Malnutrition screening can identify early HNC patients with oral dysphagia and those who are at risk of malnutrition and may subsequently need to be referred to a dietician for a comprehensive assessment and nutrition intervention and monitoring. 7 Validated screening tools like Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool, and Nutrition Risk screening (NRS2002) can be used. 7

All those patients with nutritional risk should immediately undergo a comprehensive nutritional assessment. PG-SGA or SGA has been proven to be effective in cancer patients’ nutritional assessment. 7 A detailed nutritional assessment should be able to assess subjectively and objectively to quantify specific nutritional needs. Therefore, a comprehensive nutritional assessment should include anthropometric measurements, recent and past medical history, altered dietary intake, and physical examination along with evaluation of functional capacity and cognitive changes, medications, and laboratory investigations. 3

Several imaging methods can precisely evaluate body muscle mass. Advanced techniques for body composition analysis such as BIA, DEXA, CT, MRI, and USG imaging are gold standards that appear to be the most accurate in measuring adipose tissue and organs in clinical practice.8 Patients' performance status can be assessed by using the Eastern Cooperative Oncology Group (ECOG) scale that may help to identify patients, who may benefit from therapeutic and rehabilitative interventions. 4, 9, 10 Hand Grip Strength (HGS) by hand grip dynamometer can be a useful tool in measuring muscle strength. 4

Dysphagia is the most frequent and important symptom of HNC. Studies indicate approximately 50% of HNC patients present with oropharyngeal dysphagia. 11 Neuromuscular and sensory damage due to cancer treatment can affect swallowing capacity. Malnutrition, dehydration, even aspiration, and pneumonia can be caused due to impaired swallowing ability. Tumor location and treatment modalities can predict swallowing disorders. Dysphagia screening at the baseline and periodical screening during the treatment can help in detecting high-risk patients. Timely and proper treatment selection, prophylactic exercises, and teaching and training of swallowing maneuvers can reduce impairments, and could optimize functional and therapeutic results, and improve QoL too. 12, 13, 14, 15

Radiation therapy to the head and neck area can cause several toxic effects that can make the patient difficult to consume adequate amounts of food and fluids. These side effects include loss of appetite, changes in taste, odynophagia, xerostomia, difficulty in chewing, denture issues, oral mucositis (OM), trismus, and dry mouth. Patients receiving radiation for HNC have increased nutritional requirements. Toxic effects of treatment may lead to weight loss. For a better treatment outcome, it is important that the patients maintain their weight to prevent treatment disruptions.

HNC patients may have difficulties in food consumption due to the location of the tumor causing eating, chewing, and swallowing a difficult and painful process. 16, 17, 18 Therefore, most HNC patients may have poor nutritional status before initiating the treatment, which influences negative prognosis and survivorship. 19, 20 Thus, the nutrition goal for HNC patients is to maximize nutrition intake either orally or through nutrition support therapy when oral intake is inadequate. The primary aim is to preserve body weight, and muscle mass, prevent treatment interruptions and unplanned hospitalizations, and thereby improve treatment outcome and QoL. 21 Therefore, all HNC patients should receive intensive dietary counseling and adequate nutrient supplies throughout the treatment. 2

Adequate feeding of cancer patients is of paramount importance to prevent malnutrition and its overall impact. TEE for a cancer patient can be calculated as a sum of the resting energy expenditure (REE), [which can be derived by indirect calorimetry], energy for physical activity, and, diet-induced thermogenesis. 22 The TEE in cancer patients with reduced physical activities will be lower than in healthy individuals, while REE is increased in many cancer patients.23, 24, 25 Various international societies after evaluating several studies have defined the energy requirements of a cancer patient to be equal to a healthy individual. 1, 6, 22, 26

Wasting of muscle mass is strongly related to poor functional capacity, treatment toxicity, and adverse outcome in cancer patients.27 Protein synthesis in cancer patients is not impaired and it is responsive to higher consumption of protein. 28 HNC patients who undergo surgeries as a part of the treatments, perioperative morbidity, and poor wound healing are common.29 HNC patients undergoing aggressive chemo-radiation, and having potential toxic effects impacting the treatment outcome should be identified for an aggressive nutrition regime.6 Protein is required not just to build and maintain muscles, it has many other important physiological functions. Adequate provision of proteins can achieve positive nitrogen balance, faster recovery from toxic side effects of treatments, and help to build muscles or prevent muscle loss. 27 European society for nutrition and metabolism (ESPEN) 1, Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines30 Evidence-based practice guidelines for the nutritional management of adult patients with HNC, Cancer Council Australia. 6 recommend protein in the range between 1.2 to 1.5g/kg/day.

In a Randomized Control Trial (RCT), 37 ambulatory post-operative HNC patients showed improvement in blood protein concentration and lymphocyte levels after they consumed nutritional supplements enriched with omega-3 fatty acids 31 In a systematic review, five out of seven studies reported a beneficial effect of omega-3 enriched Immuno-nutrient formula on the nutritional status of HNC patients by reducing treatment toxic effects. 32 Studies strongly indicate that ω3 PUFA increases nutrient intake and has a significant role in improving increasing body weight and body composition in cancer patients. 33, 34, 35, 36, 37, 38, 39 Couple of studies have demonstrated the protective effect of omega-3 fatty acids on chemo-induced neuropathy. 40, 38 Lyra et al in their meta-analysis, reported omega-3 ( ω-3) supplementation, with or without other immunonutrients, has benefited in maintaining or improving patients' body weight, BMI, and positive impact on nutritional status.41 In post-operative conditions, ω-3 PUFA supplementation has been shown to reduce inflammatory state 42, infection incidents 43, 44, 45, and improve overall survival46 and QoL. 47 Hence, ω-3 PUFA seems to have beneficial effects on various clinical conditions.

A systematic review of twenty studies involving 1535 patients suggested supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis. 32 In another systematic review conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO), out of 78 papers that were identified, 29 papers were analyzed. Some of these studies had heterogeneous patient populations with varying degrees of CTRT treatment. Based on the evidence level the committee stated in favor of oral glutamine with caution in HNC patients for the management of OM. 48 The meta-analysis of RCTs by Lyra et al has found significantly lower mucositis grades and shorter mucositis duration in interventional groups compared to controls. 41 In an RCT of 144 patients with nasopharyngeal cancer, who had received concurrent chemoradiotherapy (CCRT) were administered parenteral glutamine. In the glutamine (+) group 90% of patients and in the glutamine (-ve) group 92% of patients developed all-grade OM. 49 A meta-analysis of RCTs concluded oral glutamine supplementation with no certain clinical benefits in the radiation-induced onset of OM, preventing or reducing incidence and severity in HNC patients. 50

A systematic review of twenty studies indicated that immunonutrient-enriched formulas in HNC patients during chemo-radiation may have a positive impact on maintaining nutrition status.32 In another review paper, Immunonutrition showed to reduce postoperative fistula formation, but there was no other positive outcome on length of hospital stay, wound infection, and adverse events. 51  In a systematic search of oral or enteral immunonutrition versus standard nutrition, Miller et al concluded that there is insufficient evidence on the beneficial effects of immunonutrition on infectious episodes in heterogeneous populations including HNC patients during chemotherapy. 52 In 96 HNC patients undergoing salvage surgery for squamous cell carcinoma, preoperative supplementation of immunonutrition showed improvements in tissue regeneration, 53 immune response, 53 reduced complication rates, and length of hospital stay. 53, 54 In an RCT of 88 HNC patients receiving CCRT, immunonutrition supplementation in 45% of patients saw lower hematological toxicities and a much lower percentage of severe nonhematologic toxicities with no effect on the 2-year overall survival. However, the results were not statistically significant. 55 In 110 HNC patients undergoing definitive CCRT immunonutrition did not show any advantages in reducing the risk of mucositis.56 A double-blind phase III trial of immunomodulating nutrition formula administered during adjuvant chemoradiotherapy failed to reduce severe mucositis, but there was an improvement in the long-term survival and progression-free survival of compliant Head and Neck Squamous Cell Carcinoma (HNSCC) patients.46 Further investigations and well-planned larger studies are needed, to clarify the definite benefits, timing, dosage, and duration of immunonutrition.

