Background: Dysphagia and malnutrition are common among head and neck squamous cell carcinoma (HNSCC) patients. Evidence and guidelines emphasize treatment and prevention of these conditions before surgery. In this context, multimodal prehabilitation (MP) is an essential part of a holistic treatment approach. However, the specific components and their relative importance remain debated. This study aimed to evaluate the impact of nutritional, logopedic and psychological MP. Methods: Adult HNSCC patients who completed the German version of the Functional Assessment of Cancer Therapy—Head and Neck (FACT-H&N) quality-of-life (QOL) questionnaire after undergoing curative resection and reconstructive surgery were included in this cross-sectional study. Clinical data on psychological, logopedic and nutritional MP and possible confounders was collected. To evaluate the nutritional status, bodyweight loss, the body mass index (BMI) and the Graz Malnutrition Screening (GMS) score were recorded. We determined the length of stay (LOS), the QOL, the Clavien–Dindo type III and IV complication rate (CR) as the outcome parameters for MP. Results: In total, 102 patients were included. Of those, 68 were male, while the other 34 were female. The mean age was 59.82 ± 12.27 years. The average GMS was 3.11 ± 1.45. Simultaneously, 62.75% of patients were at risk or malnourished. Malnutrition was significantly associated with adverse outcomes in the univariate, but only with decreased QOL in the multivariate model. On the other hand, MP was significantly associated with reduced LOS and improved QOL. These findings remained robust even after adjustment for possible confounders. Neither had a significant effect on the CR. Conclusions: Our findings suggest that malnutrition is a potential risk factor for adverse outcomes in curative HNSCC therapy. The GMS is a sensitive tool for identifying patients at risk of malnutrition in HNSCC surgery prehabilitation. Our multimodal protocol was associated with improved postoperative outcomes following curative surgical resection and free flap reconstruction. The observed associations may reflect potential synergistic interactions within the multimodal framework.
Walch et al. (Thu,) studied this question.