Abstract
The research was conducted to examine the correlation between nutritional status and wound healing in individuals who were receiving treatment for head and neck cancer. Specifically, this study sought to identify crucial nutritional factors that influenced both the recovery process and efficacy of the treatment. From February 2022 to September 2023, this cross‐sectional study was undertaken involving 300 patients diagnosed with head and neck cancer who were treated at Tianjin Medical University Cancer Institute and Hospital, Tianjin, China. In order to evaluate nutritional status, body mass index (BMI), serum protein levels and dietary intake records were utilized. The assessment of wound healing was conducted using established oncological wound healing scales, photographic documentation and clinical examinations. After treatment, we observed a noteworthy reduction in both BMI (p < 0.05) and serum albumin levels (p < 0.05). There was slightly increased prevalence of head and neck cancer among males (61.0%, p < 0.05). Over the course of 6 months, significant enhancement in wound healing scores was noted, exhibiting overall improvement of 86% in the healing process. An inverse correlation was identified between nutritional status and wound healing efficacy through multivariate analysis. A logistic regression analysis revealed a significant positive correlation (p < 0.05) between elevated levels of serum protein and total lymphocytes and enhanced wound healing. Conversely, negative correlation (p < 0.05) was observed between larger wound size at baseline and healing. The research findings indicated noteworthy association between malnutrition and impaired wound repair among individuals diagnosed with head and neck cancer. The results underscored the significance of integrating nutritional interventions into therapeutic protocol in order to enhance clinical results. This research study provided significant contributions to the knowledge of intricate nature of head and neck cancer management by advocating for multidisciplinary approach that incorporates nutrition as the critical element of patient care and highlighted the importance of ongoing surveillance and customized dietary approaches in order to optimize wound healing and treatment efficacy.
Keywords: cancer nutrition, head and neck oncology, treatment efficacy, wound healing
1. INTRODUCTION
The term ‘Healing in Head and Neck Cancer’ pertains to the complex progression of mechanical restoration and tissue healing that individuals experience as a result of undergoing surgical interventions, chemotherapy or radiation therapy. 1 This healing process is especially difficult in cases of head and neck cancer, where critical structures and functions, such as respiration and speech are involved and where treatments may have adverse effects on these functions. 2 Healing efficacy is critical for the successful continuance of cancer treatment and restoration of quality of life, therefore, it is the primary concern in the management of patients with head and neck cancer. 3 , 4
The nutritional status of individuals is critical for their overall health and recovery, particularly those who are combating cancer. The location of head and neck cancer exponentially increases the significance of nutrition, as it can have direct influence on a patient's nutrient absorption and consumption. 5 , 6 Malnutrition or inadequate nutritional status may manifest as an outcome or factor that contributes to the disease's severity. Sufficient nutrition is widely recognized as critical factor in sustaining the body's immune system, promoting tissue regeneration and augmenting its response to therapeutic interventions like radiation and chemotherapy. 7 , 8 , 9
The correlation between nutritional status and wound recovery holds notable importance in the context of treating head and neck cancer. These patients frequently sustain wounds, which may be the consequence of surgical procedures or cancer itself. 10 The complex process of wound healing necessitates sufficient quantities of protein, vitamins and minerals. Insufficient nutrition may result in compromised treatment outcomes, elevated susceptibility to infection and postponed wound healing. 11 Efficient wound recovery is the critical factor to be taken into account, as it directly impacts the sustainability of cancer treatments and well‐being of the patients. 12
Nevertheless, investigating this correlation presents numerous obstacles. To commence, the evaluation of nutritional status in individuals diagnosed with cancer is a multifaceted task, necessitating consideration of treatment adverse effects, tumour‐induced alterations and variations among patients. 13 Furthermore, the interplay between nutritional status and wound healing is facilitated by multitude of biological processes. This calls for an interdisciplinary research approach that integrates knowledge and perspectives from oncology, nutrition, surgery and additional disciplines. 11
Comprehending this correlation carries substantial ramifications for the field of clinical practice. This has the potential to facilitate the creation of nutritional interventions that are specifically designed to enhance wound healing and treatment results. An example of how recuperation could be facilitated is by identifying particular nutrient deficiencies in patients and rectifying them via dietary modifications or supplementation. Furthermore, this understanding can assist in the development of all‐encompassing therapeutic strategies that fundamentally incorporate nutritional assistance. 14
The main purpose of this research was to examine the relationship between nutritional statuses and wound healing in individuals receiving treatment for head and neck cancer. Specifically, the study seeks to identify nutritional factors that have effect on recovery and the effectiveness of treatment. Furthermore, the study was supposed to formulate nutritional guidelines that are supported by empirical evidence, with the aim of enhancing clinical outcomes and improving the overall quality of life for the individuals involved.
