(OR07-05-24) Carotenoid and Nutritional Status During Modern Head and Neck Cancer Therapy

Objectives: Modern multidisciplinary head and neck cancer (HNC) therapy (surgery/chemotherapy/radiation) has improved survival but is rigorous and associated with acute and chronic toxicities and malnutrition. Nutritional interventions including tube feeding and oral nutrition supplements (ONS) are advised. However, they are typically devoid of plant phytochemicals such as carotenoids, which are hypothesized to have health benefits and perhaps promote healthy survivorship. The objective of the study is to describe changes in carotenoid and nutritional status in HNC patients undergoing surgery/biopsy followed by radiation with or without concomitant chemotherapy.

Methods: Carotenoid and nutrition status was assessed in 30 patients with HNC undergoing initial therapy. Weight, tube feeding, ONS use, and malnutrition assessment by registered dietitian nutritionists (RDNs) utilizing the AND/ASPEN 2012 criteria were documented at biopsy, (chemo)radiation initiation, completion of therapy, and 3 months thereafter. Participants completed an FFQ at enrollment and dietary carotenoid screener, skin carotenoid scan via resonance Raman spectroscopy, blood biomarkers, and The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) before therapy and at completion.

Results: Mean overall weight loss from biopsy to completion of therapy was 8% (17±18 lbs). Upon completion of therapy and follow-up 3 months later, a continued weight loss of 5% (10±14 lbs) was observed. At initiation of treatment, 30% reported a PG-SGA SF score ≥ 9, which is associated with malnutrition. At the end of therapy, 100% reported a PG-SGA SF score ≥ 9 despite tube feeding and ONS. Mean skin resonance Raman spectroscopy scores (biomarker of carotenoid status) decreased by 19% from (chemo)radiation start to end of therapy.

Conclusions: Weight loss and malnutrition is common in modern HNC therapy and continues following therapy completion. Carotenoid status, as a marker of phytochemical intake, also declined significantly. The loss of dietary bioactives during therapy may also compromise health and enhance toxicity of therapy, lower resilience, and contribute to long term consequences of therapy in survivors.

Funding Sources: Michael W. Curran Research Fund and USDA National Needs Fellowship