OBJECTIVES:To investigate the body composition and dietary intake in the patients with head and neck cancer (HNC) during radiotherapy (RT), and explore the relationship between them.METHODS:This was a prospective, longitudinal observational study. Adult patients with HNC undergoing RT between March 2017 and August 2018 were recruited. Patients' body compositions were evaluated by bioelectrical impedance analysis, and dietary intake was recorded by 24-hour dietary recall at three time points, including baseline (T1), mid-treatment (T2) and post-treatment (T3). Patients were divided into low, middle and high energy intake groups based on the average daily energy intake (DEI). Changes in body weight (BW), fat mass (FM), fat-free mass (FFM) and skeletal muscle mass (SMM) among these three groups were compared.RESULTS:From T1 to T3, the median loss of patients' BW, FM, FFM and SMM was 4.60, 1.90, 2.60 and 1.50 kg, respectively. The loss of BW was more dramatic from T2 to T3 than that from T1 to T2. BW loss was mainly contributed by SMM loss from T1 to T2 and by FM loss from T2 to T3. Meanwhile, patients' dietary intake reduced during treatment. High DEI group had a significantly attenuated loss of patients' BW, FFM, SMM and FM compared with the low DEI group.CONCLUSION:Patients' BW, FM, FFM and SMM all significantly reduced, especially from T2 to T3, with decreased DEI during RT, which stresses the importance of nutrition intervention during the whole course of RT.

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

Objective:To characterize the malnutrition status, nutrition impact symptoms and quality of life at the end of radiotherapy in patients with head and neck cancer (HNC) and explore the association between nutritional status with nutrition impact symptoms and quality of life.Methods:This was a cross-sectional study. HNC patients who completed radiotherapy in the head and neck radiotherapy department of a cancer hospital in Beijing from December 2018 to January 2020 were recruited through convenient sampling. Three criteria were used to assess malnutrition: (1)BMI < 18.5 kg/m 2 with poor general condition; (2) scored 3 for impaired nutritional status in nutrition risk screening 2002 (NRS 2002); (3) assessed as malnutrition using the global leadership initiative on malnutrition (GLIM) criteria (muscle mass measurement not included). According to GLIM criteria, patients were divided into two groups of malnutrition and normal nutrition. The head and neck patient symptom checklist (HNSC) was used to assess the nutrition impact symptoms and the European organization for research and treatment of cancer quality of life core questionnaire (EORTC QLQ-C30) was used to assess the quality of life. Results:A total of 210 HNC patients were included in the final analysis. Malnutrition was present in 19 (9.0%), 110 (52.4%) and 145 (69.0%) patients according to the standard of BMI, impaired nutritional status of NRS-2002 and GLIM criteria, respectively. Nutrition impact symptoms present in more than 80.0% of patients included pain, xerostomia, saliva viscid, and taste alteration, and nutrition impact symptoms interfering food intake for > 3 points were pain, dysphagia, mouth ulceration, taste alteration, and loss of appetite. The global health score of the patient was 51.47±21.48. Compared with patients with normal nutrition, patients with malnutrition had higher scores for NIS frequency (40.09±9.23 vs 33.63±9.13, P<0.01) and the interference with food intake (30.97±6.53 vs 25.85±6.54, P<0.01), and lower global health scores (48.10±20.59 vs 58.97±21.67, P=0.001). Conclusions:At the end of radiotherapy, HNC patients had a high incidence of malnutrition. Nutrition impact symptoms were generally present and had a great influence on food intake. Patients with malnutrition experienced more and worse nutrition impact symptoms and worse quality of life. It is suggested that medical staff should continue to pay attention to the nutritional status and nutrition impact symptoms of HNC patients after radiotherapy and carry out nutritional intervention and symptom management to improve their quality of life.

