title: Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review.
abstract: OBJECTIVE
  We performed a systematic review to examine the effect of nutritional interventions on nutritional status, quality of life (QoL) and mortality in patients with head and neck squamous cell cancer (HNSCC) receiving radiotherapy or chemoradiotherapy.
  
  
  METHODS
  We searched Pubmed, EMBASE, CENTRAL and Cinahl from inception through January 3rd, 2012 to identify randomized controlled trials (RCTs) from a broad range of nutritional interventions in patients with HNSCC during (chemo)radiotherapy. Two reviewers independently assessed study eligibility and risk of bias, and extracted data.
  
  
  RESULTS
  Of 1141 titles identified, 12 study reports were finally included, describing 10 different studies with 11 interventions. Four out of 10 studies examined the effects of individualized dietary counseling, and showed significant benefits on nutritional status and QOL compared to no counseling or general nutritional advice by a nurse (p < 0.05). Three studies on oral nutritional supplements (ONS) were inconsistent about the effect on nutritional status compared with no supplementation. One study showed that nasogastric tube feeding had beneficial effects on nutritional status compared to ONS, but not in all patient groups (p < 0.04). One study showed benefits of percutaneous endoscopic gastronomy (PEG) feeding on nutritional status shortly after RT compared with nasogastric feeding (p = 0.001). Two studies showed that prophylactic PEG feeding was not superior over tube feeding if required.
  
  
  CONCLUSIONS
  This review shows beneficial effects of individualized dietary counseling on nutritional status and QoL, compared to no counseling or standard nutritional advice. Effects of ONS and tube feeding were inconsistent.
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: j.langius@vumc.nl.
authors.forename: Jacqueline A E
authors.initials: JA
authors.lastname: Langius
authors.forename: Myrna C
authors.initials: MC
authors.lastname: Zandbergen
authors.forename: Simone E J
authors.initials: SE
authors.lastname: Eerenstein
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Mark H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Peter J M
authors.initials: PJ
authors.lastname: Weijs
mesh_terms: D000328:Adult; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019648:Foods, Specialized; D006258:Head and Neck Neoplasms / Q000178:diet therapy* / Q000628:therapy; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D052756:Nutritional Sciences / Q000193:education; D009752:Nutritional Status; D018529:Nutritional Support; D064686:Nutritionists; D010353:Patient Education as Topic; D057285:Precision Medicine; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: CRT; Dietary counseling; HNSCC; Head and neck cancer; Malnutrition; NG; ONS; PEG; QoL; RCT; RT; Radiotherapy; Tube feeding; Weight loss; chemoradiotherapy; head and neck squamous cell cancer; nasogastric; oral nutritional supplements; percutaneous endoscopic gastronomy; quality of life; radiotherapy; randomized controlled trial