The arginine-enriched formula showed to decrease in the incidence of fistulas in the HNC patient’s post-surgery period with a reduction in the length of hospital stay. However, the advantages seemed to be statistically insignificant after adjusting for age, tumor stage, or aggressiveness of the surgery. 57 Similarly, in a meta-analysis, 397 patients from six studies receiving arginine as a single substance with other nutrition saw a reduction in fistulas (OR ¼ 0.36, 95% CI: 0.14 to 0.95, p ¼ 0.039), and LOS (mean difference: 6.8 d, 95% CI: 12.6 to 0.9 d, p ¼ 0.023). But, there was no benefit observed in wound infections or other infections 58 Another RCT showed that enteral arginine supplementation had no advantage in postoperative nutritional status, surgery-induced immune suppression, or clinical outcome in severely malnourished HNC patients. 59 A review paper on the use of arginine on inflammatory markers concluded no benefit on inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha values (TNF-α). 60

Few studies indicate potential associations between vitamin D and HNC, and supplementation of micronutrients has been proposed to prevent several cancers. 61, 62, 63, 64, 65 HNSCC patients with severe vitamin D deficiency have shown reduced immune cell activities. 66, 67 Vitamin D supplementation, in these patients showed a significant rise in natural killer cell’s (NKC) cytotoxic activities. It is also proposed in the study that Vitamin D substitution as an adjuvant in immune therapies such as cetuximab and nivolumab treatment could support antitumorigenic activities, thus improving patients' prognosis. 66 Vitamin D/cisplatin combinations were seen to be effective in killing cisplatin-resistant cells. 68 Few studies have proposed vitamin D deficiency may increase the incidents and mortality of HNC. 69, 70, 71, 72, 73 Some studies have suggested that vitamin D supplementation in cancer patients could improve survival rates. 74 contrary to these studies Meyer F et al found no influence of pre-treatment vitamin D status on the disease outcome in HNC patients. 75 whereas some studies have asked for more RCTs in this area of research for a definite conclusion. 76

The dietary assessment of 114 HNC patients through FFQs showed reduced micronutrient intake. The majority of HNC patients did not meet their recommended dietary intakes for vitamins D, E, C, folate, and magnesium. 77 The Netherlands Cohort Study which included 120,852 participants completed an FFQ that revealed a strong inverse association between vitamin C and overall HNC incidents.78 In the same study, no statistically significant results were seen for other nutrients such as vitamin E, α-carotene, β-carotene, lycopene, and lutein plus zeaxanthin. 78 A prospective RCT of 62 HNC patients who underwent surgery, reported a deficiency of protein, vitamin D, zinc, and iron immediately after surgery. 79 In 29 HNSCC patients, the blood samples collected after radiotherapy, plasma lutein, zeaxanthin, α-carotene, β-carotene, lycopene, and total carotenoids were found to be significantly lower. 80

OM is one of the most common toxic effects seen in HNC patients undergoing anticancer therapies. A survey of scientific literature published between the years 2004 and 2019 revealed a positive effect of vitamin E, zinc, and glutamine in preventing and treating OM. 81 A systematic analysis revealed that Vitamin E topical application had performed better on OM than Vitamin E systemic administration. Vitamin A topical treatment also showed a reduction in the severity of OM similar to vitamin E. 82

Zinc is a trace element that has an important role to play in immunity and cell growth. 9 The serum zinc level was seen to have an inverse relation with the early development of mucositis and dermatitis. 83 Zinc has been proposed to have a therapeutic impact on taste loss and OM. 84, 85 A systematic review by C Hoppe et al concluded that Zinc supplementation can prevent oral toxicities, and dermatitis during radiation but no improvement in mucositis or other side effects induced by chemotherapy. 84 In a meta-analysis, three studies favored zinc in reducing the incidence and severity of mucositis in HNC patients undergoing radiotherapy with or without chemotherapy and one study by Gorge et al found no benefits in the incidence of mucositis.86 In an RCT of 120 HNC patients, 60 patients, received 150mg of Zinc sulfate once daily benefited in the delay of onset, decrease in severity, and duration of oropharyngeal mucositis.87 In a retrospective study 202 HNC patients, out of which 95 patients received Zinc supplementation and fared better in salivary gland toxicities compared to the others who dint receive Zinc supplements. 88 In a systemic review of four RCTs involving 162 HNC patients, zinc sulfate supplementation did not find the benefit of prophylaxis against radiation-induced OM. 89 Similarly, another review of five RCTs of oral zinc sulfate found no clinical benefits in chemotherapy-induced OM in preventing or reducing the incidence, severity, or pain intensity. 90

In a review of twelve RCTs majority of studies showed the benefits of glutamine and zinc supplementation in delaying the onset of OM and reducing the severity in HNC patients receiving chemoradiotherapy. 91

Perioperative nutrition deals with preoperative, intraoperative, and postoperative care. Perioperative nutrition plays a vital role in patients with poor nutritional status and surgical outcomes. Perioperative nutrition includes prehabilitation, preoperative carbohydrate loading, and immunonutrition. 92

Perioperative nutritional support, as recommended within the ERAS (Enhanced Recovery After Surgery) protocol, has been shown to be beneficial in achieving better results post-operatively.93, 94 ERAS is an earnest attempt to use metabolic strategy to reduce perioperative stress, reduce post-operative complications, reduce hospital stay, and thus improve postoperative outcomes. 95, 96, 94 A significantly shorter LOS was observed in the ERAS group of patients (median, 14 days; range, 10-19) compared to the non-ERAS group (median, 17.5 days; range, 13-21) (p = 0.0128). 97 In a recent study, Twenty-five patients underwent surgery with ERAS protocols with perioperative nutrition supplementation. A strong negative correlation between the modified Nutrition-Related Index (mNRI) and the number of complications (P = 0.01), specifically, fistula rate (P = 0.04) and unplanned reoperation (P = 0.04) was observed.94 HNC patients can benefit from comprehensive ERAS protocols, by helping them enhance their recovery, including breathing, food intake, pain, speech, swallowing, and communication.98 Prolonged inadequate oral intake is associated with higher mortality.

Prehabilitation or preoperative nutritional management does not mean correcting years of nutritional deficiencies. It focuses on optimizing the malnourished or at-risk patients for surgical stress which are complex and diverse. 99

Nutrition support of 10-14 days is recommended in severely malnourished or at-risk patients before major surgery even if surgery has to be delayed. 30 Perioperative nutritional optimization by carbohydrate loading consistent with ERAS recommendations is safe and well tolerated in patients undergoing head and neck surgery. 30, 100

In HNC surgeries preoperative immunonutrition studies have not shown any additional benefits compared to standard nutrition support in patients undergoing HNC surgery. Investigations have produced mixed results in this population. There are large variations in the study designs, the composition of immunonutrition formulas, administration protocols, and the period of administration. 101, 102 In a nonrandomized study of 195 high-risk HNC patients undergoing surgery, 59% of the patients were prescribed arginine enriched nutritional supplements, and 41% did not. Of those who did not receive the supplement, 38 (47.5%) patients experienced postoperative complications compared to 29 (25.2%) patients who consumed the arginine enriched supplement (p=0.0021). On average 2.8 days longer hospital stay was observed in patients who did not have enhanced nutrition (p=0.02), and there was no difference in readmission rates between the two groups (p=0.91). 103 Similar results were observed in a retrospective study in patients who received immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean Length of Stay (LOS) [28.25 (SD 16.11) Vs 35.50 (SD 25.73) days; p=0.030]. 57 In a systemic review of 19 RCTs (1099 patients) the authors found no evidence of a difference in the LOS (mean difference -2.5 days, 95% confidence interval (CI) -5.11 to 0.12). Similarly, the effect of immunonutrition on wound infection was found to be poor (risk ratio (RR) 0.94, 95% CI 0.70 to 1.26) However, there was reduced fistula formation with immunonutrition group; the absolute risks were 11.3% and 5.4% in the standard care and immunonutrition groups, with a RR of 0.48 (95% CI 0.27 to 0.85). But the study concluded that the evidence was of low quality. 51 A review article of 19 studies with 1099 HNC patients found no benefit of immunonutrition on wound infection. 51

