(P21-007-24) Exploring the Role of Clinical and Dietary Risk Factors in Suboptimal Diet Quality Among Patients With Oropharyngeal Cancer Across the Care Continuum

Objectives: Individuals diagnosed with oropharyngeal cancer (OPC) often experience swallowing difficulty and comorbidities that are expected to influence diet quality across the care continuum and may adversely affect treatment response and long-term survivorship. To guide evidence-based strategies to support this fast-growing segment of head and neck cancer survivors, we defined diet quality and investigated associations of clinical and dietary risk factors with diet quality among OPC patients at two stages of cancer care.

Methods: We performed an interim cross-sectional analysis in two cohorts of OPC patients—85 assessed before treatment and 116 assessed ≥18 months after treatment completion—enrolled in the ongoing longitudinal U-DINE study. Patient data obtained from health records included demographics, tube feeding, tumor subsite, and HPV-status. Usual dietary intake was assessed using repeated 24-hour recalls. We estimated diet quality and 13 health-relevant dietary components using the Healthy Eating Index (HEI-2020) and determined independent associations using multivariable linear regression adjusted for demographic factors and smoking habits.

Results: Median (SD) HEI-2020 scores among OPC patients at time of cancer diagnosis and late-stage survivorship were 49.4 (11.0) and 46.8 (12.0), respectively; both are >20% below the HEI-2015 for U.S. adults ≥60y (61). In multivariable analysis, tube placement was the sole clinical factor associated with better diet quality at time of diagnosis (Beta 10.3, 95% CI: 0.2-20.3; p=0.04), and no clinical factor was associated with diet quality at late survivorship. In both cohorts, dietary components most strongly associated with higher diet quality scores were higher consumption of fruits, whole grains, and legumes, and lower consumption of saturated fat (4-6-point higher HEI-2020 scores per 1-SD unit; p< 0.05).

Conclusions: Our findings in OPC patients suggest a disproportionate burden of poor diet quality across stages of cancer care, though the hypothesized relevant clinical risk factors may not significantly impact their diet healthfulness. The identification of key dietary components influencing diet quality informs priorities for dietary interventions to improve cancer outcomes in a fast growing, vulnerable, and underserved population of cancer patients.

Funding Sources: Department of Defense