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 summarize the evidence from guidelines, consensus and systematic reviews and provide the optimal recommendations on the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.Methods:National Guidelines Clearinghouse and databases such as CNKI and PubMed were searched for publications on pain management from January 2016 to March 2023, and for publications on other symptom management from the establishment of database to March 2023. Quality of included articles was evaluated, data were extracted, and evidence were synthesized.Results:We included 28 guidelines, 19 expert consensus, and 16 systematic reviews. The evidence synthesis included 144 items covering 12 aspects, namely general principles, assessment, optimizing radiotherapy plan, oral care, swallowing function intervention, nutritional management, psychosocial intervention, physical intervention, medication, other interventions, health education, and follow-up.Conclusion:Evidence about the management of oral and pharyngeal symptom cluster was adequate. Considering the interaction between various symptoms, healthcare professionals could integrate management measures and construct multimodal management plan for the management of oral and pharyngeal symptom cluster in patients with head and neck cancer during radiotherapy.

Body composition may influence the prognosis of head and neck cancer (HNC) patients. To find out the most crucial factors in this relationship, we explored the association between body composition and survival.

Purpose: This study aims to develop and validate machine learning (ML) models for cancer-associated deep vein thrombosis (DVT), and compare the performance of these models with the Khorana Score (KS).Methods: We randomly extracted data of 2100 cancer patients between January 1st, 2017 and October 31st, 2019 and 1035 patients with Doppler ultrasonography were enrolled to develop and validate ML models. Both uni-variable analysis and the Lasso regression were applied to select the important predictors. Model training and hyper-parameter tuning were implemented on 70% (725/1035) of the data using a ten-fold cross-validation method. The remaining 30% (310/1035) data was used to compare the performance with seven indicators, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, balanced accuracy, the Brier Score, and the calibration curve, among all five ML models, linear discriminant analysis (LDA), logistic regression (LR), classification tree (CT), random forest (RF), and support vector machine (SVM), and the KS.Results: The percentage of cancer-associated DVT in this study was 22.3% (231/1035). The top five important predictors were D-Dimer, age, Charlson Comorbidity Index (CCI), length of stay (LOS), and previously VTE history according to RF. LDA (AUC of 0.773) and LR(AUC of 0.772) out-performed KS(AUC of 0.642), but CT(AUC of 0.639), RF(AUC of 0.660), and SVM(AUC of 0.665) did not surpass it. The combination with D-Dimer showed improved performance of all models. A nomogram and a web calculator https://webcalculatorofcancerassociateddvt.shinyapps.io/dynnomapp/ were used to visualize the best recommended LR model.Conclusion: This study developed and validated cancer-associated DVT predictive models using five ML algorithms and visualized the best recommended model by a nomogram and a web calculator. The nomogram and web calculator developed in this study may be able to assist doctors and nurses to evaluate the individualized cancer-associated DVT risk and make decision making. However, other prospective cohort studies are suggested to be conducted to externally validate the recommended model.

Studies regarding malnutrition in patients with nasopharyngeal carcinoma (NPC) using the Global Leadership Initiative in Malnutrition (GLIM) criteria are still limited. Our study aimed to investigate the prevalence of malnutrition using the GLIM criteria in NPC patients receiving radiotherapy and explore the relationship between pre-radiotherapy (pre-RT) malnutrition and survival. A total of 113 NPC patients were enrolled for nutritional assessment using the GLIM criteria at different radiotherapeutic time points, and related toxicities were graded. Regarding the results, 19 patients (16.8%) were malnourished before radiotherapy and 103 patients (91.2%) were malnourished at the end of radiotherapy. Among the phenotypic GLIM criteria, low fat-free muscle index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis (p < 0.05). Importantly, patients with malnutrition before radiotherapy had significantly poorer 2-year progression free survival (PFS) than the patients being well-nourished (62.1% vs. 88.9%, p = 0.015). From the multivariate Cox regression model, being-well nourished before radiotherapy was the protective factor for PFS (HR: 0.27; 95%CI: 0.089-0.85; p = 0.023) and male was the risk factor for PFS (HR: 7.25; 95%CI: 1.548-34.00; p = 0.012). In conclusion, malnutrition according to the GLIM criteria is common in NPC patients undergoing radiotherapy, and pre-RT malnutrition is correlated with survival. Supplemental data for this article is available online at .

