TITLE:
Health Related Quality of Life and Biochemical Markers for Cachexia Evaluation in Head and Neck Cancer Patients
AUTHORS:
Joaquim Castro Silva, Patricia Tavares, Rita Ferreira, Lucio Lara Santos, Eurico Monteiro
KEYWORDS:
Cachexia, Head Neck Cancer, Quality of Life, Biochemical Markers, Malnutrition
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.10 No.4,
July
21,
2021
ABSTRACT: Cachexia is a multifactorial syndrome related to unintentional weight loss and to loss of muscle and fat mass. In head and neck cancer (HNC) its incidence is important and not only related to a deficient intake of food due to the impact of the disease in the vital functions. A complex disturbance in the normal metabolism of the patient promotes a persistent inflammatory state and a shifting in the metabolism balance toward a catabolic predominance affecting primarily the skeletal muscle. This leads to severe impairment of the functional, emotional and social status and quality of life of the patients that will compromise response to treatment and the disease prognosis. Understanding this deleterious syndrome and mainly identifying it in early stages of the disease is of a major importance in achieving better outcomes to head and neck cancer patients. This study pretends to identify clinical aspects related to cachexia in HNC in a clinical perspective for application on the routine clinical practice. In our study, 30 HNC patients were enrolled and evaluated in terms of nutritional values (actual and loss of weight in the past 6 months, body mass index (BMI), nutritional risk index (NRI), malnutrition universal screening tool), serum biochemical markers (albumin, total proteins, cholesterol, triglycerides, urea, C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and myostatin) and health related quality of life (HRQoL) evaluation (using European Organisation for the Research and Treatment of Cancer (EORTC) quality of life questionnaires (QLQ): EORTC QLQ-C30 and EORTC QLQ-HN43). A minimum follow-up of 48 months was considered for all patients. Our results showed that NRI is a good and sensitive index to identify cachexia. This index uses two parameters, one constitutional (loss of weight) and one biochemical (level of serum albumin). According to this criterion, 16 patients were assigned to the No-cachexia group and 14 patients to the Cachexia group. Significant differences in the constitutional and nutritional values between the two groups were found: the median weight loss was 4.44 kg in the No-cachexia group and 11.29 kg in the Cachexia group, while the BMI was 21.88 and 18.33, respectively. In terms of biochemical markers, significant low values of albumin and cholesterol in the Cachexia group were encountered when compared to the No-cachexia group. Regarding the inflammatory and cachexia biomarkers studied, the results show that patients in the Cachexia group had significantly higher levels of CRP and of the proinflammatory cytokines IL-6 and TNF-α and presented significantly raised levels of the myostatin. In terms of HRQoL evaluation, the scores of the EORTC QLQ-C30 revealed that all the scales and the Summary Score showed lower scores in the Cachexia group, indicating worst quality of life evaluation. The items scores were globally higher in the Cachexia group indicating more important problems related to those items in the Cachexia group. The difference encountered between the groups was significant (p