Nutritional prehabilitation in patients with head and neck cancer: an evidence mapping analysis

Head and neck cancer patients are often at high risk of malnutrition due to the disease and its treatment, and pretreatment nutritional prehabilitation is an important strategy for improving prognosis; however, the existing evidence still needs to be systematically synthesized.

To systematically describe and evaluate the evidence related to pretreatment nutritional prehabilitation in patients with head and neck cancer through evidence mapping to provide a basis for clinical practice.

Computerized searches of CNKI, Wan-fang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, Embase, and CINAHL were performed from the time of database construction to May 2025, to include systematic review/meta-analysis of nutritional prehabilitation of patients with head and neck cancer, randomized controlled trials, and observational studies. The Risk of Bias Tool, Newcastle-Ottawa Scale (NOS), and AMSTAR-2 scale were used to evaluate the methodological quality of the included studies, respectively, and the current status of the studies was demonstrated using a combination of text and graphs.

Then, 6 systematic evaluations/meta-analyses, 13 randomized controlled trials, and 4 observational studies were finally included. The largest number of studies was published in China, and all study populations consisted exclusively of patients with head and neck cancer. Interventions include pretreatment immunonutritional interventions, nutritional risk screening-guided interventions, standard enteral nutritional support, disease-specific nutritional formula support, nutritional counseling, and pretreatment swallow training. The outcome indicators mainly focused on the patients' nutritional status, complication rates, length of hospital stay, body weight, and BMI, etc. However, the methodological quality of the included studies needs to be improved. The results of the studies all showed that nutritional prehabilitation benefits the prognosis of patients with head and neck cancer.

Overall evidence suggests that nutritional prehabilitation can improve patients' nutritional status and enhance their prognosis and quality of life, showing beneficial effects. More high-quality, large-sample clinical studies should be conducted in the future to guide the clinical implementation of nutritional prehabilitation.