Re: Martínez-Herrera et al Titled “Quality of Life and Functionality of Head and Neck Cancer Patients Are Diminished as a Function of Sarcopenia and Obesity”

Dear Editor,

We found the article by Martínez-Herrera et al ¹ to be of great interest, as it presents significant findings regarding the relationship between body composition phenotypes and quality of life (QoL) in a cohort of 71 patients with head and neck cancer (HNC). The authors reported that the non-sarcopenia group demonstrated notably better physical functioning and reduced fatigue compared to both the sarcopenic group (SG) and the sarcopenic obese groups (SOG). Notably, the QoL profiles of the SG and SOG were similar, emphasizing the clinical importance of muscle mass over simple body weight metrics in managing HNC patients. This study addresses the underexplored relationship between sarcopenic obesity and patient-centered outcomes. However, we would like to stress several points that may enhance future investigations in this field.

First, despite the inherent limitations of a cross-sectional study design, the absence of stratification by tumor subsite and treatment modality may obscure the site-specific and modality-related influences on sarcopenia development and patient-reported outcomes. It is well-recognized that different subsites of HNC present unique anatomical, functional, and treatment-related challenges, which can significantly influence swallowing ability, nutritional intake, and systemic inflammatory responses, and play a crucial role in the onset and progression of sarcopenia. ² For example, oral cavity tumors frequently result in early mechanical dysphagia. In contrast, laryngeal and pharyngeal cancers may necessitate extended enteral feeding or tracheostomy, each of which has unique implications for muscle wasting and functional independence. ³ Furthermore, chemoradiation may accelerate lean body mass loss and increase fatigue beyond the effects of surgical sequelae. ⁴ Hence, future longitudinal studies that include subsite-specific analyses and treatment timelines could provide more detailed insights into sarcopenia’s temporal and anatomical patterns and their relationship with dynamic QoL indices.

And second, the findings presented by Martínez-Herrera et al ¹ raise an important question: Could targeted interventions—such as nutritional support, resistance exercise programs, or pharmacological strategies—help reduce the decline in physical function and fatigue seen in sarcopenic HNC patients? Several well-designed randomized controlled trials have illustrated that individualized multimodal interventions—which effectively combine high-protein nutritional strategies with structured physical activity—can significantly preserve or even enhance both muscle mass and functional outcomes among individuals diagnosed with cancer.^5,6 These interventions typically involve tailored dietary plans rich in essential amino acids alongside supervised exercise regimens, which together aim to counteract the physical decline associated with cancer and its treatments. Furthermore, it is important to note that sarcopenia, the loss of muscle mass and strength, rarely manifests in isolation; it commonly coexists with treatment-limiting complications such as trismus. This interplay can contribute to feeding difficulties, resulting in malnutrition and functional impairments, and ultimately leading to decreased survival rates among affected patients, ⁷ underscoring the need for sarcopenia screening in pretreatment assessments and a multidisciplinary survivorship model that integrates dental, nutritional, and physical rehabilitation planning from the outset of oncologic care. Customized treatment approaches tailored to the individual needs of patients may significantly improve their QoL, and enhance treatment tolerance and long-term outcomes.

Efsun Somay, PhDDepartment of Oral and Maxillofacial Surgery Faculty of DentistryBaskent University Ankara (Outside of the US), Turkey Erkan Topkan, MDDepartment of Radiation Oncology Faculty of MedicineBaskent University Adana, Turkey Ugur Selek, MDDepartment of Radiation Oncology Faculty of MedicineKoc University Istanbul, Turkey