目的:观察头颈部恶性肿瘤患者放射治疗期间骨骼肌量的变化,并分析其影响因素.方法:采用便利取样方法,选取2017年3月至2019年9月在北京市某专科肿瘤医院放射治疗科接受放射治疗的头颈部恶性肿瘤患者为研究对象,应用患者参与主观全面评定(Patient Generated Subjective Global Assessment,PG-SGA)的症状部分评估患者在放疗开始前(T1)、放疗中期(T2)、放疗结束时(T3)的营养相关症状(Nutrition Impact Symptoms,NIS),用24h膳食回顾法记录膳食摄入情况并采用生物电阻抗分析法测定骨骼肌量变化情况,采用广义估计方程(Generalized Estimating Equations,GEE)分析患者骨骼肌量变化的影响因素.结果:共459例患者完成3次测评.在3个测评时间点,骨骼肌量分别为(26.31±5.08)kg、(25.60±4.83)kg、(24.62±4.68)kg;NIS发生率分别为38.1％(175/459)、93.2％(428/459)、95.4％(438/459);标准化每日能量摄入量(standard Daily Energy Intake,stDEI)分别为(24.94±8.51)kcal/(kg·day)、(20.47±9.14)kcal/(kg·day)、(18.23±9.75)kcal/(kg·day),标准化每日蛋白摄入量(standard Daily Protein Intake,stDPI)分别为(0.98±0.39)g/(kg·day)、(0.86±0.39)g/(kg·day)、(0.84±0.51)g/(kg·day);随放射治疗的进行,患者骨骼肌量逐渐下降、NIS得分逐渐增加、能量及蛋白质摄入逐渐减少.骨骼肌量变化与放疗前是否手术、膳食能量摄入量及NIS得分密切相关.结论:头颈部恶性肿瘤放射治疗患者治疗后骨骼肌量减少,放疗前未手术、膳食能量摄入不足及NIS重的患者骨骼肌量减少多.提示应重视未手术患者,加强营养相关症状管理和膳食干预,以减轻患者骨骼肌量的丢失.

Objective To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT). Methods This longitudinal study included 122 patients. Data were collected at three time points: baseline (T1), the third week of RT (T2) and the completion of RT (T3). The Common Terminology Criteria for Adverse Events was used to assess the symptom of dysphagia and other toxicities; the MD Anderson Dysphagia Inventory (MDADI) was used to assess the patient-perceived swallowing functional outcomes; the nutritional status was evaluated by the weight ratio and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalised estimating equation (GEE) was used to measure the correlation of MDADI with the weight ratio or PG-SGA and also to analyse the influential factors of swallowing functional outcomes. Results The participants’ acute dysphagia rates were 5.7% at T1, 69.7% at T2 and 77.9% at T3. The swallowing functional outcomes worsen over RT (p<0.001) and were associated with weight ratio (β=0.032, p=0.008) and PG-SGA (β=−0.115, p<0.001). GEE models showed that patients with cancer of the pharynx region, advanced stage, chemoradiotherapy and high RT dose perceived worse swallowing functional outcomes. Oral mucositis, pharynx mucositis and salivary gland inflammation were positively correlated with swallowing functional outcomes, and the pharynx mucositis presented the highest absolute value of β. Conclusion The swallowing functional outcomes were negatively correlated with nutritional status. Healthcare professionals should identify early on the population at higher risk and focus on multiple toxicities, especially the management of pharynx mucositis, to improve nutritional status.

Purpose: To validate the Chinese version of the Chemotherapy-induced Taste Alteration Scale (CiTAS) among patients with head and neck cancer (HNC) undergoing radiotherapy (RT). Methods: Patients with HNC undergoing RT were enrolled from a cancer hospital. Data were collected by face-to-face interview. Patients' subjective taste alterations (TAs) were assessed by the CiTAS. The content validity was evaluated by five experts. Confirmatory and exploratory factor analysis were used to assess construct validity. Convergent validity was assessed by the correlation between the CiTAS score and the Quality of Life Questionnaire-Core 30 (QLQ-C30) score. A single-item subjective intensity taste alteration question and quartiles of RT duration were used to assess the discriminant validity. The reliability was assessed by the Cronbach's alpha and test-retest reliability. Results: 253 patients participated this investigation and 25 patients completed twice. Confirmatory factor analysis showed that the original CiTAS structure with four dimensions was not applicable to patients with HNC undergoing RT. The Chinese version of modified-CiTAS (m-CiTAS) retained 17 items (the item "bothered by the smell of food" was deleted) loading onto three factors: decline in taste, discomfort, and phantogeusia and parageusia. The m-CiTAS showed acceptable correlations with the QLQ-C30. It could effectively discriminate the intensity of subjective TAs according to the single-item question and quartiles of RT duration. The m-CiTAS showed acceptable internal consistency (Cronbach's alpha = 0.573-0.958) and test-retest reliability (r = 0.726-0.831, P < 0.05). Conclusions: The Chinese version of m-CiTAS is an acceptable and applicable instrument to evaluate TAs among patients with HNC undergoing RT.

