Nutrition impact symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy

Abstract Objectives To identify the nutrition impact symptom (NIS) clusters in patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT) and explore their relationships with weight loss rate (WLR). Methods This longitudinal study included 169 patients. At baseline (T1), the demographics, clinical information, and weight before RT were recorded. At the third week (T2) and the end of RT (T3), we assessed the weight, the prevalence, severity, and interference of NIS with the head and neck patient symptom checklist (HNSC). The mean scores of the severity of NIS at T2 and T3 were used as a whole to perform the exploratory factor analysis and identify the symptom clusters. Cronbach's α coefficient was used to evaluate the internal consistency of the symptom clusters. Generalized estimating equations (GEE) were used to analyze the relationships between clusters and WLR. Results We extracted three clusters from 14 NIS: the RT-specific symptom cluster including pain, difficulty swallowing, oral mucositis, thick saliva, difficulty chewing, and dry mouth (Cronbach's α=0.820); the gastrointestinal symptom cluster including nausea, loss of appetite, feeling full, vomiting, and taste change (Cronbach's α=0.592); the psychological status cluster including depressed, anxious, and lack of energy (Cronbach's α=0.710). The multivariable model showed that participants with more serious RT-specific symptom cluster (β=1.020, 95% CI: 0.570-1.471, P Conclusions The NIS had close internal connections with each other, so the strategies applied by healthcare professionals should focus on multiple related symptoms, especially to manage the RT-specific symptom cluster.