Association of a structured nutrition-centred multidisciplinary supportive-care program with treatment tolerance and clinical outcomes in patients undergoing precision radiotherapy for head and neck cancer: a prospective cohort study

Abstract

Malnutrition, systemic inflammation, and treatment-related toxicity may compromise radiotherapy tolerance in patients with head and neck squamous cell carcinoma (HNSCC). We evaluated a structured nutrition-centred multidisciplinary supportive-care program during precision radiotherapy. This prospective cohort included 258 patients with HNSCC receiving intensity-modulated or volumetric-modulated arc radiotherapy. Patients entered the comprehensive nutritional management (CNM) group ( n  = 129) or usual care (UC) group ( n  = 129) according to program availability. Outcomes included radiotherapy interruption, Grade ≥ 3 oral mucositis, treatment delay, longitudinal nutritional and inflammatory markers, quality of life, and exploratory survival outcomes. Linear mixed-effects, parsimonious logistic, and Cox regression models were used. Radiotherapy completion without major interruption was 95.3% in the CNM group and 89.1% in the UC group ( P  = 0.063). Grade ≥ 3 oral mucositis was less frequent with CNM (14.0% vs. 26.4%; P  = 0.013), as was Grade ≥ 2 dysphagia (17.1% vs. 28.7%; P  = 0.026). Treatment delay was shorter with CNM [2 (IQR 1–3) vs. 5 (IQR 3–7) days; P  = 0.018]. CNM was associated with more favorable longitudinal trajectories of PNI, SII, global health status, and swallowing symptoms (all interaction P  ≤ 0.020). Adjusted analyses showed lower odds of severe mucositis (OR, 0.50; 95% CI, 0.27–0.92), while the association with major interruption was not statistically significant (OR, 0.43; 95% CI, 0.17–1.05). A structured nutrition-centred multidisciplinary supportive-care program was associated with lower treatment-related toxicity, shorter delays, and more favorable nutritional, inflammatory, and quality-of-life trajectories during radiotherapy.