Hospitalization in HNSCC leads to increased

economical burden on the patient, relatives, national

health system or the insurance agencies depending on
the case scenario.
Comparative effects of different enteral feeding
methods in head and neck cancer patients receiving
radiotherapy or chemoradiotherapy: a network meta-
analysis. Zhang ZH, Zhu Y, Ling Y, Zhang LJ, Wan HW. 18 May 2016 Volume 2016:9 Pages 2897—2909. Dove
press

DOI https://doi.org/10.2147/OTT.S101983

INTRODUCTION AND DISCUSSION

Poor nutritional status was associated with less resistance to chemotherapy or RT-
toxicity, leading to treatment interruption.9–11 Malnutrition was also associated with
higher risk of infection and hospital admission, worse survival outcomes, and
deterioration in the quality of life (QoL).4,12,13 Therefore, nutrition intervention is essential
to maintain nutritional status and improve outcomes in head and neck cancer patients
undergoing RT and chemotherapy.
Dietary counseling and oral supplements showed positive influences on nutritional
outcomes and QoL in the head and neck cancer patients receiving RT or
chemoradiotherapy.14–16However, their role is limited when it comes to obstruction or
mucositis.17 Thus, enteral feeding may be a choice either through nasogastric tube
(NGT) or percutaneous endoscopic gastrostomy (PEG). Studies investigated the effects
of PEG on patients’ outcomes compared with NGT, but the conclusion was inconsistent
due to the lack of adequate evidence.18,19Research also indicated that prophylactic
percutaneous endoscopic gastrostomy (pPEG), usually early PEG before the initiation of
therapy, was able to meet nutrition needs during chemoradiotherapy20 and increase the
completeness rate of concurrent chemotherapy.21However, when compared with
reactive percutaneous endoscopic gastrostomy (rPEG), in which situation PEG was used
when necessary, pPEG was associated with less complications, but higher dependence,
with no difference in weight loss.22 Until now, the optical method and timing of
placement are still the topic of debate in recent researches.23,24
Early nutrition intervention was correlated with better nutritional status, improved
treatment tolerance, and fewer hospital admission.44 Unfortunately, several systematic
reviews failed to discuss the influences of different enteral feeding methods on the incidence
of treatment break and nutrition-related admission.23,27,45 This network meta-analysis
evaluated the effect of different enteral feeding methods in head and neck cancer patients
who received RT or chemoradiotherapy and found that pPEG was the optimal enteral
method to increase the completion of treatment and reduce hospital admission for nutrition
problems compared with rPEG and NGT.

As malnutrition is associated with poorer outcomes in head and neck cancer patients
undergoing RT or chemoradiotherapy, enteral feeding is available to meet their nutritional
needs.

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Head and neck cancer (HNC) is the sixth most common malignancy globally, and poses a substantial
economic burden to payers, healthcare systems, and patients. Costs associated with HNC are driven by
complex treatment pathways and the need for involvement of several medical specialties.

Head and neck cancer (HNC) encompasses neoplasms found in the oral cavity, pharynx, larynx, sinuses, and
salivary gland, and is common throughout the world. The collective group of HNC, though heterogeneous in
location, most often arises in the squamous cells of epithelial surfaces, and is often referred to as squamous cell
carcinoma (SCC) of the head and neck (SCCHN).

Head and neck cancer is the sixth most common cancer worldwide [1], and in 2013, 2.5 % of new cancer diagnoses
in the USA were estimated to be HNC [2]. Notably, tobacco and alcohol use are associated with higher HNC risk.
The role of infection with human papillomavirus (HPV) is less clear, although such infection appears to be more
commonly associated with oropharyngeal cancer, and possibly associated with better prognosis compared with other
factors [4, 5].

While HNC incidence has remained stable, treatment and patient management have become more complex, often
requiring a multidisciplinary team of oncologists, surgeons, radiation therapists, nutritionists, pharmacists, and
speech therapists. The majority of patients (approximately 50 %), who are diagnosed with locally advanced HNC,
are typically treated with a combination of treatment modalities including concurrent radiotherapy and
chemotherapy [concurrent chemoradiation therapy (CRT)], with surgery if indicated [6]. However, a significant
amount of rehabilitation and supportive therapies are also required for and concomitantly administered to HNC
patients to maintain or restore patients’ normal function and activities. Multidisciplinary rehabilitation also can take
the form of nutritional support, dietary counseling, and speech therapy.
The Economic Burden of Head and Neck Cancer:
A Systematic Literature Review
Erika Wissinger • Ingolf Griebsch •
Juliane Lungershausen • Talia Foster •
Chris L. Pashos PharmacoEconomics (2014) 32:865–882
DOI 10.1007/s40273-014-0169-3
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HNSCC is of significant public health importance to India. Firstly, it is diagnosed at later stages which result in low
treatment outcomes and considerable costs to the patients whom typically cannot afford this type of treatment [4].
Secondly, rural areas in middle- and low-income countries also have inadequate access to trained providers and
limited health services. As a result, delay has also been largely associated with advanced stages of these cancer [5].

Public health officials, private hospitals, and academic medical centres within India have recognised oral cancer as
a grave problem.
Journal of Cancer Epidemiology
Volume 2012, Article ID 701932, 17 pages
doi:10.1155/2012/701932

Review Article
Challenges of the Oral Cancer Burden in India
Ken Russell Coelho1, 2
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