The rationale for preoperative carbohydrate loading is that a fed state before surgery can attenuate insulin resistance and catabolism, improves better glucose management, and preserves lean body mass.104 A large number of studies on the role of carbohydrate loading in HNC surgeries are limited. However, the studies strongly indicate carbohydrate loading in patients undergoing HNC surgeries is safe and well tolerated.97

The intestine; other than the digestive, absorptive, and endocrine processes, also has an effective immunological function. The gut-associated lymphoid tissue (GALT) plays an important role in gut immunity as it is the host for many immune cells like B and T lymphocytes, macrophages, antigen-presenting cells, and enteroendocrine cells. 105, 106 Mucosal starvation leads to lymphoid tissue atrophy, a decline in immune system function, and increased bacterial translocation. 107 SCCM-ASPEN critical care nutrition guidelines recommend the oral route as the preferred choice and encourage early enteral feeding when oral feeding is not an option available. If unable to meet 60% of caloric requirements through enteral feeds for several days, parenteral nutrition can be added.108, 30 High-risk patients or severely malnourished patients whose gut is not available for enteral feeding should be administered TPN. 108, 7, 30 National Institute for Health and Care Excellence guidelines recommend gastrostomy feeding if enteral feeding is expected to prolong for more than four weeks. 109

One of the principles of ERAS is the early initiation of oral or enteral tube feeding after all surgeries. Early initiation enteral feeding has been shown to reduce the risk of infection, improved insulin resistance, and reduced the number of hospital stays. 96 Early feeding increases gastrointestinal (GI) hormone secretion and improves macrophagic activity and increases intestinal absorptive function. 110 Studies in HNC surgeries have demonstrated that early feeding (oral diet) on POD-1 reduces the length of stay without increasing perioperative complications. 111

Chyle leak (CL) leads to the loss of protein, fat, and fat-soluble vitamins, trace elements, and lymphocytes through the chyle. Large volume chyle loss may result in hypovolemia, electrolyte imbalances, malnutrition, and immunosuppression 112, 113, 114, 115. CL can be confirmed by analysis of drained fluid for triglycerides and chylomicrons. 30 All suspected CL patients should be recommended to a conservative nonfat diet, low-fat diet, or medium-chain triglycerides (MCT) diet with bed rest and bed elevation. 109 Patients on a fat-free diet or diet with MCT for a prolonged period may need essential fatty acid supplements and fat-soluble vitamins. If CL does not resolve after fat restriction or the MCT diet does not respond satisfactorily to conservative management alone, and the drainage volume is consistently high, TPN can be administered. 109 Management of chylothorax depends on the etiology and whether the leak has a high (> 1 lire) or low (< 1 liter) output. There are multiple options for patients who fail to respond to the conservative measures, which include pleurodesis, percutaneous thoracic duct embolization/ disruption, or thoracic duct ligation.

Advanced cancer patients' life expectancy may range from months to years. The main issues of cancer patients with chronic or incurable illnesses are cachexia and nutrition management. Palliative care should be focused on alleviating symptoms and improving QoL. 22, 116. Attempts can be made for good nutritional status, physical activities, and psychosocial needs for palliative patients depending upon the expected survival period and performance status. 117 Patients at the end of life receiving palliative care experience difficulties in food intake. 116, 117 Sánchez-Sánchez E et al, in their review concluded that even though the use of EN reduced diarrheal episodes and improved hospital survival, it increased visits to the emergency department and EN showed no benefit on the level of comfort and satisfaction over the group of patients those who were not on EN. 118 In a single-centered one-month observational study, 72 palliative care patients of which 34 (47%) were on parenteral nutrition had frequent venous access complications, edema, and poor QoL. 116 Thus the benefit of artificial nutrition in end-of-life treatment seems questionable and can lead to ethical issues. Artificial nutrition should be used with realistic goals of treatment outcome and wishes of patient and assessment by the doctor and other health care professionals.118, 119

Dysphagia can lead to serious clinical conditions like malnutrition, dehydration, aspiration pneumonia, reduced functional capacity, and even death.120 More than 50% of oropharyngeal cancer patients and patients who had undergone total glossectomy develop dysphagia. 11 Dysphagia has varied symptoms. The swallowing capacity of a patient with dysphagia should be evaluated by a speech and swallowing therapist. 121 The swallowing therapist based on the diagnosis will advise on the right texture of the food to ensure that they receive adequate nutrients. The bolus food consistency modification is an effective strategy for improving nutritional and hydration status in patients with dysphagia. In cases of severe dysphagia, patients will need enteral tube feedings. 120, 121 The expert committee recommends the changes in the food textures as specified in Figure 1.

