A Conceptual Framework for Managing Oral Intake in Head and Neck Cancer Patients Undergoing Chemoradiotherapy

Patients with head and neck cancer (HNC) face a high risk of malnutrition and sarcopenia, often exacerbated by the toxicities of chemoradiotherapy, such as dysphagia, xerostomia, and mucositis. These Nutritional Impact Symptoms significantly compromise oral intake and negatively affect quality of life. This paper presents a conceptual framework designed to support clinicians in optimizing oral intake through personalized nutritional management. Central to this approach is the integration of systematic screening using MUST, the Malnutrition Universal Screening Tool (MUST), and the Nutritional Risk Screening 2002 (NRS-2002). Furthermore, functional assessment of swallowing via instrumental studies (VFSS/FEES) is essential for tailoring dietary textures according to the International Dysphagia Diet Standardization Initiative framework. Key nutritional strategies include high-energy and high-protein oral fortification, the use of oral nutritional supplements, and specific dietary adjustments addressing pain management and sensory alterations. A multidisciplinary approach involving nutritionists, speech-language pathologists, and oncologists is paramount to transition from reactive symptom management to proactive "adaptive nutrition," ultimately improving clinical outcomes and patient survival.