Quality of Life in Patients with Head and Neck Cancer in the Course of Three Years of Observation in a Nutritional Outpatient Department

Authors: E. Malá 1;  E. Vejražková 2;  M. Vošmik 3;  J. Novosad 4;  L. Sobotka 5
Authors‘ workplace: Ústav klinické imunologie a alergologie, Fakultní nemocnice Hradec Králové 1;  IV. Interní hematologická klinika, Fakultní nemocnice Hradec Králové 2;  Klinika onkologie a radioterapie, Fakultní nemocnice Hradec Králové 3;  Ústav klinické imunologie a alergologie, Fakultní nemocnice Hradec Králové 4;  III. interní gerontometabolická klinika, Fakultní nemocnice Hradec Králové 5
Published in: Otorinolaryng. a Foniat. /Prague/, 65, 2016, No. 1, pp. 9-16.
Category: Original Papers


The nutritional status, consisting of nutritional support and intervention is important for the survival of patients with head and Neck Cancer.

The group of 726 patients with Head and Neck Cancer was observed. Patients were given by a nutritional support through the introduction of percutaneous endoscopic gastrostomy (group A) and sipping (group B). Monitoring the quality of life of patients was carried out in the defined checks through questionnaires - in module of general quality of life and module of quality of life for patients with head and neck cancer. Du to dominating symptoms in modules of quality of life, we compared results between groups and the sexes. Group A and B are comparable in terms of representation of cancer stage and treatment modality.

Nutritional intervention is the causal factor affecting the development of nutritional parameters and complications, quality of life, pain, depending on the other person and survival of patients. Patients with nutritional intervention due to percutaneous endoscopic gastrostomy showed better tolerance of cancer treatment (p < 0.02), less complications, significantly lower incidence of depending on the care of another person (p < 0.04), better quality of life (p < 0.04). Women have also improved tolerance oncology therapies, improved physical fitness despite higher input weight loss.

Monitoring the quality of life we consider as one of the key factors of comprehensive care in the oncological treatment. It has become obvious that it correlates with independent predictive factors of cancer care (malnutrition and lack of development of weight loss, quality of life, and nutritional intervention).

head and neck cancer, malnutrition, percutaneous endoscopic gastrostomy, quality of life, nutrition, weight loss


1. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res 2, 1993, s. 153-159.

2. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41, 1995, s. 1403-1409.

3. What quality of life? The WHOQOL Group. World Health Organization Quality of Life Assessment. World Health Forum 17, 1996 s. 354-356.

4. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc. Sci. Med., 46, 1998, s. 1569-1585.

5. www.svod.cz 2015. Ref Type: Online Source.

6. Aaronson, N. K. et al.: Quality of life: what is it? How should it be measured? Oncology (Williston Park), 64, 1988, s. 69-76

7. Aaronson, N. K. et al.: Quality of life assessment in clinical trials: methodologic issues. Kontrol. Clin. Trials, 10, 1989, s. 195-208.

8. Aaronson, N. K. et al.: Quality of life research in cancer clinical trials: a need for common rules and language. Oncology (Williston Park), 4, 1990, s. 59-66.

9. Aaronson, N. K. et al.: Methodologic issues in assessing the quality of life of cancer patients. Cancer, 67, 1991, s. 844-850.

10. Aaronson, N. K., Ahmedzai, S., Bergman, B. et al.: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J. Natl. Cancer Inst., 85, 1993, s. 365-376.

11. Aaronson, N. K., Bullinger, M., Ahmedzai, S.: A modular approach to quality-of-life assessment in cancer clinical trials. Recent Results Cancer Res., 111, 1988, s. 231-249.

12. Aaronson, N. K., Meyerowitz, B. E., Bard, M. et al.: Quality of life research in oncology. Past achievements and future priorities. Cancer, 67, 1991, s. 839-843.

13. Aaronson, N. K., Snyder, C. et al.: Using patient-reported outcomes in clinical practice: proceedings of an International Society of Quality of Life Research conference. Qual Life Res., 17, 2008, s. 1295.

14. Aaronson, N. K., Sprangers, M. A. et al.: Measuring quality of life in every oncological patient. Ned Tijdschr Geneeskd, 155, 2011, A3749.

