title: Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival.
abstract: OBJECTIVE
  To evaluate the impact of 17 symptoms on reduced dietary intake, weight loss, and survival of patients with Head and Neck Cancer (HNC).
  
  
  METHODS
  635 Consecutive patients were screened (Patient- Generated Subjective Global Assessment©, Head and Neck Symptom Checklist©) before radiation and/or chemotherapy. Multivariate regression analyses were used to relate severity of symptoms to reduced dietary intake and weight loss and identify prognostic individual symptoms impact on dietary intake. Cox proportional hazards model was used to find significant predictors of survival.
  
  
  RESULTS
  Aggregate burden of symptoms was a significant independent predictor of reduced intake, weight loss and survival. Patients with a highest total symptom scores survived significantly less (205days, 95% CI=146-264) compared to patients with lowest total symptom score (577days, CI=429-725), log-rank P<0.001). Loss of appetite, difficulty chewing, dry mouth, thick saliva and pain were individual symptoms that significantly associated with reduced dietary intake in the entire cohort. In subgroup analyses, tumor location, disease stage, performance status, and presence of dysphagia altered the profile of individual symptoms that predict intake. However across all subgroups loss of appetite had the highest impact (OR=4.6; 95% CI=3.1-6.8), followed by difficulty chewing (OR=2.5; 95% CI=2.0-3.9).
  
  
  CONCLUSIONS
  HNC patients experience significant symptom burden prior to radiation and chemotherapy. The nutritional impact of these symptoms on dietary intake is revealed by multivariate analysis and support the suggestion that unique individual symptom profiles require management to improve nutritional status.
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Canada.
authors.forename: Arazm
authors.initials: A
authors.lastname: Farhangfar
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Canada.
authors.forename: Marcin
authors.initials: M
authors.lastname: Makarewicz
authors.affiliation: Division of Medical Oncology, Department of Oncology, University of Alberta, Canada; Alberta Health Services - Cancer Control, Cross Cancer Institute, Edmonton, Alberta, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Division of Radiation Oncology, Department of Oncology, University of Alberta, Canada.
authors.forename: Naresh
authors.initials: N
authors.lastname: Jha
authors.affiliation: Division of Radiation Oncology, Department of Oncology, University of Alberta, Canada.
authors.forename: Rufus
authors.initials: R
authors.lastname: Scrimger
authors.affiliation: Department of Medicine, University of Alberta, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Canada. Electronic address: vickie.baracos@ualberta.ca.
authors.forename: Vickie
authors.initials: V
authors.lastname: Baracos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004032:Diet; D002149:Energy Intake; D005260:Female; D006258:Head and Neck Neoplasms / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015431:Weight Loss; D055815:Young Adult
keywords: Dysphagia; Head and neck cancer; Mucositis; Nutrition; Patient-Generated Subjective Global Assessment(©); Symptoms