Objective:To observe the critical weight loss(weight loss rate>5%) in patients with head and neck cancer (HNC) during radiotherapy and analyze its influencing factors.Methods:Patients with head and neck cancer treated with radiotherapy in a cancer hospital in Beijing from March 2017 to September 2019 were recruited. The day before the beginning of radiotherapy, general information was collected, and Nutritional Risking Screening 2002 (NRS2002) was used as a nutritional screening tool. Malnutrition was assessed by criteria: 1.the score of normal nutritional status in NRS2002 was 3; 2.body mass index<18.5 kg/m 2 with poorer general condition; 3.Global leadership initiative on malnutrition criteria was used except whole body muscle mass measurement. Dietary intake was recorded by 24-hour dietary recall. The weight of patients before and after radiotherapy was recorded. Results:435 patients were completely investigated. The average weight of patients was 65.52 kg±12.20 kg before radiotherapy, and 61.01 kg±11.17 kg after radiotherapy. The weight loss was 4.50 kg±3.17 kg(-3.20~20.90 kg), and the weight loss rate was 6.72%±4.34 %(-5.19%~25.49%). 66.0% of patients had critical weight loss. Multifactor logistic regression analysis showed that the influencing factors of critical weight loss were planned radiotherapy dose ( OR=1.069, 95% CI=1.014~1.127, P=0.013), concurrent chemoradiotherapy ( OR=1.798, 95% CI=1.148~2.816, P=0.010), baseline malnutrition ( OR=2.693, 95% CI=1.223~5.933, P=0.014) and nasopharyngeal tumors ( OR=2.059, 95% CI=1.158~3.661, P=0.014). Conclusions:HNC patients experience significant critical weight loss during radiotherapy. Patients with more planned radiotherapy dose, concurrent chemoradiotherapy, nasopharyngeal tumors and without malnutrition at baseline are at high risk of having critical weight loss. It is suggested that clinical medical staff should pay more attention to patients' weight loss during radiotherapy, give corresponding preventive measures, strengthen nutrition education, and increase the intake of energy and protein and provide nutritional support when necessary to improve the critical weight loss.

Objective To describe the characteristics of dysphagia in patients with head and neck cancer during radiotherapy,and analyze the cause of dysphagia and the relationship between dysphagia and weight change.Methods Patients with head and neck cancer treated with radiotherapy in Beijing Cancer Hospital from November 2017 to June 2018 were recruited.The M.D.Anderson Dysphagia Inventory (MDADI) was used to assess the dysphagia of patients before (T1),during (T2) and at the end (T3) of the radiotherapy.Meanwhile,the weight,dietary intake and radiation adverse effects were investigated.Generalized estimating equations were used to analyze the impact factors of dysphagia and the relationship among dysphagia,dietary intake and weight change.Results Ninety-six patients were completely investigated and the incidence of dysphagia were 6.3％ (6/ 96),80.2％ (77/96) and 85.4％ (82/96) in T1,T2 and T3.With the progress of radiotherapy,the total score and the scores of 4 dimensions of MDADI dropped and the dietary intake declined.The average weight loss was (5.09±3.31) kg,and 76.1％ of the patients had weight loss over 5％ at the end of radiotherapy.The occurrence of dysphagia was associated with the radiotherapy-related oral and laryngeal mucositis and the weight loss was closely associated with the site of radiation,dysphagia,and dietary intake decline.Conclusions The dysphagia of patients with head and neck cancer is affected by radiation adverse effects,and is most severe at the end of radiotherapy.Dysphagia might result in dietary intake decline and weight loss.Clinicians should pay close attention to the swallowing function of the patients and take measures earlier accordingly.

Objective To describe the characteristics of radiation induced mucositis in patients withhead and neck cancer ( HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis. Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eat-ing, diet patterns and weight. Results Two hundred and two patients were completely investigated and 43.5％and 34. 2％ of the patients suffered from moderate to severe (≥grade 2) oral mucositis and pharyngeal mucosi-tis, respectively during the radiotherapy. At the end of radiotherapy, 53. 5％ and 51. 5％ of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2 ) , respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight ( P<0. 05) . Tumor site was the main reason that affected the severity of mucositis ( Wald χ2 =26. 033, 14. 216;P<0.001). Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is re-lated to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutri-tional status of patients.