Background Nutritional status of nasopharyngeal carcinoma (NPC) patients lying at a high risk of nutrition defect to a great extent determines the post-treatment outcomes, which deserves thorough observation. However, limited ever-conducted studies regarding the NPC patients’ malnutrition by effective methods like the Global Leadership Initiative in Malnutrition (GLIM) criteria heavily obstructed this prospect. Our study aimed to investigate the incidence of malnutrition in NPC cancer patients using GLIM criteria and explore the relationships between malnutrition and adverse effects, survival status.Methods A retrospective chart review of 113 patients with NPC from December 2016 to October 2019. The nutritional status of NPC undergoing radiotherapy (RT) was determined by GLIM criteria at three-time points: pre-RT, in the middle of RT, and at the end of RT. The adverse effects were graded according to the Radiation Therapy Oncology Group (RTOG) scoring criteria. Kaplan–Meier method was used to compare survival outcomes, and the differences were evaluated using the log-rank test.ResultsNineteen cases (16.8%) were malnutrition before radiotherapy; overall stage ( p =0.017) and induction chemotherapy( p =0.002) contributed to pre-radiotherapy malnourishment, and the nutritional status worsened with radiotherapy. Of the phenotypic GLIM criteria, low fat free mass index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis ( p <0.05). With a median follow-up of 28.3 months, the Kaplan-Meier curve indicated that malnutritional patients had significantly poorer Progress Free survival (PFS); 2-year PFS was 88.9% in the well-nourishment group vs. 62.1% in the malnutrition group ( p =0.015). In multivariate analysis, nutritional status and gender were independent prognostic factors of poorer PFS (HR 3.387, 95%CI 1.299-8.834, p =0.013 and HR 5.698, 95%CI 1.290-25.168, p =0.022).Conclusion Malnutrition is common in NPC patients, and it increases significantly during radiotherapy. Malnutrition, according to GLIM criteria, is correlated with survival. Our study could justify the effectiveness and usability of GLIM for NPC patients undergoing RT. Appropriate nutritional guidance or nutritional support should be taken to improve the NPC patients’ nutritional status during radiotherapy.

Abstract Background Nutritional status of nasopharyngeal carcinoma (NPC) patients lying at a high risk of nutrition defect to a great extent determines the post-treatment outcomes, which deserves thorough observation. However, limited ever-conducted studies regarding the NPC patients’ malnutrition by effective methods like the Global Leadership Initiative in Malnutrition (GLIM) criteria heavily obstructed this prospect. Our study aimed to investigate the incidence of malnutrition in NPC cancer patients using GLIM criteria and explore the relationships between malnutrition and adverse effects, survival status.Methods A retrospective chart review of 113 patients with NPC from December 2016 to October 2019. The nutritional status of NPC undergoing radiotherapy (RT) was determined by GLIM criteria at three-time points: pre-RT, in the middle of RT, and at the end of RT. The adverse effects were graded according to the Radiation Therapy Oncology Group (RTOG) scoring criteria. Kaplan–Meier method was used to compare survival outcomes, and the differences were evaluated using the log-rank test.ResultsNineteen cases (16.8%) were malnutrition before radiotherapy; overall stage (p=0.017) and induction chemotherapy(p=0.002) contributed to pre-radiotherapy malnourishment, and the nutritional status worsened with radiotherapy. Of the phenotypic GLIM criteria, low fat free mass index (FFMI) before radiotherapy was associated with mucositis and radiodermatitis (p<0.05). With a median follow-up of 28.3 months, the Kaplan-Meier curve indicated that malnutritional patients had significantly poorer Progress Free survival (PFS); 2-year PFS was 88.9% in the well-nourishment group vs. 62.1% in the malnutrition group (p=0.015). In multivariate analysis, nutritional status and gender were independent prognostic factors of poorer PFS (HR 3.387, 95%CI 1.299-8.834, p=0.013 and HR 5.698, 95%CI 1.290-25.168, p=0.022).Conclusion Malnutrition is common in NPC patients, and it increases significantly during radiotherapy. Malnutrition, according to GLIM criteria, is correlated with survival. Our study could justify the effectiveness and usability of GLIM for NPC patients undergoing RT. Appropriate nutritional guidance or nutritional support should be taken to improve the NPC patients’ nutritional status during radiotherapy.

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.

