196 Chapter 6 Patients were counselled by a dietician on a weekly basis according to the Dutch malnutrition guideline as part of standard clinical care [28]. TF was indicated if oral intake including oral nutritional supplements did not meet >75% of the calculated nutritional requirements [29]. TF was administered through a nasogastric tube, percutaneous endoscopic gastrostomy or radiologically inserted gastrostomy. Anthropometric measurements Weight was measured weekly at the start of RT during the standard visits to the Comprehensive Cancer Center of MUMC+. Height was measured only once before the start of CRT/BRT to calculate the body mass index (BMI). Pretreatment weight loss was a patient-reported outcome measure. Weight loss during the course of CRT/BRT was converted into a binary variable, comparing losses of more than 5% to stable or increased weight, based on the definition of grade 1 weight loss in the Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE). The same CTCAE version was also used by the radiation oncologists to report the severity of oropharyngeal dysphagia at start of RT. At the same time, the World Health Organization Performance Status (WHO PS) was assessed. The Charlson comorbidity index (CCI) was determined based on the medical history in the individual electronic health records [29]. The p16 status was used as surrogate marker for HPV infection [30]. Dental status was determined at two time points: during the dental assessment at first visit (dental sources of infection and functional dental status) and after tooth extractions prior to the start of CRT/BRT (functional dental status). The dental terminology and classification systems used are listed in Table 1. Whether or not patients underwent tooth extractions, the number of extracted teeth, and additional dental interventions including the removal of exostoses and implant insertion were recorded. The use of TF during CRT/BRT was treated as a binary measure, consisting of TF started during CRT/BRT for any duration versus remaining on a total oral diet. Statistical analyses Descriptive statistics were reported as means and standard deviations (SDs) for normally distributed, continuous variables, and medians and inter quartile ranges (IQRs) for non-normally distributed data. Comparisons between groups were performed with independent t-tests in case of a normal distribution or the
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