# Head and neck cancer patients present late cancer cachexia two years after curative chemoradiotherapy

## TL;DR

Head and neck cancer patients who are disease-free after treatment often develop cancer cachexia years later, unrelated to swallowing issues.

## Contribution

This study is the first to show late-onset cancer cachexia in disease-free head and neck cancer survivors.

## Key findings

- 20.7% and 8.6% of patients met cachexia criteria using Fearon and Evans standards after two years of follow-up.
- Cachexia was not associated with dysphagia despite high prevalence in disease-free patients.
- Cachectic patients showed reduced muscle strength and mid-arm muscle circumference.

## Abstract

•Two diagnostic criteria diagnose cancer cachexia in HNSCC patients.•Disease-free HNSCC patients present cancer cachexia after long-term follow-up.•Cachexia is not associated with dysphagia.

Two diagnostic criteria diagnose cancer cachexia in HNSCC patients.

Disease-free HNSCC patients present cancer cachexia after long-term follow-up.

Cachexia is not associated with dysphagia.

Over 90% of Head and Neck Cancers are Squamous Cell Carcinoma (HNSCC). HNSCC patients with no evidence of disease after treatment completion usually present a high frequency of late treatment-related toxicities. Here, we aimed to evaluate the prevalence of cachexia among head and neck squamous cell carcinoma patients treated with cisplatin-based chemoradiation with curative intent and presenting no evidence of disease. We hypothesize that even patients post long-term follow-up and curative-intention treatment present a high frequency of cancer cachexia.

This cross-sectional observational study included 120 patients with HNSCC who had previously received definitive or adjuvant chemoradiation. Eligible patients were in regular follow-up for at least 2-years, with no evidence of disease. We assessed clinical characteristics, body composition, muscle strength, nutritional status, and blood tests. The primary outcome was the prevalence of cachexia, and the secondary outcome was an association between cachexia and self-reported dysphagia.

Using two different diagnostic criteria (Fearon and Evans criteria), we found that 20.7% and 8.6% of patients presented cancer cachexia after more than two years of follow-up after curative chemoradiation treatment. As expected, cachectic patients presented lower mid-arm muscle circumference, with dysphagia in 73%. In addition, in cachectic patients diagnosed according to Evans's cancer cachexia criteria, we found lower muscle strength levels. There is no association between dysphagia and cancer cachexia, regardless of the diagnostic criteria.

In long-term follow-up, head and neck squamous cell carcinoma patients with no evidence of disease frequently present with cachexia after curative chemoradiation.