Purpose: Our study aims to investigate dietary intake characteristics and their association with skeletal muscle mass in head and neck cancer patients treated with radiotherapy. Methods: From March 2017 to August 2018, patients with head and neck cancer who received radiotherapy at our affiliated hospital were enrolled. Dietary intake was assessed through 24-hr dietary recall and skeletal muscle mass was evaluated by bioelectrical impedance analysis at three-time points. Appendicular skeletal muscle mass was adjusted for height squared defined sarcopenia and correlated with dietary intake by generalized estimating equations (GEE). Results: This study sample comprised 287 patients [median age: 54 years; 187 (65.2%) men]. Median dietary intake at post-treatment was 14.95 kcal/kg/day energy and 0.63 g/kg/day protein. Skeletal muscle mass decreased significantly in all patients. The prevalence of sarcopenia increased from 24.4% before treatment to 46.7% at the end of treatment. Exploratory univariate GEE analysis revealed that radiotherapy time-point, malegender, age >= 60 and decreased dietary energy intake significantly impacted on muscle loss represented by the appendicular skeletal muscle index. After controlling covariates, dietary energy intake was only positively associated with muscle loss in women (P = 0.013, 95% CI = 0.003-0.027) but not in men (P = 0.788, 95% CI = - 0.007-0.009). Conclusion: While the loss in skeletal muscle is more prevalent in men receiving radiotherapy, the effects of dietary energy intake were only associated with women. A prospective randomized clinical trial is required to identify the appropriate amount of dietary energy supplement by gender in cancer patients treated with radiotherapy.

Objectives. The objective of this study was to identify the nutrition impact symptom (NIS) clusters in patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT) and explore their relationships with the weight loss rate (WLR). Methods. This longitudinal study included 169 patients. At baseline (T1), the demographics, clinical information, and weight before radiotherapy (RT) were recorded. At the third week (T2) and the end of RT (T3), we assessed the weight, prevalence, severity, and interference of the NIS with the Head and Neck Patient Symptom Checklist. The mean scores of the severity of NIS at T2 and T3 were used as a whole to perform the exploratory factor analysis and identify the symptom clusters. Cronbach's a coefficient was used to evaluate the internal consistency of the symptom clusters. Generalized estimating equations were used to analyze the relationships between clusters and the WLR. Results. We extracted three clusters from 14 NISs: the RT-specific symptom cluster including pain, difficulty swallowing, oral mucositis, thick saliva, difficulty chewing, and dry mouth (Cronbach's a = 0.820); the gastrointestinal symptom cluster including nausea, loss of appetite, feeling full, vomiting, and taste change (Cronbach's a = 0.592); the psychological status cluster including depressed, anxious, and lack of energy (Cronbach's a = 0.710). The multivariable model showed that participants with more serious RT-specific symptom cluster (b = 1.020, 95% CI: 0.570-1.471, P < 0.001) had higher WLR. Conclusions. The NIS had close internal connections with each other, so the strategies applied by healthcare professionals should focus on multiple related symptoms, especially to manage the RT-specific symptom cluster. J Pain Symptom Manage 2021;62:277-285. (c) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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 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 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.

目的 描述头颈部恶性肿瘤(head and neck cancer,HNC)放疗患者放疗前的营养状况,并分析其影响因素.方法 采用便利抽样法,选取2017年3月至2019年6月于北京大学肿瘤医院放疗科门诊拟接受放疗的HNC患者为研究对象,在放疗前一天进行测评,测评内容包括一般资料、 营养筛查和营养评定.营养筛查采用营养风险2002(nutritional risking screening 2002,NRS2002),营养评定采用营养不良评定标准全球领导人共识(global leadership initiative on malnutrition,GLIM),采用体成分仪进行肌肉量测定.结果 共661名HNC患者纳入分析,28.7％患者存在营养风险,26.8％存在营养不良;诊断为营养不良的主要表现型指标为非意向性体质量丢失.多因素Logistic回归分析结果 显示,年龄≥65岁、 口腔癌和鼻腔鼻窦肿瘤的患者在放疗前更易存在营养风险和营养不良(P<0.05).结论 近30％HNC患者在放疗前就存在营养风险和营养不良; 年龄和疾病部位是营养风险和营养不良的危险因素.为提高患者预后, 医务人员应关注放疗前HNC患者的营养状况, 尤其是老年患者、 口腔和鼻腔鼻窦肿瘤患者.