Refeeding syndrome in head and neck cancers: a risk in the prehabilitation of patients?

Refeeding syndrome (RS) is characterized by electrolyte and fluid shifts caused by the rapid reintroduction of nutrition after a period of undernutrition. This study aimed to determine the prevalence of RS in patients with head and neck cancer (HNC) affected by a malnutrition risk. The study involved 69 patients with HNC at the outset of management with one of the following risk factors of RS: BMI ≤ 18.5 kg/m2, weight loss > 5%, significant decrease in oral intake on a visual analog scale (≤ 5), or inability to swallow. RS was defined by serum ionic depletion (phosphorus, potassium, magnesium) within 5 days of refeeding. The study sample comprised 51 males and 18 females with a mean age of 62.80 ± 9.19 SD. Oropharyngeal squamous cell carcinoma (SCC) was the most prevalent histologic type in these patients (42%), predominantly associated with a negative P16 status and a high prevalence of a current or past history of smoking (94.2%) and/or alcoholism (69.6%). RS prevalence was 98% in the patients who had risk factors of malnutrition. No patient had organ failure. No clinical criteria were able to predict the severity of RS. RS is extremely common in malnourished patients with HNC. With adequate supplementation and close laboratory monitoring of refeeding, RS rarely causes clinical complications. The very high prevalence of RS in this study is due to the inclusion of patients with risk factors for malnutrition, this indicates that these factors are highly predictive of RS in patients with HNC.