15. Arunachalam, D., Thirumoorthy, A., Devi, S. et al.: Quality of life in cancer patients with disfigurement due to cancer and its treatments. Indian J. Pallia. Care, 17, 2011, s. 184-190.

16. Billington, D. R., Landon, J., Krageloh, C. U. et al.: The New Zealand World Health Organization Quality of Life (WHOQOL) Group. N Z Med. J., 123, 2010, s. 65-70.

17. Bjordal, K., Hammerlid, E., Ahlner-Elmqvist, M. et al.: Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J. Clin. Oncol., 17, 1999, s. 1008-1019.

18. Bossola, M. et al.: Nutritional Interventions in head and neck cancer patients undergoing chemoradiotherapy: A narrative review. Nutrients, 7, 2015, s. 265-276.

19. Bozzetti, F. et al.: Nutrition and gastrointestinal cancer. Curr. Opin. Clin. Nutr. Metab. Care, 4, 2001, s. 541-546.

20. Bozzetti, F. et al.: Quality of life and enteral nutrition. Curr. Opin. Clin. Nutr. Metab. Care, 11, 2008, s. 661-665.

21. Bozzetti, F. et al.: Management of cancer cachexia. Tumori, 100, 2014, e1.

22. Bozzetti, F. et al.: Nutritional supplementation in advanced cancer patients: Re: „Influence of a nutritional intervention on dietary intake and quality of life in cancer patients“. Nutrition, 30, 2014, s. 957-958.

23. Bozzetti, F. et al.: Nutrition, hydration, and patient‘s preferences at the end of life. Support Care Cancer, 2015, Suppl.

24. Bozzetti, F., Arends. J., Lundholm, K. et al.: ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin. Nutr., 28, 2009, s. 445-454.

25. Bozzetti, F., Cozzaglio, L., Gavazzi, C. et al.: Nutritional support in patients with cancer of the esophagus: impact on nutritional status, patient compliance to therapy, and survival. Tumori, 84, 1998, s. 681-686.

26. Bozzetti, F., Cozzaglio, L., Gavazzi, C. et al.: Total nutritional manipulation in humans: report of a cancer patient. Clin. Nutr., 15,1996, s. 207-209.

27. Bozzetti, F., Gavazzi, C., Mariani, L. et al.: Artificial nutrition in cancer patients: which route, what composition? World J. Surg., 23,1999, s. 577-583.

28. Cacicedo, J., Casquero, F., Martinez-Indart, L. et al.: A prospective analysis of factors that influence weight loss in patients undergoing radiotherapy. Chin. J. Cancer, 33, 2014, s. 204-210.

29. Capuano, G., Gentile, P. C., Bianciardi, F. et.al.: Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer, 18, 2010, s. 433-437.

30. Charlson, M., Szatrowski, T. P., Peterson, J. et al.: Validation of a combined comorbidity index. J. Clin. Epidemiol., 47,1994, s. 1245-1251.

31. Charlson, M., Wells, M. T., Ullman, R. et al.: The Charlson comorbidity index can be used prospectively to identify patients who will incur high future costs. PLos One, 9. 2014, e112479.

32. Denaro, N., Merlano, M. C., Russi, E. G. et al.: Dysphagia in head and neck cancer patients: Pretreatment evaluation, predictive factors, and assessment during radio-chemotherapy, recommendations. Clin. Exp. Otorhinolaryngol., 6, 2013, s. 117-126.

33. Dodesini, A. R., Benedini, S., Terruzzi, I. et al.: Protein, glucose and lipid metabolism in the cancer cachexia: A preliminary report. Acta Oncol., 46, 2007, s. 118-120.

34. Dusek, L., Pavlik, T., Májek, O. et al.: Odhady incidence, prevalence a počtu onkologických pacientů léčených protinádorovou terapií v letech 2015-2020, analýza Národního onkologického registru . Klin. Onkol., 28, 2015, 1, s. 30-43.

35. Dusek, L., Muzik, J., Gelnarova, E. et al.: Cancer incidence and mortality in the Czech Republic. Klin. Oncol., 23, 2010, s. 311-324.