2. MATERIALS AND METHODS
2.1. Study design
A cross‐sectional investigation was undertaken to examine the correlation between nutritional statuses and wound healing in head and neck cancer treatment. The main aim of this study was to examine the relationship between patients' nutritional status and effectiveness of wound repair while undergoing treatment for head and neck cancer.
2.2. Setting and period
The investigation was conducted at Tianjin Medical University Cancer Institute and Hospital, Tianjin, China, that specializes in oncology‐related treatment. The research investigation spanned from February 2022 to September 2023, which afforded sufficient duration for comprehensive data gathering and analysis.
2.3. Sample size
A total of 300 patients who had received a diagnosis of cancer of the head and neck comprised the study population. The individuals who were included in this study had to meet rigorous inclusion requirements, including definitive diagnosis of head and neck cancer, ongoing treatment and informed consent to participate.
2.4. Inclusion and exclusion criteria
Patients who were 18 years of age or older, had been diagnosed with head and neck cancer and were undergoing treatment modalities such as surgery, chemotherapy or radiation throughout the study period were eligible to participate. Patients who were undergoing palliative care, those who had concurrent cancers or those who were unable to provide informed consent due to cognitive impairment or language barriers were excluded from the study.
2.5. Data collection methods
Extensive documentation was compiled regarding the nutritional status of the patients, encompassing body mass index (BMI), serum protein levels and dietary intake records. The progression of wound healing was methodically monitored and documented via routine clinical evaluations, which included wound size measurements and observations of healing rates.
2.6. Method of nutritional assessment
Standardized instruments, including laboratory tests and Subjective Global Assessment (SGA), were utilized in nutritional status evaluation to quantify albumin and pre‐albumin levels, among other vital nutritional markers. In addition, dietary evaluations were carried out via interviews with patients and food frequency questionnaires.
2.7. Methods of wound healing evaluation
Periodically, photographic documentation and comprehensive clinical examinations were utilized to assess wound healing. Prominent scoring systems and established scales, which have been validated in oncological wound healing research, were applied quantitatively to evaluate the progression of healing.
2.8. Statistical analysis
Statistical analysis was performed on the gathered data utilizing SPSS software Version 26.0. In order to evaluate the association between nutritional statuses and wound healing, regression analysis and correlation coefficients were applied. Additionally, subgroup analyses were performed in order to ascertain the effects of various treatment modalities and nutritional interventions on the process of wound healing. p‐values were employed to ascertain the significance of results, with the predetermined threshold for statistical significance at p < 0.05.
2.9. Ethical determinations
Upon evaluation and approval by the institutional review boards of the participating centres, study protocol was implemented. Written informed consent was obtained from all participants and research was carried out in adherence to ethical standards and guidelines specific to human subjects.
3. RESULTS
The findings of our research provide an exhaustive examination of a range of factors pertaining to patient characteristics, nutritional status and wound healing indicators. The findings provided substantial knowledge regarding the interaction of these variables within the framework of head and neck cancer therapy. It was observed that males had marginally higher incidence of head and neck cancer than females (61.0%, p < 0.05). According to the distribution of cancer categories, laryngeal and hypopharyngeal cancers were the most prevalent at 20.0% (p < 0.05); frequency of the remaining types did not vary significantly. Significantly, there was notable correlation between the type and location of cancer, with particular emphasis on the oral cavity and pharynx (33.0%, p < 0.05) and larynx and hypopharynx (20.0%, p < 0.05) (Table 1).
