Sarcopenia in head and neck cancer: Towards personalized medicine

This thesis showed that low skeletal muscle mass (sarcopenia) is a prevalent problem which occurs in approximately 55% of patients. Skeletal muscle mass can be easily assessed on a single slice at the level of C3 (or L3) on routinely performed CT or MRI scans which are performed for head and neck cancer diagnosis and treatment evaluation. Skeletal muscle mass is a promising imaging biomarker which predicts negative treatment outcomes in various treatment strategies applied in head and neck cancer management. Besides negative treatment outcomes, low skeletal muscle mass has also shown to be prognostic for decreased survival.

We hypothesize that multimodal pre-habilitation will improve skeletal muscle mass status of the patient before treatment which will lead to an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects in surgically treated patients and to reduced treatment-related toxicities in patients treated with (chemo- or bio) radiotherapy. We also hypothesize that multimodal pre-habilitation leads to a reduced duration of hospital stay, reduced health care costs and improved quality of life. In addition, pre-habilitation is an opportunity to foster patient empowerment which increases patient’s autonomy and self-management. This may facilitate an improved quality of life before treatment and may positively affect long-term health. Therefore, the aims of a future randomized controlled trial should be to compare the effect of a multimodal pre-habilitation program including exercise, nutritional support and psychological support with usual care on treatment outcomes and prognosis for patients with head and neck cancer, particularly those with low skeletal muscle mass.

Further research is needed to validate these hypotheses. This thesis provides information that can contribute to the development of these studies.