Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;30(9):7191-7204.
doi: 10.1007/s00520-022-07056-9. Epub 2022 Apr 27.

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

Anna Edwards  1   2   3 , Teresa Brown  4   5 , Brett G M Hughes  6   7 , Judy Bauer  4   8
Affiliations

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

Anna Edwards et al. Support Care Cancer. 2022 Sep.

Abstract

Purpose: Human papillomavirus (HPV) is now the primary cause of oropharyngeal head and neck cancer (OPC) worldwide; yet limited research has examined the effect of HPV-positive status (OPC+) on nutrition outcomes. This study aims to determine the impact of HPV status on nutritional outcomes for adult patients with OPC undergoing any treatment modality.

Methods: A systematic literature review was conducted up to and including July 2021 of PubMed, Embase, CENTRAL, CINAHL, and Web of Science to identify studies conducted in adults (>18 years) with known OPC reporting on any outcome(s) related to nutrition, according to HPV status (OPC+ versus OPC-). Bias was assessed using QUIPS tool, with certainty of evidence assessed using GRADE system.

Results: Six studies (total n = 635) all at moderate-high risk of bias were included. Three studies reported on weight change (n = 255), three feeding tube dependency (n = 380), three feeding tube timing of placement (prophylactic or reactive) and/or utilisation (n = 255), two nutritional (energy and/or protein) intake (n = 230), and one nutritional status (n = 83). Patients with OPC+ may experience greater weight loss, 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 OPC- . 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.

Keywords: Human papillomavirus; Malnutrition; Nutrition; Nutrition support; Oropharyngeal cancer; Weight loss.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRIMSA diagram. Key: HPV human papillomavirus, OPC oropharyngeal squamous cell carcinoma, OPC + human papillomavirus-positive oropharyngeal squamous cell carcinoma, OPC − human papillomavirus-negative oropharyngeal squamous cell carcinoma
Fig. 2
Fig. 2
Quality In Prognosis Studies (QUIPS) tool applied utilizing Robovis online software to visualise a traffic light plot and b weighted summary plot across six risk of bias domains
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Citak E, Tulek Z, Uzel O. Nutritional status in patients with head and neck cancer undergoing radiotherapy: a longitudinal study. Support Care Cancer. 2019;27:239–247. - PubMed
    1. Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJM, Kolkman-Deurloo I-K, Prevost J-B, Poll J, Schmitz PIM, Heijmen BJ. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85:64–73. - PubMed
    1. Anderson NJ, Jackson JE, Wada M, Schneider M, Poulsen M, Rolfo M, Fahandej M, Gan H, Khoo V. The changing landscape of head and neck cancer radiotherapy patients: is high-risk, prolonged feeding tube use indicative of on-treatment weight loss? J Med Radiat Sci. 2019;66:250–258. - PMC - PubMed
    1. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008;30:503–508. - PubMed
    1. Langius JAE, Bakker S, Rietveld DHF, Kruizenga HM, Langendijk JA, Weijs PJM, Leemans CR. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013;109:1093–1099. - PMC - PubMed

Publication types