Figure 1

Arends J Baracos V Bertz H Bozzetti F Calder P C Deutz N E P Erickson N Laviano A Lisanti M P Lobo D N Mcmillan D C Muscaritoli M Ockenga J Pirlich M Strasser F Schueren M De Van Der Gossum A Van Vaupel P Weimann A ESPEN expert group recommendations for action against cancer-related malnutrition Clinical Nutrition 2017 36 5 1187 1196 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2017.06.017 Wagner C Nutritional management during treatment for head and neck cancer memo - Magazine of European Medical Oncology 2020 13 4 405 408 1865-5041 Springer Science and Business Media LLC https://doi.org/10.1007/s12254-020-00613-0 Reber Emilie Gomes Filomena Vasiloglou Maria F Schuetz Philipp Stanga Zeno Nutritional Risk Screening and Assessment Journal of Clinical Medicine 2019 8 7 1 19 MDPI AG https://doi.org/10.3390/jcm8071065 Arends J Bertz H Bischoff S Fietkau R Herrmann H Holm E Horneber M Hütterer E Körber J Schmidhttps://doi.org/10.1055/s-0035-1552741https://doi.org/10.1055/s-0035-1552741 I S3-Leitline der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) in Kooperation mit der Deutschen Gesellschaft für Hämatologie und Onkologie e. V. (DGHO), der Arbeitsgemeinschaft „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“ der Deutschen Krebsgesellschaft (ASORS) und der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE) Aktuelle Ernährungsmedizin 2015 40 05 e1 e74 0341-0501 Georg Thieme Verlag KG https://doi.org/10.1055/s-0035-1552741 Sandmæl Jon Arne Sand Kari Bye Asta Solheim Tora Skeidsvoll Oldervoll Line Helvik Anne‐sofie S Nutritional experiences in head and neck cancer patients European Journal of Cancer Care 2019 28 6 0961-5423 Hindawi Limited https://doi.org/10.1111/ecc.13168 Head and Neck Guideline Steering Committee. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Clinical Oncological Society of Australia 2022 https://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines Kreymann K G Berger M M Deutz N E P Hiesmayr M Jolliet P Kazandjiev G Nitenberg G Berghe G Van Den Wernerman J Ebner C Hartl W Heymann C Spies C ESPEN Guidelines on Enteral Nutrition: Intensive care Clinical Nutrition 2006 25 2 210 223 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2006.01.021 Prado C M Elliott S A Mota J F Advanced imaging techniques for assessment of undernutrition Advanced Nutrition and Dietetics in Nutrition Support 2018 91 105 https://doi.org/10.1002/9781118993880.ch2.7 Wang Jennifer R Habbous Steven Espin-Garcia Osvaldo Chen Duoduo Huang Shao Hui Simpson Colleen Xu Wei Liu Fei-Fei F Brown Dale H Gilbert Ralph W Gullane Patrick J Irish Jonathan C Goldstein David P Liu Geoffrey F Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma Head & Neck 2016 38 5 736 742 1043-3074 Wiley https://doi.org/10.1002/hed.23947 Corrêa Gefter Thiago Batista Bandeira Gabriela Alencar Cavalcanti Bruna Gonçalves Santos Francis Balduíno Guimarães Neto João Felício Rodrigues Guimarães André Luiz Sena Haikal Desirée Sant’ana Paula Alfredo Maurício Batista De Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival Supportive Care in Cancer 2012 20 11 2679 2685 0941-4355 Springer Science and Business Media LLC https://doi.org/10.1007/s00520-012-1386-y García-Peris P Parón L Velasco C Cuerda C De La Camblor M Bretón I Herencia H Verdaguer J Navarro C Clave P Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life Clinical Nutrition 2007 26 6 710 717 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2007.08.006 Christianen Miranda E M C Schilstra Cornelis Beetz Ivo Muijs Christina T Chouvalova Olga Burlage Fred R Doornaert Patricia Koken Phil W Leemans C René Rinkel Rico N P M Bruijn Marieke J De Bock G H De Roodenburg Jan L N Laan Bernard F A M Van Der Slotman Ben J Leeuw Irma M Verdonck-De Bijl Hendrik P Langendijk Johannes A Predictive modelling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational study Radiotherapy and Oncology 2012 105 1 107 114 0167-8140 Elsevier BV https://doi.org/10.1016/j.radonc.2011.08.009 Eisbruch Avraham Kim Hyungjin M Feng Felix Y Lyden Teresa H Haxer Marc J Feng Mary Y Worden Frank P Bradford Carol R Prince Mark E Moyer Jeffrey S Wolf Gregory T Chepeha Douglas B Haken Randall K Ten Chemo-IMRT of Oropharyngeal Cancer Aiming to Reduce Dysphagia: Swallowing Organs Late Complication Probabilities and Dosimetric Correlates International Journal of Radiation Oncology*Biology*Physics 2011 81 3 e93 e99 0360-3016 Elsevier BV https://doi.org/10.1016/j.ijrobp.2010.12.067 Denaro Nerina Merlano Marco C Russi Elvio G Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations Clinical and Experimental Otorhinolaryngology 2013 6 3 117 126 1976-8710 Korean Society of Otorhinolaryngology-Head and Neck Surgery https://doi.org/10.3342/ceo.2013.6.3.117 Clarke P Radford K Coffey M Stewart M Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines The Journal of Laryngology & Otology 2016 130 S2 S176 S180 0022-2151 Cambridge University Press (CUP) https://doi.org/10.1017/s0022215116000608 Larsson Maria Hedelin Birgitta Johansson Inger Athlin Elsy Eating Problems and Weight Loss for Patients With Head and Neck Cancer Cancer Nursing 2005 28 6 425 435 0162-220X Ovid Technologies (Wolters Kluwer Health) https://doi.org/10.1097/00002820-200511000-00004 Langius Jacqueline A E Zandbergen Myrna C Eerenstein Simone E J Tulder Maurits W Van Leemans C René Kramer Mark H H Weijs Peter J M Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review Clinical Nutrition 2013 32 5 671 678 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2013.06.012 Brenda Nugent Lewis Sian O'Sullivan Joe M Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy Cochrane Database of Systematic Reviews 2013 Wiley https://doi.org/10.1002/14651858.cd007904.pub3 Bhattacharjee Abhinandan Bahar Iqbal Saikia Abijit Nutritional assessment of patients with head and neck cancer in North-East India and dietary intervention Indian Journal of Palliative Care 2015 21 3 289 289 0973-1075 Scientific Scholar https://doi.org/10.4103/0973-1075.164889 Chasen Martin R Bhargava Ravi A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer Supportive Care in Cancer 2009 17 11 1345 1351 0941-4355 Springer Science and Business Media LLC https://doi.org/10.1007/s00520-009-0684-5 Ackerman D Laszlo M Provisor A Yu A Nutrition Management for the Head and Neck Cancer Patient Cancer Treat Res 2018 174 187 208 https://doi.org/10.1007/978-3-319-65421-8_11 Muscaritoli Maurizio Arends Jann Bachmann Patrick Baracos Vickie Barthelemy Nicole Bertz Hartmut Bozzetti Federico Hütterer Elisabeth Isenring Elizabeth Kaasa Stein Krznaric Zeljko Laird Barry Larsson Maria Laviano Alessandro Mühlebach Stefan Oldervoll Line Ravasco Paula Solheim Tora S Strasser Florian Schueren Marian De Van Der Preiser Jean-Charles Bischoff Stephan C ESPEN practical guideline: Clinical Nutrition in cancer Clinical Nutrition 2021 40 5 2898 2913 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2021.02.005 Avancini Alice Pala Valeria Trestini Ilaria Tregnago Daniela Mariani Luigi Sieri Sabina Krogh Vittorio Boresta Marco Milella Michele Pilotto Sara Lanza Massimo Exercise Levels and Preferences in Cancer Patients: A Cross-Sectional Study International Journal of Environmental Research and Public Health 2020 17 15 5351 MDPI AG https://doi.org/10.3390/ijerph17155351 Gibney E Elia M Jebb S Murgatroyd