. Therefore, optimal nutrition care plays a significant role in optimising patient outcomes.