Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Energy expenditure in head and neck cancer: a systematic literature review (#247)

Lauren Hanna 1 , Kay Nguo 1 , Teresa Brown 2 3 , Judy Bauer 1
  1. Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
  2. Dietetics & Food Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
  3. School of Human Movement & Nutrition Services, University of Queensland, Brisbane, QLD, Australia

Aims:  Cancer-associated malnutrition is prevalent in head and neck cancer (HNC). Nutrition interventions require accurate determination of daily energy needs, however predictive equations to estimate energy requirements may be inaccurate in people with cancer, and do not account for the influence of treatment. This review aims to synthesise evidence regarding energy expenditure in HNC to inform effective intervention delivery. 

Methods:  Four databases were searched in May 2024 to identify studies using reference methods (indirect calorimetry or doubly labelled water (DLW)) to measure resting or total energy expenditure (REE or TEE) in adults with any stage of HNC. Studies comparing to a) non-cancer controls, b) predictive equations, c)wearable devices, or d) energy expenditure measured before and after treatment, were sought.

Results: 724 studies were screened, 11 studies (380 participants) were eligible for inclusion with varied HNC cancers where indirect calorimetry was used to measure REE. No studies measured TEE using DLW. Weight-adjusted REE was comparable to non-cancer controls in two studies (n=48).  Measured vs. predicted REE was reported in eight studies; three studies reported hypermetabolism (measured/predicted REE ≥110%) in 25-57% of participants (n=219). Measured REE at baseline was comparable to predicted REE in four studies (n=53), and significantly lower than predicted in one study (n=18). Seven studies measured REE before and after (chemo)radiotherapy treatment, with post treatment unadjusted REE comparable to baseline in two studies (n=36), a U-curve in one study (n=18), and significantly lower in four studies (n=157); although not significant when REE was adjusted for weight and/or fat-free mass in two studies (n=109).  

Conclusions: Energy expenditure in patients with HNC was comparable to non-cancer controls and the accuracy of equations to predict REE varied. Further research with larger sample sizes and adjustments for body composition are needed to understand changes in energy needs during HNC treatment.