الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Incidence of cancer-related malnutrition ranges from 40 to 80 percent worldwide, and it depends on factors like the type of cancer, location, stage and type of treatment given. Malnutrition among cancer patients leads to many undesired outcomes, and it is responsible for 20% of cancer deaths. Impairment of immune functions, decreased response to chemotherapy and increased toxicity are other poor outcomes related to malnutrition. Furthermore, it can affect patients’ performance status by causing fatigue and malaise, leading to poor quality of life. It also prolongs patients’ hospital stay, which leads to an economic burden.
Many studies have shown that Head and Neck Cancer (HNC) has a high incidence of malnutrition; 20% to 67% of HNC patients are malnourished at the time of diagnosis or they are at high risk of becoming malnourished during treatment. The main treatment modalities in HNC include surgery, definitive or post-operative radiotherapy with or without chemotherapy. The unique location of HNC, treatment modalities, and especially side effects of radiotherapy, such as oropharyngeal mucositis, xerostomia and dysphagia, has a significant role in developing malnutrition among HNC patients.
Among various nutritional assessment methods such as anthropometric measurements, biochemical, clinical, dietary assessments, dual-energy X-ray absorptiometry, CT and MRI, BIA (Body Impedance Analysis) remains a reliable, economical method to assess nutritional status. It can give details of Total Body Water (TBW), Fat Mass (FM), Fat-Free Mass (FFM) and Bone Mass (BM).
This was a clinically controlled pilot study conducted in Alexandria University Hospital, Clinical Oncology Department from August 2021 to May 2022. It included 15 patients in the study arm (ONS group) and 15 patients in the control arm (No ONS group) who had confirmed diagnosis of head and neck cancer and received radiotherapy with or without chemotherapy. The primary objective of this study was to compare the changes in body composition of FFM, FM and BM in ONS and No ONS groups. At the same time, it aimed to correlate the relationship between ONS and radiation-related acute toxicity as well as patients’ compliance with treatment.
In this study, patients’ demographic data, age, sex, education employment, education level, marital status and history of smoking did not have statistically significant differences between the two groups. The median age for patients was 60 years and 55 years in the ONS and No ONS groups, respectively, while the majority of the patients were male, corresponding to 73.33% and 80% in the ONS and No ONS groups, respectively. Most of the patients had larynx cancer, 73.33% in the ONS group and 60% in the No ONS group. In the present study, 80% of the ONS group patients had RT only; in the No ONS group, 73.33% had concurrent chemoradiotherapy as the treatment option.
The current study showed that patients who didn’t receive ONS had a statistically significant reduction in their nutritional status. Repeated measures throughout the treatment period had a statistically significant reduction in body weight (p<.001), BMI (p<.001), fat mass (p<.001), fat-free mass (p<.001) and bone mass (p=.031) in the No ONS group while in the ONS group there was no statistically significant change. In addition, this study showed that the nutritional status starts to deteriorate at the middle of the radiotherapy course, which corresponds to the third or fourth week of the treatment. This study also showed no significant correlation between ONS supplementation and radiotherapy-related acute side effects or compliance to treatment among HNC patients.