Table 1.

Nutritional status and quality of life in head and neck cancer

First Author, Year, Study Place	Data Collection Period	Study Design	Sample Size	Nutritional Assessment	Quality of Life Assessment	Groups being compared	Key results	Conclusion
Jager-Wittenaar H, 2011, The Netherlands [16]	October 2004 and February 2006	Convenience sample, cross-sectional study	115 oral or oropharyngeal cancer	Percentage weight loss was calculated as: [(normal body weight - actual body weight)/normal body weight] *100	EORTC QLQ C-30	Weight loss > =10% in 6 months or > =5% in 1 month	Median scores of malnourished patients on physical functioning (p = .007) and fatigue (p = .034) were significantly lower than those of well-nourished patients.	Malnourished patients treated for oral/oropharyngeal cancer score lower on quality of life scales related to physical fitness.
Capuano G, 2010, Italy [8]	NA	Prospective, consecutive case series	61 Head & Neck Cancer Oropharynx: n = 21; Oral cavity: n = 19 Nasopharynx: n = 13; Larynx: n = 5; Maxillary sinus: n = 2 Submandibular gland: n = 1	1. Unintended weight loss (UWL) 2. PG-SGA score	EORTC QLQ C-30	Unintended weight loss – Non-malnourished: involuntary loss of < 5% of body weight in the last 3 months (n = 36) &Malnourished: ≥ 5% loss of body weight in the last 3 months (n = 25)	1. Unintended weight loss – Multivariate: Malnutrition (UWL) and Hb level independently influenced physical (p = 0.002; p = 0.005), role (p = 0.004; p = 0.001), and social functions (p = 0.024; p = 0.009). 2. PG-SGA score – Mean ± SD = 3 ± 2 & 9 ± 5 respectively for non-malnourished & malnourished patients, p < 0.001.	An early and intensive nutritional support might reduce weight loss before, during, and after treatment completion, improving outcome, QoL, and PS.
Morton RP, 2009, New Zealand [17]	Over a 24-month period, ending in 2005	Retrospectiveconsecutive case series	36 head and neck cancer	BMI drop over 12 months	UW-QOL	BMI change was taken as a continuous variable	The 12-month BMI drop was inversely correlated with current HRQOL, signifying that weight loss correlated with a poorer subsequent HRQOL score (r = −0.47, P = 0.026). It was significantly related to lower speech and swallowing function scores.	The observed relationship between a drop in BMI and the current HR-QOL may be a function of greater general impact of treatment.
van den Berg MGA, 2007, the Netherlands [18]	May 2002 to May 2004	Observationalprospective non-randomized, longitudinal study	47 Squamous Cell Carcinoma of the oral cavity, oropharynx, hypopharynx. Oral cavity: n = 23; Oropharynx: n = 18; Hypopharynx: n = 5	Unintended weight loss Malnutrition was defined as unintended weight loss of 10% or more within the previous 6 months before baseline	EORTC QLQ C-30and EORTC QLQ – H&N35	≥ 10% & < 10% weight loss at baseline	1. At baseline: Patients ≥10% weight loss in 6 months before baseline had lower scores for global, physical, role, and emotional functioning. Fatigue, pain, insomnia, appetite loss, swallowing, decreased sexuality, sticky saliva and coughing were worse in the ≥ 10% weight loss group. 2. At the end of treatment: Patients who had lost ≥ 10% weight had lower role and social functioning. Scores significantly differed for global (p = 0.01), fatigue (p = 0.03), pain (p = 0.04), senses problems (0.05), sticky saliva (p = 0.01), coughing (p = 0.02) and feeling ill (p = 0.01) during treatment. 3. Six months after treatment: Patients ≥ 10% weight loss lower on physical, role, emotional and cognitive functioning.	Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL.
Petruson KM, 2005, Sweden [19]	February 1996 to May 1997	Prospective, longitudinal study	49 primary untreated head and neck cancer Pharyngeal: n = 15; Laryngeal: n = 12; Oral: n = 12; Other: n = 10	Weight loss* * Severe weight loss (malnutrition) defined as loss of more than 10% weight during 6 months	1. EORTC QLQ-C30 2. EORTC QLQ-H&N35 3. HADS	≥ 10% weight loss (n = 20) & < 10% weight loss (n = 29)	(A) At different time-points: Patients who lost ≥ 10% in weight during 6 months had worse HRQL at diagnosis than did patients who lost less at all time-points. (B) HADS: At diagnosis, 37% of the ≥ 10% weight loss group had Possible/probable depression versus 17% of the <10% weight-loss group. This tendency remained after 3 months (38% vs 20%), at 1-year follow-up (44% vs 5%), and after 3 years (27% vs 15%).	Patients with head and neck cancer who are at risk of severe weight loss developing during treatment may be detected with the aid of HRQL questionnaires at diagnosis.
Hammerlid E, 1998, Norway, Sweden [12]	NA	Prospective, consecutive case series	48 head and neck cancer Oral cavity: n = 16 Larynx: n = 11 Sinus: n = 10 Skin: n = 4 Esophagus/ Hypopharynx: n = 4 Other: n = 3	1. Weight loss 2. Anthropo-metry: (a) AMC and (b) TSF 3. WI 4. BMI 5. S-alb	EORTC QLQ-C30 supplemented by a provisional H&N cancer module constructed in Norway	1. Weight loss: > 5% & ≤ 5% of the body weight 2. Anthropometry: Based on Swedish reference values 3. WI: < 0.80 & ≥ 0.80 4. BMI: ≥ 20 & < 20 5. S-alb: < 33 g/L & ≥ 33 g/L Groups for analysis (1) malnutrition (n =25) versus normal (n = 22), (2) weight loss (n = 20) versus no weight loss (n = 24), (3) negative energy balance (n = 18) versus positive energy balance (n = 15)	1. Malnutrition versus normal nutritional status: Malnourished patients scored worse for 12 of the 16 functions/symptoms. The greatest differences between the two groups were found for Physical Function, global QoL, and Role Function, NS. 2. Weight loss versus no weight loss: Patients with weight loss scored worse for 11 of 16 functions. (a) Swallowing difficulties Mean score = 52 & 18 for those with weight loss and no weight loss respectively, p < 0.01. (b) Problems swallowing food Mean score = 62 & 29 for those with weight loss and no weight loss respectively, p < 0.01. 3. Negative and positive energy balance: The groups of patients with negative energy balance scored better than the group of patients with positive energy balance for 11 of the 16 function/symptoms, NS.	This study demonstrated few significant differences, depending on nutritional status, in some of the QL scales or item scores.