Effectiveness of nutritional interventions for nasopharyngeal carcinoma: A systematic review and meta-analysis
Main Article Content
Abstract
Malnutrition occurs in 53.6 – 80.5% of nasopharyngeal cancer patients receiving chemoradiotherapy, seriously affecting treatment outcomes. Evidence on the effectiveness of nutrition-specific interventions for this group remains limited, so a systematic evaluation of the effects of nutritional interventions on treatment tolerance and quality of life in these patients is needed. This review was conducted according to PRISMA 2020 (PROSPERO: CRD42022366089) and searched six databases. We analyzed 10 RCTs (n = 879) and 4 non‑RCTs; risk of bias was assessed using ROB 2.0, NOS, and NHLBI; evidence certainty was graded with GRADE. Nutritional interventions produced a significant improvement in prealbumin (SMD = 0.256; p = 0.032), hemoglobin, and lymphocyte count (SMD = 1.125; p < 0.001), and reduced oral mucositis by 25%. Albumin and BMI improved markedly in the ≥ 70 Gy dose subgroup. PG-SGA > 3 combined with NLR ≥ 3 was associated with a 4.43-fold increased risk of death. Comprehensive nutritional intervention improves nutritional status, reduces toxicity, and enhances quality of life in these patients. Routine PG-SGA screening is recommended, particularly for the ≥ 70 Gy dose subgroup.
Article Details
Keywords
nasopharyngeal carcinoma, malnutrition, nutritional intervention, chemoradiotherapy, PG-SGA, systematic review, meta-analysis
References
2. Chen YP, Chan ATC, Le QT, et al. Nasopharyngeal carcinoma. Lancet. 2019;394(10192):64-80. doi:10.1016/S0140-6736(19)30956-0
3. Lin JC, Jan JS, Hsu CY, et al. Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma. J Clin Oncol. 2003;21(4):631-637.
4. Tao Xu, J Tang, M Gu, et al. Recurrent nasopharyngeal carcinoma: A clinical dilemma and challenge. Curr Oncol. 2013;20:e406-419.
5. Langius JA, Zandbergen MC, Eerenstein SE, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013;109(5):1093-1099.
6. Wang P, Soh KL, Ying Y, et al. Risk factors for malnutrition in patients with nasopharyngeal carcinoma. Supportive Care in Cancer. 2023;31(12):723.
7. Sonis ST. Oral mucositis. Anticancer Drugs. 2011;22(7):607-612.
8. Bernhardson BM, Tishelman C, Rutqvist LE. Taste and smell changes in patients receiving cancer chemotherapy. Cancer Nurs. 2009;32(1):45-54.
9. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26(3):289-301.
10. Hebuterne X, Lemarie E, Michallet M, et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN. 2014;38(2):196-204.
11. Prevost V, Grach MC. Assessment of nutritional status in patients with head and neck cancer. Curr Opin Clin Nutr Metab Care. 2014;17(5):507-513.
12. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-336.
13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
14. Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.3. Cochrane, 2022.
15. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.
16. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-188.
17. Beck FK, Rosenthal TC. Prealbumin: a marker for nutritional evaluation. Am Fam Physician. 2002;65(8):1575-1578.
18. Delano MJ, Moldawer LL. The origins of cachexia in acute and chronic inflammatory diseases. Nutr Clin Pract. 2006;21(1):68-81.
19. Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc. 2004;104(8):1258-1264.
20. Elting LS, Keefe DM, Sonis ST, et al. Patient-reported measurements of oral mucositis in head and neck cancer. J Support Oncol. 2008;6(4):174-180.
21. Barber MD, Ross JA, Voss AC, et al. Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia. Nutr Cancer. 2001;40(2):118-124.
22. Pimentel GD, Rosa JC, Lira FS, et al. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation and resistance exercise. Nutr Metab. 2011;8:79.
23. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-899.
24. Dolan RD, Laird BJA, Klepstad P, et al. The relationship between the systemic inflammatory response, nutritional status, and prognosis in patients with advanced cancer. Cancers (Basel). 2021;13(11):2773.
25. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48.
26. Ling-Long Tang, Yu-Pei Chen, Chuan-Ben Chen, et al. Chinese Society of Clinical Oncology (CSCO) clinical guidelines for diagnosis and treatment of nasopharyngeal carcinoma. Cancer Communications. 2021;41(11).
27. Isenring E, Capra S, Bauer J. The impact of nutrition support on body composition in cancer outpatients receiving radiotherapy. Acta Oncol. 2007;46(5):639-646.
28. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005;23(7):1431-1438.