Kubrak Catherine, Farhangfar Arazam, Woynorowski Matthew, Jha Naresh, Preshing William, Baracos Vickie
Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
Faculty of Dentistry, Division of Oral Medicine, University of Alberta, Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta, T6G 1Z1, Canada.
Heliyon. 2020 Mar 31;6(3):e03617. doi: 10.1016/j.heliyon.2020.e03617. eCollection 2020 Mar.
To examine the relationship of reduced numbers of occluding teeth and dietary intake (DI), nutrition impact symptoms (NIS), and weight loss (WL) in head and neck cancer (HNC) patients.
As a part of the standard of care, treatment-naïve HNC patients (n = 104) completed dental evaluation (number of teeth, total anterior/posterior occlusal teeth, Eichner Index (EI) classification), WL, DI questionnaire and HNC Symptom Checklist©. Descriptive statistics (Kruskal-Wallis, Fisher-exact, χ tests) and (uni-) multi-variable logistic regression.
Overall, 42, 45 and 13% of patients were in EI-class A, B and C with a median of 8, 3, and 0 total posterior occlusal teeth. EI-class B/C patients were older, more likely to have impaired DI (OR = 3.88; 95%CI:1.63-9.26; = 0.002) and reported interference with DI by 11 NIS (p < 0.05). DI was, however, reported as unimpaired in 77, 49 and 39% of patients in EI-class A, B and C, respectively. The subset of EI-class B/C patients with impaired DI, had more NIS interference with DI ( < 0.05; difficulty chewing, pain, early satiety, lack of energy); EI-class C patients additionally had dry mouth, thick saliva and dysphagia ( < 0.05). In logistic regression, EI-classes B/C patients with reduced (vs unimpaired) DI were more likely to have ≥5% WL (OR = 10.1; 95%CI:2.0-50.0), higher NIS interference (range OR 4.3-10.7).
More than half of these HNC patients had reduced numbers of occlusal teeth or were edentulous. EI-class B/C patients did not necessarily have impaired DI, however the combination of EI-class B/C and a constellation of NIS, associated with reduced DI.
Treatment naïve head and neck cancer (HNC) patients with reduced occlusal and masticatory performance (Eichner Index B/C) and reduced dietary intake are at high risk for weight loss. Identifying HNC patients at risk may improve their oral health, dietary intake and reduce their risk of weight loss.
研究头颈部癌（HNC）患者中咬合牙数量减少与饮食摄入（DI）、营养影响症状（NIS）及体重减轻（WL）之间的关系。
作为标准治疗的一部分，未经治疗的HNC患者（n = 104）完成了牙科评估（牙齿数量、前后总咬合牙数量、艾希纳指数（EI）分类）、体重减轻情况、饮食摄入问卷及HNC症状清单。进行描述性统计（克鲁斯卡尔 - 沃利斯检验、费舍尔精确检验、χ检验）以及（单）多变量逻辑回归分析。
总体而言，42%、45%和13%的患者分别处于EI - A级、B级和C级，后牙总咬合牙数量的中位数分别为8颗、3颗和0颗。EI - B/C级患者年龄较大，更有可能存在饮食摄入受损（比值比（OR）= 3.88；95%置信区间（CI）：1.63 - 9.26；P = 0.002），并且有11种营养影响症状会干扰饮食摄入（P < 0.05）。然而，EI - A级、B级和C级患者中分别有77%、49%和39%报告饮食摄入未受损。EI - B/C级中饮食摄入受损的患者亚组，有更多营养影响症状干扰饮食摄入（P < 0.05；咀嚼困难、疼痛、早饱、缺乏能量）；EI - C级患者还存在口干、唾液黏稠和吞咽困难（P < 0.05）。在逻辑回归分析中，饮食摄入减少（与未受损相比）的EI - B/C级患者更有可能体重减轻≥5%（OR = 10.1；95%CI：2.0 - 50.0），营养影响症状干扰程度更高（OR范围为4.3 - 10.7）。
这些HNC患者中超过一半的人咬合牙数量减少或无牙。EI - B/C级患者不一定存在饮食摄入受损，然而EI - B/C级与一系列营养影响症状相结合，与饮食摄入减少有关。
未经治疗的头颈部癌（HNC）患者，若咬合和咀嚼功能降低（艾希纳指数B/C级）且饮食摄入减少，则有较高的体重减轻风险。识别有风险的HNC患者可能改善他们的口腔健康、饮食摄入并降低体重减轻风险。
