title: The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review.
abstract: BACKGROUND
  Combined-modality treatment of head and neck cancer is becoming more common, driven by the idea that organ(s) preservation should maintain patient appearance and the function of organ(s) involved. Even if treatments have improved, they can still be associated with acute and late adverse effects. The aim of this systematic review was to retrieve current data on how swallowing disorders, dysgeusia, oral mucositis, and xerostomia affect nutritional status, oral intake and weight loss in head and neck cancer (HNC) patients.
  
  
  METHODS
  A systematic literature search covered four relevant electronic databases from January 2005 to May 2015. Retrieved papers were categorised and evaluated considering their methodological quality. Two independent reviewers reviewed manuscripts and abstracted data using a standardised form. Quality assessment of the included studies was performed using the Edwards Method Score.
  
  
  RESULTS
  Of the 1459 abstracts reviewed, a total of 25 studies were included. The most studied symptom was dysphagia, even if symptoms were interconnected and affected one other. In most of the selected studies the level of evidence was between 2 and 3, and their quality level was from medium to low.
  
  
  CONCLUSIONS
  There are limited data about dysgeusia, oral mucositis and xerostomia outcomes available for HNC patients. There is a lack of well-designed clinical trials and multicenter-prospective cohort studies, therefore further research is needed to ascertain which aspects of these symptoms should be measured.
authors.affiliation: Department of Otolaryngology/Head & Neck Surgery, University Hospital Santa Maria della Misericordia, Udine, Italy; Department of Health Sciences, University of Genoa, Italy. Electronic address: breva05@gmail.com.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bressan
authors.affiliation: University Hospital of Padova, Padua, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Stevanin
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Bianchi
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aleo
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bagnasco
authors.affiliation: Department of Health Sciences, University of Genoa, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Sasso
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology*; D004408:Dysgeusia / Q000209:etiology*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D013280:Stomatitis / Q000209:etiology*; D015431:Weight Loss; D014987:Xerostomia / Q000209:etiology*
keywords: Dysgeusia; Head and neck cancer patients; Nutritional status; Oral mucositis; Swallowing disorders; Weight loss; Xerostomia