TABLE 1.
Participant demographics and clinical characteristics.
| S. No. | Variables | No. of participants (n = 300) | Frequency (%) | p‐values |
|---|---|---|---|---|
| 1 | Age (years) | |||
| Mean ± SD | 51.7 ± 8.3 | ‐ | ‐ | |
| 2 | Gender | |||
| Male | 183 | 61.0 | 0.035* | |
| Female | 117 | 39.0 | 0.041* | |
| 3 | Type of cancer | ‐ | ||
| Laryngeal and hypopharyngeal | 60 | 20.0 | 0.432 | |
| Nasal cavity | 36 | 12.0 | 0.320 | |
| Oropharyngeal | 54 | 18.0 | 0.065 | |
| Nasopharyngeal | 45 | 15.0 | 0.071 | |
| Salivary gland cancers | 45 | 15.0 | 0.561 | |
| 4 | Location | |||
| Larynx and hypopharynx | 60 | 20.0 | 0.021* | |
| Nose | 36 | 12.0 | 0.054 | |
| Oral cavity and pharynx | 99 | 33.0 | 0.040* | |
| Salivary glands | 45 | 15.0 | 0.418 | |
| 5 | Stage of cancer | |||
| 0 | 18 | 6.0 | 0.001* | |
| I | 54 | 18.0 | 0.032* | |
| II | 78 | 26.0 | 0.020* | |
| III | 90 | 30.0 | 0.022* | |
| IV | 60 | 20.0 | 0.041* | |
| 6 | Treatment modality | |||
| Surgery | 91 | 30.3 | 0.001* | |
| Chemotherapy | 122 | 40.7 | 0.040* | |
| Radiation therapy | 87 | 29.0 | 0.003* | |
| 7 | Baseline nutritional status | |||
| BMI (kg/m2) | 23.4 ± 3.8 | ‐ | ‐ | |
| 8 | Serum albumin (g/dL) | 3.6 ± 0.5 | ‐ | ‐ |
Indicates the significant values.
A decline in nutritional status during treatment was indicated by the statistically significant decrease in BMI (p < 0.05) and serum albumin levels (p < 0.05) from baseline to post‐treatment (Table 2). It was also indicated that wound healing improved gradually over time. From 1 month to 6 months after treatment, mean wound healing score increased substantially (p < 0.05), indicating noteworthy overall enhancement of 86% in the healing process (Table 3). A comprehensive analysis of wound characteristics is presented in Table 4. During the course of treatment, notable decreases in both lesion size and depth (p < 0.05) were observed, in addition to improvements in pain intensity and infection status. The impact of multivariate factors on wound healing is explicated in Table 5. The negative coefficients for nutritional status (p < 0.05) and BMI (p < 0.05) indicated an inverse relationship between these variables and wound healing efficacy. Additionally, age and modality of treatment emerged as significant factors. The results of logistic regression analysis is presented in Table 6, demonstrating that increased total lymphocyte count and serum protein levels were statistically substantially correlated with improved wound healing outcomes (p < 0.05). Conversely, larger wound size at baseline had negative impact on healing (p < 0.05). Thus the significance of nutritional status and particular clinical parameters in the wound healing process for patients undergoing treatment for head and neck cancer was clearly highlighted by these findings.
TABLE 2.
Nutritional status at baseline and post‐treatment.
| Nutritional parameter | Baseline | Post‐treatment | p‐values |
|---|---|---|---|
| BMI (kg/m2) | 23.5 ± 4.2 | 22.0 ± 3.8 | 0.015* |
| Serum albumin (g/dL) | 3.5 ± 0.5 | 3.2 ± 0.6 | 0.011* |
| Dietary intake score | 7.5 ± 2.0 | 6.0 ± 2.5 | 0.001* |
Indicates the significant values.