P Jennings G Total energy expenditure in patients with small-cell lung cancer: Results of a validated study using the bicarbonate-urea method Metabolism 1997 46 12 90140 90142 https://doi.org/10.1016/s0026-0495(97)90140-2 Moses A W G Slater C Preston T Barber M D Fearon K C H Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids British Journal of Cancer 2004 90 5 996 1002 0007-0920 Springer Science and Business Media LLC https://doi.org/10.1038/sj.bjc.6601620 Peñas R De Las Majem M Perez-Altozano J Virizuela J A Cancer E Diz P Donnay O Hurtado A Jimenez-Fonseca P Ocon M J SEOM clinical guidelines on nutrition in cancer patients (2018) Clinical and Translational Oncology 2019 21 1 87 93 1699-048X Springer Science and Business Media LLC https://doi.org/10.1007/s12094-018-02009-3 Ravasco P Nutrition in Cancer Patients Journal of Clinical Medicine 2019 8 8 1211 MDPI AG https://doi.org/10.3390/jcm8081211 Macdonald Alisdair J Johns Neil Stephens Nathan Greig Carolyn Ross James A Small Alexandra C Husi Holger Fearon Kenneth C H Preston Tom Habitual Myofibrillar Protein Synthesis Is Normal in Patients with Upper GI Cancer Cachexia Clinical Cancer Research 2015 21 7 1734 1740 1078-0432 American Association for Cancer Research (AACR) https://doi.org/10.1158/1078-0432.ccr-14-2004 Nesemeier Ryan Dunlap Neal Mcclave Stephen A Tennant Paul Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer Current Surgery Reports 2017 5 8 18 Springer Science and Business Media LLC https://doi.org/10.1007/s40137-017-0179-0 Talwar B Donnelly R Skelly R Donaldson M Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines The Journal of Laryngology & Otology 2016 130 S2 S32 S40 0022-2151 Cambridge University Press (CUP) https://doi.org/10.1017/s0022215116000402 Luis D A De Izaola O Cuellar L Terroba M C Fuente B De La Cabezas G A randomized clinical trial with two doses of a omega 3 fatty acids oral and arginine enhanced formula in clinical and biochemical parameters of head and neck cancer ambulatory patients Eur Rev Med Pharmacol Sci 2017 17 8 1090 1094 PMID https://pubmed.ncbi.nlm.nih.gov/23661523/ Tan Sing Ean Satar Nur Fadhlina Abdul Majid Hazreen Abdul Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review Frontiers in Nutrition 2022 9 821924 Frontiers Media SA https://doi.org/10.3389/fnut.2022.821924 Burns C Patrick Halabi Susan Clamon Gerald Kaplan Ellen Hohl Raymond J Atkins James N Schwartz Michael A Wagner Brett A Paskett Electra Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia Cancer 2004 101 2 370 378 0008-543X Wiley https://doi.org/10.1002/cncr.20362 Tobberup Randi Carus Andreas Rasmussen Henrik H Falkmer Ursula G Jorgensen Martin G Schmidt Erik B Jensen Nikolaj A Mark Esben B Delekta Agnieszka M Antoniussen Christian S Bøgsted Martin Holst Mette Feasibility of a multimodal intervention on malnutrition in patients with lung cancer during primary anti-neoplastic treatment Clinical Nutrition 2021 40 2 525 533 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2020.05.050 Patursson Poula Møller Grith Muhic Aida Andersen Jens Rikardt N-3 fatty acid EPA supplementation in cancer patients receiving abdominal radiotherapy - A randomised controlled trial Clinical Nutrition ESPEN 2021 43 130 136 2405-4577 Elsevier BV https://doi.org/10.1016/j.clnesp.2021.03.001 Fietkau Rainer Lewitzki Victor Kuhnt Thomas Hölscher Tobias Hess Null- F Berger Bernhard Wiegel Thomas Rödel Claus Niewald Marcus Hermann Robert M Lubgan Dorota A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: Results of a randomized, controlled, multicenter trial Cancer 2013 119 18 3343 3353 0008-543X Wiley https://doi.org/10.1002/cncr.28197 Cereda Emanuele Cappello Silvia Colombo Sara Klersy Catherine Imarisio Ilaria Turri Annalisa Caraccia Marilisa Borioli Valeria Monaco Teresa Benazzo Marco Pedrazzoli Paolo Corbella Franco Caccialanza Riccardo Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy Radiotherapy and Oncology 2018 126 1 81 88 0167-8140 Elsevier BV https://doi.org/10.1016/j.radonc.2017.10.015 Sánchez-Lara Karla Turcott Jenny G Juárez-Hernández Eva Nuñez-Valencia Carolina Villanueva Geraldine Guevara Patricia Torre-Vallejo Martha De La Mohar Alejandro Arrieta Oscar Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: Randomised trial Clinical Nutrition 2014 33 6 1017 1023 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2014.03.006 Mcglory Chris Calder Philip C Nunes Everson A The Influence of Omega-3 Fatty Acids on Skeletal Muscle Protein Turnover in Health, Disuse, and Disease Frontiers in Nutrition 2019 6 Frontiers Media SA https://doi.org/10.3389/fnut.2019.00144 Ghoreishi Zohreh Esfahani Ali Djazayeri Abolghasem Djalali Mahmoud Golestan Banafsheh Ayromlou Hormoz Hashemzade Shahriar Jafarabadi Mohammad Asghari Montazeri Vahid Keshavarz Seyed Ali Darabi Masoud Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: A randomized double-blind placebo controlled trial BMC Cancer 2012 12 1 12 Springer Science and Business Media LLC https://doi.org/10.1186/1471-2407-12-355 Lyra Marília De Melo Freire Meira Junia Elisa Carvalho De Guedes Glaucevane Da Silva Bueno Nassib Bezerra Immunonutrition in head and neck cancer: Systematic review and metanalysis of its clinical and nutritional effects Clinical Nutrition ESPEN 2021 41 30 41 2405-4577 Elsevier BV https://doi.org/10.1016/j.clnesp.2020.12.014 Machon Christelle Thezenas Simon Dupuy Anne-Marie M Assenat Eric Michel Françoise Mas Emilie Senesse Pierre Cristol Jean-Paul P Immunonutrition before and during radiochemotherapy: improvement of inflammatory parameters in head and neck cancer patients Supportive Care in Cancer 2012 20 12 3129 3135 0941-4355 Springer Science and Business Media LLC https://doi.org/10.1007/s00520-012-1444-5 Boisselier Pierre Kaminsky Marie-Christine C Thézenas Simon Gallocher Olivier Lavau-Denes Sandrine Garcia-Ramirez Muriel Alfonsi Marc Cupissol Didier De forges Hélène Janiszewski Chloé Geoffrois Lionnel Sire Christian Senesse Pierre A double-blind phase III trial of immunomodulating nutritional formula during adjuvant chemoradiotherapy in head and neck cancer patients: IMPATOX The American Journal of Clinical Nutrition 2020 112 6 1523 1531 0002-9165 Elsevier BV https://doi.org/10.1093/ajcn/nqaa227 Aida Toshiaki Furukawa Katsunori Suzuki Daisuke Shimizu Hiroaki Yoshidome Hiroyuki Ohtsuka Masayuki Kato Atsushi Yoshitomi Hideyuki Miyazaki Masaru Preoperative immunonutrition decreases postoperative complications by modulating prostaglandin E2 production and T-cell differentiation in patients undergoing pancreatoduodenectomy Surgery 2014 155 1 124 133 0039-6060 Elsevier BV https://doi.org/10.1016/j.surg.2013.05.040 Uno Hidehiko Furukawa Katsunori Suzuki Daisuke Shimizu Hiroaki Ohtsuka Masayuki Kato Atsushi Yoshitomi Hideyuki Miyazaki Masaru Immunonutrition suppresses acute inflammatory responses through modulation of resolvin E1 in patients undergoing major hepatobiliary resection Surgery 2016 160 1 228 236 0039-6060 Elsevier BV https://doi.org/10.1016/j.surg.2016.01.019 Boisselier Pierre Kaminsky Marie-Christine C Thézenas Simon Gallocher Olivier Lavau-Denes Sandrine Garcia-Ramirez Muriel Alfonsi Marc Cupissol Didier De forges Hélène Janiszewski Chloé Geoffrois Lionnel Sire Christian Senesse Pierre A double-blind phase III trial of immunomodulating nutritional formula during adjuvant