Pre- and post-treatment malnutrition in head and neck cancer patients

Malnutrition is a common problem in head and neck cancer patients. Malnutrition in head and neck cancer patients may have multiple causes. Oral symptoms caused by the localization of the tumor or cancer treatment may hinder drinking and eating, possibly resulting in insufficient energy and protein intake. Furthermore, inflammatory activity, caused by cancer itself or its treatment may cause malnutrition. This thesis aimed to assess malnutrition during the various phases of the treatment head and neck cancer patients are subjected to, viz. from diagnosis up to the period after completion of cancer treatment, and to identify risk factors for malnutrition that occur during these phases. The studies described in this thesis have shown that pretreatment prevalence of malnutrition is nearly 20%. One month post-treatment prevalence of malnutrition increases to more than 50% en declines in the period after that. Unfortunately, this decline in prevalence of malnutrition is not accompanied by improvement of lean mass (i.e. muscle mass). Additionally, this thesis illustrated that even an intake of energy and protein generally considered sufficient cannot prevent loss of body weight and lean mass during treatment. Moreover, swallowing problems was identified as important risk factor for both pre- and post-treatment malnutrition in head and neck cancer patients. Finally, this thesis showed that post-treatment malnutrition is associated with reduced physical functioning.