Does nutritional support prevent severe mucositis in patients with head and neck cancer treated with...

For patients with advanced head and neck cancer (HNC) chemoradiotherapy (CHRT) is the main treatment option. CHRT is a severe treatment with a high ratio of side effects which may be even more pronounced due to mucosities related malnutrition. Nutritional intervention like nutritional counseling (NC) and oral nutritional supplements (ONS) may prevent malnutrition. A systematic review and meta-analysis was performed to assess the effect of NC with or without ONS (NC±ONS) on CHRT-related grade ≥3 mucositis in patients with HNC undergoing CHRT.

PubMed/MEDLINE, Web of Science, and Scopus were searched to identify randomized and non-randomized clinical studies of HNC patients undergoing CHRT, where mucositis grade ≥3 data were provided. Comparative and proportional meta-analyses were performed to calculate the odds ratio (OR) and incidence of a mucositis grade ≥3 in the included studies (%) with 95% confidence intervals (95% CI).

There were seven studies fulfilling inclusion criteria with 655 participants included. NC±ONS revealed no risk reduction of grade ≥3 mucositis (OR: 1.2, 95%CI: 0.7-1.9). The overall mucositis rate was 38.3% (95% CI: 24.8%-52.6%) and 32.8% (95% CI: 14.9%-53.5%) (P = 0.67) in NC+ONS and NC-ONS respectively.

Despite the undeniable role of NC±ONS for patients with HNC undergoing CHRT, we found it insufficient to avoid grade ≥3 CHRT-related mucositis. Further research should be conducted to determine recomendations how to decrease the risk of oral mucosities and, in consequence, how to prevent malnutrition in patients with CHRT.