chemoradiotherapy in head and neck cancer patients: IMPATOX The American Journal of Clinical Nutrition 2020 112 6 1523 1531 0002-9165 Elsevier BV https://doi.org/10.1093/ajcn/nqaa227 Wei Lengyun Wu Zhipeng Chen Yong Q Multi-targeted therapy of cancer by omega-3 fatty acids-an update Cancer Letters 2022 526 193 204 0304-3835 Elsevier BV https://doi.org/10.1016/j.canlet.2021.11.023 Yarom Noam Hovan Allan Bossi Paolo Ariyawardana Anura Jensen Siri Beier Gobbo Margherita Saca-Hazboun Hanan Kandwal Abhishek Majorana Alessandra Ottaviani Giulia Pentenero Monica Nasr Narmin Mohammed Rouleau Tanya Lucas Anna Skripnik Treister Nathaniel Simon Zur Eyal Ranna Vinisha Vaddi Anusha Cheng Karis Kin Fong Barasch Andrei Lalla Rajesh V Elad Sharon Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines—part 1: vitamins, minerals, and nutritional supplements Supportive Care in Cancer 2019 27 10 3997 4010 0941-4355 Springer Science and Business Media LLC https://doi.org/10.1007/s00520-019-04887-x Wang Chih-Chun C Hwang Tzer-Zen Z Yang Chuan-Chien C Lien Ching-Feng Wang Chien-Chung C Shih Yu-Chen Yeh Shyh-An Hsieh Meng-Che Impact of Parenteral Glutamine Supplement on Oncologic Outcomes in Patients with Nasopharyngeal Cancer Treated with Concurrent Chemoradiotherapy Nutrients 2022 14 5 997 MDPI AG https://doi.org/10.3390%2Fnu14050997 Shuai Ting Tian Xu Xu Ling-Li Chen Wei-Qing Pi Yuan-Ping Zhang Lin Wan Qiao-Qin Li Null- E Oral Glutamine May Have No Clinical Benefits to Prevent Radiation-Induced Oral Mucositis in Adult Patients With Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials Frontiers in Nutrition 2020 7 49 Frontiers Media SA https://doi.org/10.3389/fnut.2020.00049 Howes N Atkinson C S Thomas Lewis Stephen J Immunonutrition for patients undergoing surgery for head and neck cancer Cochrane Database Syst Rev 2018 8 8 CD010954 https://doi.org/10.1002/14651858.cd010954.pub2 Miller Laura J Douglas Cara Mccullough Fiona S Stanworth Simon J Calder Philip C Impact of enteral immunonutrition on infectious complications and immune and inflammatory markers in cancer patients undergoing chemotherapy: A systematic review of randomised controlled trials Clinical Nutrition 2022 41 10 2135 2146 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2022.07.039 Mueller S A Mayer C Bojaxhiu B Aeberhard C Schuetz P Stanga Z Giger R Effect of preoperative immunonutrition on complications after salvage surgery in head and neck cancer J Otolaryngol Head Neck Surg 2019 48 1 PMCID https://doi.org/10.1186/s40463-019-0345-8 Aeberhard C Mayer C Meyer S Mueller S A Schuetz P Stanga Z Giger R Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinoma Head Neck 2018 40 5 1057 1067 https://doi.org/10.1002/hed.25072 Chitapanarux Imjai Traisathit Patrinee Chitapanarux Taned Jiratrachu Rungarun Chottaweesak Pattawee Chakrabandhu Somvilai Rasio Withee Pisprasert Veeradej Sripan Patumrat Arginine, glutamine, and fish oil supplementation in cancer patients treated with concurrent chemoradiotherapy: A randomized control study Current Problems in Cancer 2020 44 1 100482 0147-0272 Elsevier BV https://doi.org/10.1016/j.currproblcancer.2019.05.005 Dechaphunkul Tanadech Arundon Tippawan Raungkhajon Ponpis Jiratrachu Rungarun Geater Sarayut Lucien Dechaphunkul Arunee Benefits of immunonutrition in patients with head and neck cancer receiving chemoradiation: A phase II randomized, double-blind study Clinical Nutrition 2022 41 2 433 440 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2021.12.035 Barajas-Galindo D E Vidal-Casariego A Maza B Pintor-De La Fernández-Martínez P Ramos-Martínez T García-Arias S Hernández-Moreno A Urioste-Fondo A Cano-Rodríguez I Ballesteros-Pomar M D Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes Endocrinol Diabetes Nutr (Engl Ed) 2019 67 1 13 19 https://doi.org/10.1016/j.endinu.2019.05.006 Vidal-Casariego Alfonso Calleja-Fernández Alicia Villar-Taibo Rocío Kyriakos Georgios Ballesteros-Pomar María D Efficacy of arginine-enriched enteral formulas in the reduction of surgical complications in head and neck cancer: A systematic review and meta-analysis Clinical Nutrition 2014 33 6 951 957 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2014.04.020 Schueren Marian Ae Van Bokhorst-De Van Der Quak Jasper J Flier B Mary E Von Blomberg-Van Der Kuik Dirk J Langendoen Sterre I Snow Gordon B Green Ceri J Leeuwen Paul Am Van Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients The American Journal of Clinical Nutrition 2001 73 2 323 332 0002-9165 Elsevier BV https://doi.org/10.1093/ajcn/73.2.323 Armentano Campos Tiago Rodrigues Barros, Carlos Magno de Marce Evidence on the use of arginine in response to inflammatory markers in patients with head and neck cancer: a Review Rev. bras. cir. cabeça pescoço 2019 https://www.epistemonikos.org/fr/documents/30eca87a7bc7e71ee808fa26bca9511b99a666dc# Mochamat Cuhls Henning Marinova Milka Kaasa Stein Stieber Christiane Conrad Rupert Radbruch Lukas Mücke Martin A systematic review on the role of vitamins, minerals, proteins, and other supplements for the treatment of cachexia in cancer: a European Palliative Care Research Centre cachexia project Journal of Cachexia, Sarcopenia and Muscle 2017 8 1 25 39 2190-5991 Wiley https://doi.org/10.1002/jcsm.12127 Gröber Uwe Holzhauer Peter Kisters Klaus Holick Michael F Adamietz Irenäus A Micronutrients in Oncological Intervention Nutrients 2016 8 3 163 MDPI AG https://doi.org/10.3390/nu8030163 Pu Yuting Zhu Gangcai Xu Yimin Zheng Siyuan Tang Bin Huang Huimei Wu Irene X Y Huang Donghai Liu Yong Zhang Xin Association Between Vitamin D Exposure and Head and Neck Cancer: A Systematic Review With Meta-Analysis Frontiers in Immunology 2021 12 Frontiers Media SA Yokosawa Eva B Arthur Anna E Rentschler Katie M Wolf Gregory T Rozek Laura S Mondul Alison M Vitamin <scp>D</scp> intake and survival and recurrence in head and neck cancer patients The Laryngoscope 2018 128 11 371 376 0023-852X Wiley https://doi.org/10.1002/lary.27256 Izreig S Hajek M Edwards H A Mehra S Sasaki C Bl Judson Rahmati R W The role of vitamin D in head and neck cancer Laryngoscope Investig Otolaryngol 2020 5 6 1079 1088 PMCID https://doi.org/10.1002%2Flio2.469 Bochen F Balensiefer B Körner S Bittenbring J T Neumann F Koch A Bumm K Marx A Wemmert S Papaspyrou G Zuschlag D Kühn J P Kadah Al Schick B Linxweiler B M Vitamin D deficiency in head and neck cancer patients - prevalence, prognostic value and impact on immune function Oncoimmunology 2017 7 9 PMCID https://doi.org/10.1080%2F2162402X.2018.1476817 Maturana-Ramírez A Aitken-Saavedra J Guevara-Benítez Al. L Espinoza-Santander I Hypovitaminosis D, oral potentially malignant disorders, and oral squamous cell carcinoma: a systematic review Medicina Oral Patología Oral y Cirugia Bucal 2022 27 2 e135 e141 Medicina Oral, S.L. https://doi.org/10.4317/medoral.25049 Khamis Aya Gül Désirée Wandrey Madita Lu Qiang Knauer Shirley K Reinhardt Christoph Strieth Sebastian Hagemann Jan Stauber Roland H The Vitamin D Receptor–BIM Axis Overcomes Cisplatin Resistance in Head and Neck Cancer Cancers 1920 14 20 5131 MDPI AG https://doi.org/10.3390/cancers14205131 Afzal Shoaib Bojesen Stig E Nordestgaard Børge G Low Plasma 25-Hydroxyvitamin D and Risk of Tobacco-Related Cancer Clinical Chemistry 2013 59 5 771 780 0009-9147 Oxford University Press (OUP) https://doi.org/10.1373/clinchem.2012.201939 Fanidi Anouar Muller David C Midttun Øivind Ueland Per Magne Vollset Stein Emil Relton Caroline Vineis Paolo Weiderpass Elisabete Skeie Guri Brustad Magritt Palli Domenico Tumino Rosario Grioni Sara Sacerdote Carlotta Bueno-De-Mesquita H B Peeters Petra H Boutron-Ruault Marie-Christine Kvaskoff Marina Cadeau Claire Huerta José María Sánchez Maria-José Agudo Antonio Lasheras Cristina Quirós J Ramón Chamosa Saioa Riboli Elio Travis Ruth C Ward Heather Murphy Neil Khaw Kay-Tee Trichopoulou Antonia Lagiou Pagona Papatesta Eleni-Maria Boeing Heiner Kuehn Tilman Katzke Verena Steffen Annika Johansson Anders Brennan Paul Johansson Mattias Circulating vitamin D in relation to cancer incidence and survival of the head and neck and oesophagus in the EPIC cohort Scientific Reports 2016 6 1 1 11 Springer Science and Business Media LLC https://doi.org/10.1038/srep36017 Giovannucci Edward Liu Yan Rimm Eric B Hollis Bruce W Fuchs Charles S Stampfer Meir J Willett Walter C Prospective Study of Predictors of Vitamin D Status and Cancer Incidence and Mortality in Men JNCI: Journal of the National Cancer Institute 2006 98 7 451 459 0027-8874 Oxford University Press (OUP) https://doi.org/10.1093/jnci/djj101 Lipworth L Rossi M Mclaughlin J K Negri E Talamini R Levi F Franceschi S Vecchia C La Dietary vitamin D and cancers of the oral cavity and esophagus Annals of Oncology 2009 20 9 1576 1581 0923-7534 Elsevier BV https://doi.org/10.1093/annonc/mdp036 Gugatschka Markus Kiesler Karl Obermayer-Pietsch Barbara Groselj-Strele Andrea Griesbacher Antonia Friedrich Gerhard Vitamin D status is associated with disease-free survival and overall survival time in patients with squamous cell carcinoma of the upper aerodigestive tract European Archives of Oto-Rhino-Laryngology 2011 268 8 1201 1204 0937-4477 Springer Science and Business Media LLC https://doi.org/10.1007/s00405-010-1481-y Gnagnarella Patrizia Muzio Valeria Caini Saverio Raimondi Sara Martinoli Chiara Chiocca Susanna Miccolo Claudia Bossi Paolo Cortinovis Diego Chiaradonna Ferdinando Palorini Roberta Facciotti Federica Bellerba Federica Canova Stefania Gandini Sara Vitamin D Supplementation and Cancer Mortality: Narrative Review of Observational Studies and Clinical Trials Nutrients 2021 13 9 3285 MDPI AG https://doi.org/10.3390/nu13093285 Meyer François Liu Geoffrey Douville Pierre Samson Élodie Xu Wei Adjei Araba Bairati Isabelle Dietary vitamin D intake and serum 25-hydroxyvitamin D level in relation to disease outcomes in head and neck cancer patients International Journal of Cancer 2011 128 7 1741 1746 0020-7136 Wiley https://doi.org/10.1002/ijc.25496 Akutsu Taisuke Kitamura Hikaru Himeiwa Shoko Kitada Shinto Akasu Tatsuya Urashima Mitsuyoshi Vitamin D and Cancer Survival: Does Vitamin D Supplementation Improve the Survival of Patients with Cancer? Current Oncology Reports 2020 22 6 62 1523-3790 Springer Science and Business Media LLC https://doi.org/10.1007/s11912-020-00929-4 Nejatinamini S Kubrak C Álvarez-Camacho M Baracos V E Ghosh S Wismer W V Mazurak V C Head and Neck Cancer Patients Do Not Meet Recommended Intakes of Micronutrients without Consuming Fortified Products Nutr Cancer 2018 70 3 474 482 https://doi.org/10.1080/01635581.2018.1445767 Munter Leonie De Maasland Denise He Brandt Piet A Van Den Kremer Bernd Schouten Leo J Vitamin and carotenoid intake and risk of head-neck cancer subtypes in the Netherlands Cohort Study The American Journal of Clinical Nutrition 2015 102 2 420 432 0002-9165 Elsevier BV https://doi.org/10.3945/ajcn.114.106096 Nett Hannah Steegmann Julius Tollkühn-Prott Birgit Hölzle Frank Modabber Ali A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancer Scientific Reports 2022 12 1 Springer Science and Business Media LLC https://doi.org/10.1038/s41598-022-18292-8 Sakhi Amrit Kaur B⊘hn Siv Kj⊘lsrud Smeland Sigbj⊘rn Thoresen Magne Smedshaug Guro Berge Taus Johan Karlsen Anette Kjell Magne Russnes, Tone Svilaas & Rune Blomhoff (2010) Postradiotherapy Plasma Lutein, α-Carotene, and β-Carotene Are Positively Associated With Survival in Patients With Head and Neck Squamous Cell Carcinoma Nutrition and Cancer 2010 62 3 322 328 https://doi.org/10.1080/01635580903441188 Melo Amanda De Sousa Dantas Juliana Borges De Lima Medrado Alena Ribeiro Alves Peixoto Lima Hayana Ramos Martins Gabriela Botelho Carrera Manoela Nutritional supplements in the management of oral mucositis in patients with head and neck cancer: Narrative literary review Clinical Nutrition ESPEN 2021 43 31 38 2405-4577 Elsevier BV https://doi.org/10.1016/j.clnesp.2021.03.030 Chaitanya N C Role of Vitamin E and Vitamin A in Oral Mucositis Induced by Cancer Chemo/Radiotherapy- A Meta-analysis Journal of Clinical & Diagnostic Research 2017 11 5 2249-782X JCDR Research and Publications https://doi.org/10.7860/jcdr/2017/26845.9905 Rao S Kalekhan F Hegde S K Rao P Suresh S Baliga M S Serum zinc status and the development of mucositis and dermatitis in head-and-neck cancer patients undergoing curative radiotherapy: A pilot study Journal of Cancer Research and Therapeutics 2022 18 1 42 48 https://doi.org/10.4103/jcrt.jcrt_344_20 Hoppe C Kutschan S Dörfler J Büntzel J Büntzel J Huebner Jutta Zinc as a complementary treatment for cancer patients: a systematic review Clinical and Experimental Medicine 2021 21 2 297 313 1591-8890 Springer Science and Business Media LLC https://doi.org/10.1007/s10238-020-00677-6 Nascimento R B Leite É G D S Dantas J B De Lima Costa T F Martins G B Carrera M Lima H R Zinc supplementation in the management of oral mucositis in head and neck cancer patients: narrative literature review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2022 134 3 E234 https://doi.org/10.1016/j.oooo.2022.01.750 Shuai Ting Yi Li-Juan J Tian Xu Chen Wei-Qing Q Chen Hui Q Li Null- E Prophylaxis with oral zinc sulfate against radiation-induced oropharyngeal mucositis in patients with head and neck cancer Medicine 2018 97 48 e13310 0025-7974 Ovid Technologies (Wolters Kluwer Health) https://doi.org/10.1097/md.0000000000013310 Sharief Rahamathullamudassar Anandhi P Rahila C The benefit of zinc sulfate in oropharyngeal mucositis during hyperfractionated accelerated concomitant boost radiotherapy with concurrent cisplatin for advanced-stage oropharyngeal and hypopharyngeal cancers Indian Journal of Palliative Care 2020 26 4 437 443 0973-1075 Scientific Scholar https://doi.org/10.4103/ijpc.ijpc_20_20 Khan Mohsin Siddiqui Shahid A Akram Mohd Alam Mohdshadab Can zinc supplementation widen the gap between control and complications in head and neck cancer patients treated with concurrent chemo-radiotherapy Journal of Medical Sciences 2019 39 6 267 1011-4564 Medknow https://doi.org/10.4103/jmedsci.jmedsci_20_19 Shuai Ting Tian Xu Shi Bing Chen Hui Liu Xiao-Ling Yi Li-Juan Chen Wei-Qing Li Null- E Prophylaxis With Oral Zinc Sulfate Against Radiation Induced Oral Mucositis in Patients With Head and Neck Cancers: A Systematic Review and Meta-Analysis of Four Randomized Controlled Trials Frontiers in Oncology 2019 9 165 Frontiers Media SA https://doi.org/10.3389/fonc.2019.00165 Tian Xu Liu Xiao-Ling Pi Yuan-Ping Chen Hui Chen Wei-Qing Oral Zinc Sulfate for Prevention and Treatment of Chemotherapy-Induced Oral Mucositis: A Meta-Analysis of Five Randomized Controlled Trials