e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic literature review  (#223)

Anna Edwards 1 2 3 , Teresa Brown 1 3 , Brett G.M. Hughes 4 5 , Judy Bauer 1 3
  1. School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
  2. Nutrition & Dietetics, Toowoomba Hospital, Toowoomba, Queensland, Australia
  3. Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  4. Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  5. School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Rationale: Human papillomavirus (HPV) is the primary cause of the growing epidemic of patients diagnosed with oropharyngeal head and neck cancer (OPC) worldwide1; yet limited research has examined the effect of HPV status on nutritional outcomes. This study aimed to determine the impact of HPV status on nutritional outcomes for patients with OPC undergoing curative treatment.

Methods: A systematic literature review was conducted to February 2021 of PubMed, Embase, CENTRAL, CINAHL, and Web of Science to identify empirical studies conducted in adults with known OPC reporting on any outcome(s) related to nutrition, according to HPV status (OPC+ vs OPC-). Study bias was assessed using the Quality In Prognosis Studies tool, with certainty of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Results: Seven studies (total n=702) met inclusion criteria, and all were deemed to be at moderate-high risk of bias. All studies displayed a higher proportion of patients with OPC+ than OPC-. Five studies reported feeding tube dependency (n=451); two reported timing of feeding tube placement (reactive or prophylactic, n=183); one reported feeding tube utilisation (n=72); one reported nutritional intake (n=83); three reported weight change (n=255); and one reported nutritional status (n=83). Patients with OPC+ status may experience greater weight-loss during and post treatment, may have higher utilisation of reactive feeding tubes (both GRADE low certainty, downgraded due to serious bias and imprecision); and may have lower feeding tube dependency rates (GRADE low certainty, downgraded due to serious bias and inconsistency) versus patients with OPC- status. It is uncertain whether nutritional intake and nutritional status differed between populations (GRADE very low certainty, downgraded due to serious bias and very serious imprecision).

Conclusion: Further high-quality research is needed to understand optimal nutritional care practices for patients with OPC+ to achieve positive health outcomes into survivorship.

  1. Marur S, D'Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. The lancet oncology. 2010;11(8):781-789.