TABLE 3.
Wound healing assessment.
| S. No. | Time point | Average wound healing score | Improvement (%) | p‐values |
|---|---|---|---|---|
| 1 | Baseline | ‐ | ‐ | ‐ |
| 2 | 1 month post‐treatment | 7.0 ± 1.5 | 14 | 0.032* |
| 3 | 3 months post‐treatment | 8.5 ± 1.3 | 29 | 0.017* |
| 4 | 6 months post‐treatment | 9.0 ± 1.2 | 38 | 0.001* |
| 5 | Overall change (baseline to 6 months) | 2.0 ± 1.6 | 86 | 0.001* |
Indicates the significant values.
TABLE 4.
Wound healing metrics.
| S. No. | Wound characteristics | Measurement tool | Baseline | 1 month post‐treatment | 3 months post‐treatment | 6 months post‐treatment | p‐values |
|---|---|---|---|---|---|---|---|
| 1 | Wound size (cm2) | Digital imaging | 2.4 | 2.0 | 1.5 | 1.0 | 0.001* |
| 2 | Wound depth (cm) | Depth gauge | 0.5 | 0.4 | 0.3 | 0.1 | 0.001* |
| 3 | Inflammation | Visual scale | Moderate | Mild | Slight | None | ‐ |
| 4 | Pain intensity | VAS scale | 7/10 | 6/10 | 4/10 | 2/10 | 0.001* |
| 5 | Tissue regeneration | Biopsy analysis | Low | Moderate | High | Very High | ‐ |
| 6 | Infection status | Lab testing | Positive | Negative | Negative | Negative | 0.029* |
Indicates the significant values.
TABLE 5.
Multivariate analysis of factors influencing wound healing.
| S. No. | Factor | Coefficient | 95% CI | Standard error | p‐values |
|---|---|---|---|---|---|
| 1 | Nutritional status (SGA) | −0.32 | −0.45 to −0.19 | 0.06 | 0.001* |
| 2 | Age | 0.05 | 0.02 to 0.08 | 0.02 | 0.032* |
| 3 | BMI | −0.20 | −0.30 to −0.10 | 0.05 | 0.031* |
| 4 | Treatment modality | 0.12 | 0.05 to 0.19 | 0.04 | 0.035* |
Indicates the significant values.
TABLE 6.
Logistic regression analysis on wound healing completion.
| S. No. | Predictor variable | Odds ratio | 95% CI | Wald Chi‐square | p‐values |
|---|---|---|---|---|---|
| 1 | Serum protein level | 1.8 | 1.2 to 2.7 | 5.32 | 0.05* |
| 2 | Total lymphocyte count | 2.3 | 1.5 to 3.4 | 6.75 | 0.01* |
| 3 | Albumin concentration | 2.1 | 1.3 to 3.3 | 4.89 | 0.05* |
| 4 | Wound size at baseline | 0.5 | 0.3 to 0.8 | 7.22 | 0.01* |
| 5 | Age | 1.03 | 1.00 to 1.06 | 4.15 | 0.05* |
Indicates the significant values.
4. DISCUSSION
The investigation conducted in this study regarding the relationship between nutritional status and wound healing in patients with head and neck cancer has produced noteworthy findings that support and expand current understanding in the fields of oncological nutrition and wound care.
Our results indicated a significant reduction in the BMI and serum albumin concentrations. Continue previous investigations that have identified malnutrition as the prevalent concern among patients with head and neck cancer following treatment. 15 The substantial decline in dietary intake scores serves to emphasize the difficulty of sustaining sufficient nutrition throughout the course of treatment. The significance of these findings lies in the fact that they support the concept that nutritional decline is not simply an adverse effect of the illness, but rather a causal element that affects the efficacy of treatment. 7
The pivotal finding of our study is the progressive improvement in wound healing scores that was observed over the period of 6 months. The observed association between enhanced nutritional indicators (such as lymphocyte count and serum protein levels) and wound healing is consistent with the findings of Wang et al. (2022), who demonstrated the critical role that nutrition assumes in the processes of wound healing. 16 The unexpected correlation between nutritional status and wound healing effectiveness, specifically negative coefficients for BMI, represents fresh perspective that proposes wound recovery dynamics may be influenced not only by the existence but also by the severity of malnutrition.
