Association between the nutritional status and radiation pharyngeal mucositis in patients with head and neck cancer during radiotherapy: A longitudinal study

Abstract Objective Radiation mucositis, especially pharyngeal mucositis, severely affects the oral intake of patients of head and neck cancer (HNC) during radiotherapy. Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown. This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis. Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study. Data were collected at baseline (T1), midtreatment (T2), and at the end of treatment (T3). The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status, respectively. Results There were 348 HNC patients who completed all assessments. The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy (χ2 = 553.521, P < 0.001). At T3, 56.0% of patients had moderate or severe pharyngeal mucositis. The proportion of patients with malnutrition increased significantly during treatment (21.3% at T1 vs 46.8% at T2 vs 76.1% at T3, χ2 = 209.768, P < 0.001). Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition. Conclusions Malnutrition was common in patients with HNC during radiotherapy, and it was closely related to pharyngeal mucositis. Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.