Nutritional Management in Head and Neck Squamous Cell Cancer Patients: Unmet Medical Need in Italian Real World

Head and Neck Squamous Cell Cancer (HNSCC) includes cancer of the oral cavity, oropharynx, hypopharynx and larynx and represents the seventh most common cancer worldwide with an annual incidence of approximately 700 000 [1]. Much weaker risk factors include tobacco use and alcohol consumption, and Human Papillomavirus (HPV) infection causes of oropharyngeal cancer. These tumors are frequently burdened by a diagnostic delay with approximately half of cases diagnosed in advanced stage cancer. Many patients in this setting are malnourished on diagnosis. Generally, half of all cancer patients lose some body weight; a third lose more than 5% of their original body weight and about 20% of all cancer deaths are caused directly by cachexia (through immobility, heart/respiratory failure). Specifically, HNSCC patients frequently complain several treatment-related problems such as dysphagia, mucositis, vomiting and nausea. These conditions determine reduced food intake and inevitable weight loss with simultaneous malnutrition and disnutrition. About 50% of HNSCC have malnutrition before starting radiotherapy [2]. This percentage inevitably rises during chemo-radiotherapy treatments, endangering both treatment completion and patient survival [3]. Malnutrition determines increased mortality rates as 10–20% of deaths in cancer patients can be attributed to malnutrition independently from malignancy itself [4]. It is recognized that malnutrition causes a wide range of physiological and clinically relevant complications including treatment interruption of chemo(radio) therapy, lower chemotherapy response rates that Determine Impaired Quality of Life (QoL) and increased mortality.