title: Nutritional considerations for head and neck cancer patients: a review of the literature.
abstract: OBJECTIVE
  Approximately 35% to 60% of all patients with head and neck cancer are malnourished at the time of their diagnosis because of tumor burden and obstruction of intake or the anorexia and cachexia associated with their cancer. The purpose of this article is to provide a contemporary review of the nutritional aspects of care for patients with head and neck cancer.
  
  
  METHODS
  A literature search was performed in Medline, Cochrane, and other available databases from 1990 through 2012 for the clinical effectiveness of nutritional support, treatment modalities, and methods of delivery in relation to patients with head and neck malignancies. Human studies published in English and having nutritional status and head and neck cancer as a predictor variable were included. Randomized controlled trials, meta-analyses, prospective clinical studies, and systemic reviews were selected based on their relevance to the abovementioned subtitles. The resultant articles were analyzed and summarized into the definition, impact, assessment, treatment, and modes of administration of nutrition on the outcome of patients with head and neck cancer.
  
  
  RESULTS
  Articles were reviewed that focused on the etiology and assessment of malnutrition and current nutritional treatments for cancer-induced anorexia and cachexia. Two hundred forty-eight articles were found: 2 clinical trials, 10 meta-analyses, 210 review studies, and 26 systematic reviews. Because of the lack of prospective data, a summative review of the conclusions of the studies is presented.
  
  
  CONCLUSIONS
  Nutritional interventions should be initiated before cancer treatment begins and these interventions need to be ongoing after completion of treatment to ensure optimal outcomes for patients. A nutritional assessment must be part of all comprehensive treatment plans for patients with head and neck cancer. Alternative medical interventions, such as immune-enhancing nutrients or anticytokine pharmaceutical agents, also may be effective as adjuvant therapies, but more research is needed to quantify their clinical effect.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Boston University, Boston Medical Center, Boston, MA. Electronic address: alshadwi@bu.edu.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alshadwi
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nadershah
authors.forename: Eric R
authors.initials: ER
authors.lastname: Carlson
authors.forename: Lorrie S
authors.initials: LS
authors.lastname: Young
authors.forename: Peter A
authors.initials: PA
authors.lastname: Burke
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Daley
mesh_terms: D000855:Anorexia / Q000517:prevention & control; D002100:Cachexia / Q000517:prevention & control; D006258:Head and Neck Neoplasms / Q000503:physiopathology*; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control; D015596:Nutrition Assessment; D009747:Nutritional Physiological Phenomena / Q000502:physiology*; D018529:Nutritional Support; D010347:Patient Care Planning