Pre-treatment Dietary Patterns Are Associated with the Presence of Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer

Ninety percent of head and neck cancer (HNC) survivors experience disease and treatment related symptoms. Diet has the potential to reduce inflammation, modulate epigenetic changes and affect biological processes involved in the pathogenesis of symptoms. The objective of this study was to determine if pre-treatment dietary patterns are associated with the presence of symptoms 1-year after diagnosis. Methods: This was a longitudinal study of 295 newly diagnosed HNC patients. All patients completed a food frequency questionnaire and epidemiologic health survey. Self-reported symptoms were assessed pre-treatment and 1-year after diagnosis using a Likert scale ranging from "1: not at all bothered" by symptom to "5: extremely bothered". Symptom scores were dichotomized as "not at all" vs. "slight - extremely". Principal component analysis was used to derive pre-treatment dietary patterns. Multivariable logistic regression models examined the association of derived dietary patterns (fit by quartiles) and seven symptoms (trismus, xerostomia, dysphagia of liquids, dysphagia of solids, difficulty chewing, taste and mucositis). An overall symptom summary score was calculated (range 8–39) and dichotomized as <17 vs. ≥17. This cut-off was chosen by examining the distribution of scores and categorizing into two distinct subgroups naturally present in the data. Results: Two dietary patterns emerged: Prudent (high intakes of vegetables, fruit, fish, poultry, and whole grains) and Western (high intakes of red and processed meats, refined grains, potatoes, and French fries). After adjusting for age, baseline symptoms, tumor site, cancer stage, smoking, calories and HPV status, significant inverse associations were observed between pre-treatment Prudent pattern score and dysphagia of liquids (P = 0.01), dysphagia of solids (P = 0.02) and difficulty chewing (P = 0.02) at 1 year post- diagnosis. A statistically significant inverse association was observed between the overall symptom summary score and the Prudent pattern (P < 0.001). No significant associations were observed between the Western pattern and symptoms. Conclusion: Consumption of a pre-treatment Prudent diet may help reduce the risk of symptoms such as dysphagia and difficulty chewing 1-year after diagnosis in HNC survivors.

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