Treatment options selected determine the immediate, intermediate, and long-term impact on nutrition status (see Table 13.1). HNC treatment approaches are chosen based upon disease factors (site, extent of disease, pathologic findings), presence or absence of comorbid conditions, and patient preference. Treatment is often aggressive involving surgery, chemotherapy, radiation therapy, or a combination of modalities. Potential nutrition complications resulting from the tumor, surgery, chemotherapy, and radiation therapy in the treatment of HNC are identified in Table 13.1 [4, 12, 20–25]. The size and location of the tumor may affect oral function, particularly if involving the oral tongue, base of tongue, and oropharynx. In addition to mass effects and affect on function of the involved site, pain may affect oral intake. Localized oral lesions (Stages I and II) are primarily treated surgically, whereas those of the oropharynx are primarily treated by radiation therapy. For locally advanced cancer and those with locoregional disease (Stage III/IV disease) multimodality therapy is required.

Oral toxicities, those symptoms that occur secondary to cancer treatments often coexist and are interdependent; they may be classified as acute or late effects. An acute toxicity typically occurs early in the course of treatment and generally resolves by treatment completion. For example, patients who undergo concurrent chemoradiation therapy experience acute effects that create nutritional challenges. However, it is possible that an acute toxicity may fail to resolve and may persist as a late effect toxicity [26]. Early nutrition screening and assessment and prevention and management of oral complications in patients with HNC are essential. The Vanderbilt Head and Neck Symptom Survey 2.0 (VHNSS) allows practitioners to assess, qualify, and quantify symptom burden and duration in a timely manner [27, 28]. Symptom burden is a concept that refers to the combination of both the severity of symptoms and the patient’s perception of the impact of the symptom. The VHNSS was designed for use in a clinic setting by health professionals to identify specific symptoms associated with HNC including acute and late stage toxicities and to help guide clinical care. There are 50 questions within 13 domains that are specific to the HNC population. Questions are ranked on a scale of 0–10 with 0 indicating no issue and 10 indicating severe symptom issues. The VHNSS 2.0 addresses the possible adverse effects of treatment such as mucosal sensitivity, dental health, and trismus [27, 28]. OHCPs and RDs as well as other health professionals can use this tool during initial and periodic patient visits to determine symptoms impacting the ability to eat and drink and quality of life. The value of its use lies in the information gleaned that can be used to guide changes in treatment plans and management strategies.

In dentate, patients with xerostomia, the frequency of fermentable carbohydrate (carbohydrates that can be metabolized by salivary amylase) (e.g., fruits and juices, sugar-sweetened foods and beverages) intake must also be considered because they can increase the caries risk in already at-risk patients [29]. Some suggestions are to complete appropriate oral hygiene procedures (e.g., brushing teeth) before or immediately following consumption of sugar-sweetened foods and fluids including those with natural sugars such as fruits and juices/sweetened beverages, limiting these foods to mealtimes, and to maintain caries prevention strategies on a daily basis. In addition, acidic products in liquid form (e.g., citrus beverages including sugar-sweetened and sugar-free: fruit drinks, carbonated beverages, and ice tea) and in foods should be limited as they can irritate soft tissue and increase risk of tooth demineralization and caries. Common nutrition impact symptoms resulting from treatment and recommendations for management of diet and nutrition for individuals with acute toxicities are described in Table 13.2 [12, 20, 22, 30–32].