Pre- and Post-Treatment Dietary Factors Could Affect Head and Neck Cancer Outcomes

Patients’ dietary intake leading up to a diagnosis of head and neck squamous cell carcinoma (HNSCC) could impact their disease outcomes, according to a study published in the International Journal of Cancer.

Researchers — from the University of Illinois at Urbana-Champaign, University of Alabama at Birmingham and the University of Michigan – gave health behavior surveys to 414 newly diagnosed patients using Food Frequency Questionnaires and epidemiologic surveys.

Dietary data were obtained at baseline and again one year after diagnosis, for which patients were followed for about 26 months after they were first diagnosed and treated.

Patients, whose average age at diagnosis was 61 years, varied in the type of head and neck cancers they had — including oral cavity (152 patients), oropharynx (166 patients), hypopharynx (10 patients) and larynx (86 patients) – and more than 69 percent of participants were diagnosed when their disease was at stage 3 or 4.

Those who consumed the lowest amounts of simple carbohydrates (refined grains, desserts and sugar-sweetened beverages) consumed a little over one serving daily compared with more than four servings by patients who were considered high intake.

During follow-up, 72 patients (17.4 percent) faced recurrences and 70 (16.9 percent) died, including 42 from the disease.

Pretreatment analyses showed high intakes of total carbohydrate, total sugar, glycemic load and simple carbohydrates were associated with a significantly increased risk for all‐cause mortality compared to low intake. In particular, high carbohydrate intake and total sugar appeared to be associated with increased risk of HNSCC‐specific mortality. Meanwhile, post‐treatment analyses demonstrated that medium fat intake was significantly associated with reduced risk of recurrence and all‐cause mortality.

No other dietary factors showed an association with mortality and recurrence, but this could have been due to a few things, including a relatively short follow-up time and the fact that dietary intake of carbohydrates has the largest effect on health outcomes before or during cancer treatment.

“Interestingly, statistically significant associations remained for oral cavity cancers, but not for oropharyngeal cancers,” the researchers wrote. “Similarly, significant associations remained for stage 1 to 3 cancers but not stage 4 cancers. The exception was for total sugar, which was not statistically significant for stage 1 to 3 cases, but was significant for stage 4 cases.”

The researchers also suggested that these findings could be a result of a theory called the “Warburg effect,” that states that cancer cells metabolize glucose. So, essentially, consuming a high amount of sugar or carbohydrates may be fueling the cancer cells. The Warburg effect has not definitively been proven, but studies like these continue to bring that theory — and others regarding food and cancer – into the center of attention.

Previous studies have shown that a ketogenic diet (high fat and low carbs) could be beneficial to patients with cancer.

“While our data supports a potential benefit to HNSCC patients avoiding higher levels of carbohydrate intake, it cannot be used to draw conclusions related to the benefits of a ketogenic diet,” the authors wrote. “However, there may be biological plausibility for benefits of the ketogenic diet in HNSCC patients in particular, since HNSCC is a highly glycolytic form of cancer.”

Ultimately, the researchers mentioned that more research needs to be done before they can definitively link cancer outcomes and dietary intake, and if there are different outcomes across different patient populations.

“Future studies should address potential differences of the effect of carbohydrate intake on HNSCC outcomes across different tumor site and cancer stages,” they added.