Frontiers in Oncology 2018 8 484 Frontiers Media SA https://doi.org/10.3389/fonc.2018.00484 Menêses Amanda Gomes Normando Ana Gabriela Costa Toledo Isabela Porto De Reis Paula Elaine Diniz Guerra Eliete Neves Silva Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta‐analysis of randomized clinical trials Journal of Oral Pathology & Medicine 2020 49 2 117 125 0904-2512 Wiley https://doi.org/10.1111/jop.12901 Torgersen Zachary Balters Marcus Perioperative Nutrition Surgical Clinics of North America 2015 95 2 255 267 0039-6109 Elsevier BV https://doi.org/10.1016/j.suc.2014.10.003 Martínez-Ortega Antonio Jesús Piñar-Gutiérrez Ana Serrano-Aguayo Pilar González-Navarro Irene Remón-Ruíz Pablo Jesús Pereira-Cunill José Luís García-Luna Pedro Pablo Perioperative Nutritional Support: A Review of Current Literature Nutrients 2022 14 8 1601 MDPI AG https://doi.org/10.3390/nu14081601 Moore Cindy Pegues J’undra Narisetty Vamsi Spankovich Christopher Jackson Lana Jefferson Gina D Enhanced Recovery After Surgery Nutrition Protocol for Major Head and Neck Cancer Surgery OTO Open 2021 5 2 2473-974X Wiley https://doi.org/10.1177/2473974x211021100 Ljungqvist O ERAS--enhanced recovery after surgery: moving evidence-based perioperative care to practice JPEN J Parenter Enteral Nutr 2014 38 5 559 566 https://doi.org/10.1177/0148607114523451 Coyle M J Main B Hughes C Craven R Alexander R Porter G R Thomas S Enhanced recovery after surgery (ERAS) for head and neck oncology patients Clinical Otolaryngology 2016 41 2 118 126 1749-4478 Wiley https://doi.org/10.1111/coa.12482 Bertazzoni G Testa G Tomasoni M Mattavelli D Bon Del Montalto F Ferrari N Andreoli M Morello M Sbalzer R Vecchiati N Piazza D Nicolai C Deganello P A The Enhanced Recovery After Surgery (ERAS) protocol in head and neck cancer: a matched-pair analysis Acta Otorhinolaryngol Ital 2022 42 4 325 333 PMCID https://doi.org/10.14639/0392-100x-n2072 Prasad A Chorath K Barrette L X Go B Deng J Moreira A Rajasekaran K Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients: Considerations and best practices World J Otorhinolaryngol Head Neck Surg 2022 8 2 91 95 PMCID https://doi.org/10.1002/wjo2.20 Martindale R G Mcclave S A Taylor B Lawson Christy M Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr 2013 37 5S 5 20 https://doi.org/10.1177/0148607113496821 Nesemeier Ryan Dunlap Neal Mcclave Stephen A Tennant Paul Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer Current Surgery Reports 2017 5 8 18 Springer Science and Business Media LLC https://doi.org/10.1007/s40137-017-0179-0 Head and Neck Guideline Steering Committee. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Clinical Oncological Society of Australia 2022 https://wiki.cancer.org.au/australiawiki/index.php?oldid=215353 Dort J C Farwell D G Findlay M Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society JAMA Otolaryngol Head Neck Surg 2017 143 3 292 303 https://doi.org/10.1001/jamaoto.2016.2981 Rowan Nicholas R Johnson Jonas T Fratangelo Christina E Smith Brenda K Kemerer Patricia A Ferris Robert L Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients Oral Oncology 2016 54 42 46 1368-8375 Elsevier BV https://doi.org/10.1016/j.oraloncology.2016.01.006 Pogatschnik Cassandra Steiger Ezra Review of Preoperative Carbohydrate Loading Nutrition in Clinical Practice 2015 30 5 660 664 0884-5336 Wiley https://doi.org/10.1177/0884533615594013 Mörbe Urs M Jørgensen Peter B Fenton Thomas M Burg Nicole Von Riis Lene B Spencer Jo Agace William W Human gut-associated lymphoid tissues (GALT); diversity, structure, and function Mucosal Immunology 2021 14 4 793 802 1933-0219 Elsevier BV https://doi.org/10.1038/s41385-021-00389-4 Stahl Marisa Gallant Belkind-Gerson Jaime 1 - Development of the Gastrointestinal Tract Pediatric Gastrointestinal and Liver Disease (Sixth Edition) 2021 2 10.e2 https://doi.org/10.1016/b978-0-323-67293-1.00001-3 Szefel Jarosław Kruszewski Wiesław J Buczek Tomasz Enteral feeding and its impact on the gut immune system and intestinal mucosal barrier Gastroenterology Review 2015 2 2 71 77 1895-5770 Termedia Sp. z.o.o. https://doi.org/10.5114/pg.2015.48997 Mcclave S A Taylor B E Martindale R G Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition JPEN J Parenter Enteral Nutr 2016 40 8 159 211 https://doi.org/10.1177/0148607115621863 Delaney Sean W Shi Haoran Shokrani Alireza Sinha Uttam K Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies International Journal of Otolaryngology 2017 2017 1 12 1687-9201 Hindawi Limited https://doi.org/10.1155/2017/8362874 Kawasaki Naruo Suzuki Yutaka Nakayoshi Tomoko Hanyu Nobuyoshi Nakao Masatoshi Takeda Akihiro Furukawa Yoshiyuki Kashiwagi Hideyuki Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status Surgery Today 2009 39 3 225 230 0941-1291 Springer Science and Business Media LLC https://doi.org/10.1007/s00595-008-3861-0 Kerawala Cyrus J Riva Francesco Paleri Vinidh The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay Oral Oncology 2021 113 105094 1368-8375 Elsevier BV https://doi.org/10.1016/j.oraloncology.2020.105094 Crumley Roger L Smith James D Postoperative chylous fistula prevention and management The Laryngoscope 1976 86 6 804 813 0023-852X Wiley https://doi.org/10.1288/00005537-197606000-00008 Ilczyszyn Andrei Ridha Hyder Durrani Amer J Management of chyle leak post neck dissection: A case report and literature review Journal of Plastic, Reconstructive & Aesthetic Surgery 2011 64 9 e223 e230 1748-6815 Elsevier BV https://doi.org/10.1016/j.bjps.2010.12.018 Jiang H Deng X F Duan C M Chen C Xiang J L Lu Y L Ma Q F Somatostatin receptors SSTR2 and SSTR5 are expressed in the human thoracic duct Lymphology 2011 44 1 21 28 https://pubmed.ncbi.nlm.nih.gov/21667819/ 2nd Broughton G Janis J E Attinger C E The basic science of wound healing Plast Reconstr Surg 2006 117 7 12S 34S https://doi.org/10.1097/01.prs.0000225430.42531.c2 Berbée Clara Marx Jan Philipp Voelker Maria Theresa Schotte Dörte Bercker Sven Parenteral nutrition in palliative care: single-centre observational study BMJ Supportive & Palliative Care 2022 2045-435X BMJ https://doi.org/10.1136/bmjspcare-2022-003581 Murai M Higashiguchi T Ohara H Katsura N Futamura A Nakayama N Multicentric prospective study of effect of dietary intake on quality of life for patients with end-stage cancers Fujita Med J 2020 6 1 1 6 https://doi.org/10.20407/fmj.2018-023 Sánchez-Sánchez E Ruano-Álvarez M A Díaz-Jiménez J Díaz A J Ordonez F J Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review Nutrients 2021 13 5 1562 PMCID https://doi.org/10.3390/nu13051562 Druml Christiane Ballmer Peter E Druml Wilfred Oehmichen Frank Shenkin Alan Singer Pierre Soeters Peter Weimann Arved Bischoff Stephan C ESPEN guideline on ethical aspects of artificial nutrition and hydration Clinical Nutrition 2016 35 3 545 556 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2016.02.006 Tagliaferri Sara Lauretani Fulvio Pelá Giovanna Meschi Tiziana Maggio Marcello The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of outpatient older individuals Clinical Nutrition 2019 38 6 2684 2689 0261-5614 Elsevier BV https://doi.org/10.1016/j.clnu.2018.11.022 Reber E Gomes F Dähn I A Vasiloglou M F Stanga Z Management of Dehydration in Patients Suffering Swallowing Difficulties J Clin Med 2019 8 11 1923 https://doi.org/10.3390/jcm8111923