Work

Nutritional management and oral health-related outcomes in head and neck cancer treated with radiotherapy or chemoradiotherapy: a systematic review

Year: 2026

Type: review

Abstract: BACKGROUND: Head and neck cancers are frequently diagnosed at a locally advanced stage and are commonly treated with radiotherapy or chemoradiotherapy, which significantly affect oral function and nutritional intake. Treatment delivery is often compromised by malnutrition, which affects 30–50% of patients at diagnosis and up to 90% during therapy. Despite its impact on treatment tolerance and continuity, the optimal nutritional strategy during radiotherapy or chemoradiotherapy remains unclear. This systematic review evaluated the possible influence of oral nutritional supplements, percutaneous endoscopic gastrostomy or nasogastric tube feeding on treatment delivery and tolerance, oral health-related outcomes including mucositis, dysphagia, and oral intake in patients with head and neck cancer receiving radiotherapy or chemoradiotherapy. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included adult patients with head and neck cancer treated with radiotherapy or chemoradiotherapy who required nutritional support. Methodological quality was assessed using an adapted version of the Mixed Methods Appraisal Tool (MMAT). RESULTS: Thirty-one studies were included. Mucositis, as well as dysphagia and impaired oral intake, remained the most significant oral health-related outcomes, even with the implementation of multiple nutritional support measures. Early use of oral nutritional supplements was associated with fewer treatment interruptions, particularly before escalation to enteral feeding. Prophylactic percutaneous endoscopic gastrostomy appeared to be associated with reduced weight loss, fewer unplanned hospitalizations, and higher treatment completion rates, but these findings should be interpreted with caution given the observational nature of the available evidence. Nasogastric tube feeding was associated with fewer device-related complications and lower long-term dependence; however, heterogeneity across studies and the predominance of gastrostomy-focused evidence limited direct comparative conclusions. CONCLUSIONS: Nutritional support is closely linked to oral function and treatment delivery during radiotherapy or chemoradiotherapy for head and neck cancer. Proactive strategies may improve treatment continuity in high-risk patients, but comparative evidence remains insufficient to define the optimal enteral approach. High-quality randomized trials integrating oral health-related outcomes are needed to inform evidence-based, nutrition-integrated clinical practice.

Source: BMC Oral Health

DOI: 10.1186/s12903-026-08352-0

Authors: Camille Barakat, Aline Houessinon, Marin Caron, Jihane Lehyanti, Aurélie Moreira, Cyriaque Wagner-Ballon

Institutions: Centre Hospitalier Universitaire Amiens-Picardie, Inserm, Chirurgie et extrémité céphalique, caractérisation morphologique et fonctionnelle, Université de Picardie Jules Verne

Language: English

Topic: Oral health in cancer treatment

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,190