The higher prevalence of head and neck cancer observed in males, as confirmed by our study, is consistent with global epidemiological data that also indicate the male preponderance in the incidence of head and neck cancer. 17 The correlation that exists between the type and location of cancer, specifically in the larynx and hypopharynx and oral cavity and pharynx, provides additional insight into the complex ways in which the location of cancer may impact nutritional status and wound healing.
The multivariate analysis that uncovers the influence of nutritional status, age and treatment modality on wound recovery is especially enlightening. The results of this study indicate that personalized treatment strategies that take into account these factors may be advantageous. The detrimental effect of an initial larger lesion size on healing outcomes, as demonstrated by our logistic regression analysis, emphasizes the significance of concerning aggressive wound management and early intervention in therapy of head and neck cancer.
Moreover, correlation between distinct wound healing trajectories and utilization of diverse treatment modalities indicates the necessity for integrated care strategies. The discovery that radiation therapy and chemotherapy have distinct effects on wound healing in these patients supports Deptula et al. (2019) claims regarding the complexity of wound management in cancer patients and calls for a more individualized approach to wound care. 18
Significant implications for clinical practice result from our findings. They suggest that proactive nutritional interventions, such as dietary counselling and nutritional supplementation, should be incorporated into standard of care for patients with head and neck cancer. This aligns with the suggestions put forth by Ravasco et al. (2019), which endorse the provision of ongoing and timely nutritional assistance to individuals diagnosed with cancer. 19 The observed association between enhanced nutritional status and improved wound healing outcomes suggests that addressing nutritional deficiencies may represent the crucial approach to improving treatment efficacy and, consequently, wound healing.
Although our research offers valuable insights, it is not devoid of constraints. Because of its cross‐sectional design, it is difficult to establish causality. In order to enhance comprehension of the temporal associations between nutritional status and wound healing, longitudinal studies are imperative. Additionally, the concentration of the study on patients diagnosed with head and neck cancer in Tianjin may restrict the applicability of the results. Further investigation should strive to incorporate a wide range of populations in order to augment the practicality of the findings.
Our research concluded by emphasizing the critical importance of nutritional status in the recovery of wounds in patients with head and neck cancer. This highlighted the importance of incorporating nutritional assessment and intervention into cancer treatment as an integral part of comprehensive care.
5. PRACTICAL IMPLICATIONS
By proactively addressing malnutrition and specific nutrient deficiencies, healthcare providers can significantly improve patient recovery outcomes and quality of life.
6. CONCLUSION
The present study investigates the intricate relationship between nutritional status and wound repair in patients diagnosed with head and neck cancer. The results of our study demonstrate a significant association between compromised wound healing and deteriorating nutritional indicators, such as serum albumin levels and BMI. This study highlights the importance of incorporating nutritional assessment and targeted interventions into the treatment plan for patients with head and neck cancer in order to improve wound healing outcomes, treatment efficacy as a whole and quality of life for patients. These observations facilitate the development of innovative and all‐encompassing strategies for cancer treatment.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ACKNOWLEDGEMENTS
Funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK‐009A); Tianjin Health Technology Project (TJWJ2023MS004).
Chen Y, Li Y, Ceng Y, et al. Examining the relationship between nutritional status and wound healing in head and neck cancer treatment: A focus on malnutrition and nutrient deficiencies. Int Wound J. 2024;21(3):e14810. doi: 10.1111/iwj.14810
DATA AVAILABILITY STATEMENT
The authors can provide all the data if required.
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Associated Data
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Data Availability Statement
The authors can provide all the data if required.