36. Fearon, K., Arends, J., Baracos, V. et al.: Understanding the mechanisms and treatment options in cancer cachexia. Nat. Rev. Clin. Oncol., 10, 2013, s. 90-99.

37. Fearon, K., Strasser, F., Anker, S. D. et al.: Definition and classification of cancer cachexia: an international consensus. Lancet Oncol., 12, 2011, s. 489-495.

38. Galbraith, J. K. et al.: Economics and the quality of life. Science, 14, 1964, s. 145, 117-123.

39. Gaziano, J. E. et al.: Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control., 9, 2002, s. 400-409.

40. Johnson, G., Salle, A., Lorimier, G. et al.: Cancer cachexia: measured and predicted resting energy expenditures for nutritional needs evaluation. Nutrition, 24, 2008, s. 443-450.

41. Karnofsky, D. A., Ellison, R. R., Golbey, R. B. et al.: Selection of patients for evaluation of chemotherapeutic procedures in advanced cancer. J. Chronic. Dis., 15, 1962, s. 243-249.

42. Karnofsky, D. A., Rawson, R. W. et al.: Symposium on the medical aspects of cancer; introduction. Med. Clin. North Am., 40, 1956, s. 575-579.

43. Laviano, A., Renvyle, T., Yang, Z. J. et al.: From laboratory to bedside: new strategies in the treatment of malnutrition in cancer patients. Nutrition, 12, 1996, s. 112-122.

44. Lochs, H., Valentini, T., Schutz, S. P. et al.: ESPEN Guidelines on adult enteral nutrition . Clinical Nutrition, 25, 2015, s. 177-360.

45. Lochs, H, Allison, S. P., Meier, R. et al.: Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin. Nutr., 25, 2006, s. 180-186.

46. Loser, C., Aschl, G., Hebuterne, X. et al.: ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin. Nutr., 24, 2005, s. 848-861.

47. Lovik, A., Almendingen, K., Dotterud, M. et al.: (Dietary information after radiotherapy of head and neck cancer). Tidsskr Nor Laegeforen, 116, 1996, s. 2303-2306.

48. Meier, R. et al.: Enteral feeding in tumor patients. Schweiz Med Wochenschr., 125, 1995, s. 159-162.

49. Power, M. J., Green, A. M.: Development of the WHOQOL disabilities module. Qual. Life Res., 19, 2010, s. 571-584.

50. Prevost, V., Joubert, C., Heutte, N. et al.: Assessment of nutritional status and quality of life in patients treated for head and neck cancer. Eur. Ann. Otorhinolaryngol. Head Neck Dis., 131, 2014, s. 113-120.

51. Ravasco, P. et al.: Cancer and nutrition: key determinants of quality of life. Eur. J. Cancor, 45, 2009, Suppl 1, s. 409.

52. Ravasco, P., Monteiro-Grillo, I., Marques, V. P. et al.: Quality of life in gastrointestinal cancer: what is the impact of nutrition?. Acta Med. Port., 19, 2006, s. 189-196.

53. Takenaka, Y., Takemoto, N., Nakahara, S. et al.: Prognostic significance of body mass index before treatment for head and neck cancer. Head Neck, 9, 2014, s. 224-311.

54. Takenaka, Y., Yamamoto, M., Nakahara, S. et al.: Factors associated with malnutrition in patients with head and neck cancer. Acta Otolaryngol., 134, 2014, s. 1079-1085.

55. van Bokhorst,-de van der Schuer, van Leeuwen, P. A., Kuik, D. J. et al.: The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer, 86, 1999, s. 519-527.

56. van den Berg, M. G., Rasmussen-Conrad, E. L., van N. L. et al.: A prospective study on malnutrition and quality of life in patients with head and neck cancer. Oral Oncol., 44, 2008, s. 830-837.

57. van den Berg, M. G., Rutten, H., Rasmussen-Conrad, E. L. et al.: Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head Neck, 36, 2014, s. 60-65.

58. van den Berg, E. J. et al.: Nutrition and cancer: physiological interrelationships. Ann. Rev. Nutr. 5, 1985, s. 435-461.

Audiology Paediatric ENT ENT (Otorhinolaryngology)
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account