Nutritional status in head and neck cancer patients.
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Patients suffering from cancer of head and neck are at risk of nutritional depletion. The aim of our study was to investigate the role of type, location and stage of tumors in nutritional status.A population of 230 consecutive patients with head and neck cancer was enrolled. A nutritional evaluation was realized.The distribution of tumour sites was: oral cavity (77 patients), pharynx (30 patients) and larynx (123 patients). Subjective Global Assessment (SGA) test showed significant differences. Midly malnourished frequency is higher in larynx site than others. Severely malnourished is higher in larynx and oral cavity than pharynx. In pharynx, larynx and oral cavity tumours is more frequent to be well nourished than severely malnourished. In pharynx and larynx tumours is more frequent to be mildly malnourished than severely malnourished. In stages II, III and IV are more frequent to be well nourished than severely malnourished and in stages II and III is more frequent to be mildly malnourished than severely malnourished.SGA test shows a good nutritional status in patients with head and neck tumours. However, SGA test shows statistical differences in some categories of tumours stages or sites.Cite
[Purpose] To investigate the relationship between preradiation nutritional status and acute radiotoxicity in patients with head and neck cancer. [Methods] Nutritional status before radio-therapy and acute radiotoxicity of 130 cases with head and neck cancer were prospectively surveyed. Radiotoxicities before radiation, 2 weeks and 4 weeks after beginning of radiation, and the end of radiation were assessed respectively. A comprehensive model was established to assess the nutritional status by factor analysis. Relationships between nutritional status and acute radiotoxicities were analyzed by generalized additive models. [Results] According to comprehensive evaluation index of nutritional status, malnourished cases were 88 (67.7%) before radiotherapy. Of all the malnourished cases, mild, moderate and severe were 47(36.2%), 32(24.6%) and 9(6.9%) respectively. Linear relationships were found between nutritional status and radiation dermatitis (t=-4.65,P0.001), xe- rostomia(t=-5.67,P0.001), pharyngitis/laryngitis (t=-2.67,P=0.008), fatigue(t=-4.01,P0.001), apocleisis (t=-3.13,P=0.002). Definite curve relationship was found between nutritional status and dysphagia(χ2=16.799,P0.001) or oral mucositis (χ2=3.653,P=0.037). [Conclusion] Nutritional status is correlated to acute radiotoxicities in head and neck cancer patients. Malnourished patients should be offered nutritional support before radiotherapy.
Mucositis
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In treating patients with malignant head and neck disease, radiotherapy may compromise their oral intake and, thus, their nutritional status. This study aimed to assess a subgroup of patients who received small field radiotherapy, where their early primary tumour itself would not be expected to affect swallowing and where significant nutritional problems are not traditionally identified. A retrospective analysis of hospital records was undertaken on 61 patients, treated for T1 and T2 N0 laryngeal squamous cell carcinoma with primary radical radiotherapy over a three year period (1993-1995 inclusive). At presentation, 97% had their weight and height recorded, enabling calculation of their body mass index (BMI); 13% presented with a BMI < 20 kg/m2 and the 26% of patients who complained of weight loss at presentation had a mean percentage weight loss of 5.35%. During treatment, 79% of patients had their weight recorded and 49% had a documented mean percentage weight loss of 6.4%. The mean BMI at the end of treatment was significantly lower than at presentation (P = 0.03). These effects occurred despite 80% of patients having at least one dietetic consultation (mean 3.5 consults), and 75% having received high protein/high calorie supplementation. The percentage weight loss during treatment correlated significantly with the gamma-glutamyl transpeptidase (gamma-GT) level at presentation. The biochemical markers, haemoglobin and albumin, were normal in the great majority at presentation and fell non-specifically during treatment in 82% and 56% of patients, respectively. We conclude that significant numbers of patients with early laryngeal malignancy are undernourished at presentation and, despite dietetic support, endure considerable nutritional problems during radiotherapy. Attention to nutritional issues is mandatory even in this group of patients previously considered to be less at risk because of the site and early stage of their disease.
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Performance status
Concomitant
Anorexia
Mucositis
Chemoradiotherapy
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We aimed to determine changes in body mass and body composition in relation to energy balance, inflammatory state, and physical function before and after concurrent chemoradiation (CCR).Seventeen patients with stage III and IVa head and neck cancer, aged 58.9 +/- 5.4 years, who had completed a 9-week regimen of low-dose induction chemotherapy came to the General Clinical Research Center pre- and post-CCR for measurement of body mass composition by dual-energy X-ray absorptiometry, resting energy expenditure (REE) by indirect calorimetry, physical performance (by Modified Baecke Questionnaire and Reuben's Physical Performance Test), and functionality (Activities and Instrumental Activities of Daily Living scores). Fasting venous samples were collected to determine C-reactive protein and cytokines interleukin (IL)-1beta, IL-6, IL-8, and IL-10. Random 24-hour telephone diet recalls assessed energy intakes.Weight loss began 1 week after CCR. Lean body mass (LBM) accounted for 71.7% +/- 21% of body mass loss. No change occurred in energy intakes or calorie/nitrogen ratio. REE was significantly increased when adjusted for LBM loss (kcal/kg), p = .019. LBM loss was significantly associated with physical performance decline, r = .71, p = .004, and increased functional dependence, r = .58, p = .02. Total physical activity level declined significantly, p = .003. Cytokine levels were strongly associated with physical and functional decline.The aberrant changes in body composition, metabolism, and inflammatory state were associated with clinically and statistically significant impairments in physical performance and function. Future investigations and clinical practice should combine nutrition with antiinflammatory agents and exercise activities to support lean tissue anabolism and prevent physical and functional decline of patients with head and neck cancer undergoing CCR.
Resting energy expenditure
Body water
Regimen
Calorie
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Chemoradiotherapy
Mucositis
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Nasopharynx cancer (NPC) occurs frequently in southern China. Radiotherapy (RT) is the standard treatment for this cancer, and weight loss is commonly observed during and for a prolonged period after RT. The determinants of this phenomenon are not well known. The nutritional status of 38 NPC patients was assessed serially before and for a 6-mo period after RT. Body weight, body composition (by dual X-ray absorptiometry), basal metabolic rate (BMR, by indirect calorimetry), and calorie intake (by 3-day dietary record) were documented at pre-RT (T0), end-RT (T1), 2 mo post-end-RT (T2), and 6 mo post-end-RT (T3). The BMI at end-RT was 21.5 +- 3.7 kg/m2 (range = 13.7-27.9 kg/m2) and was significantly lower than that at pre-RT (P < 0.001). Body weight at T1-T3 was significantly lower than that at T0 (P < 0.001). Mean percentage weight loss was 10.8% at end-RT. Fifty-five percent of patients (20 of 30) had 10% weight loss by the end of RT. BMR corrected for body weight did not change significantly among the four time points, but BMRs corrected for lean body mass at T2 and T3 were significantly lower than that at T0 (P < 0.01). Patients' calorie intake generally declined from T0 to T1 (from 1,857 P < 411 kcal to 11,68 +- 549 kcal, P < 0.001) and then increased from T1 to T3. The calorie intakes at T2 and T3 were not significantly different from that at T0 but were significantly higher than that at T1. Patients were in negative energy balance before, during, and up until 6 mo after RT. The recovery in body weight lagged behind the recovery of dietary intake. Eighty-two percent of NPC patients had significant weight loss and was in negative energy balance at the end of RT, which persisted for at least 6 mo. This finding suggests that there is room for improvement in the nutritional status of patients with NPC treated with RT.
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Pathologies involving tumours of the neck are an important group of neoplasias. The tumours themselves are often the cause of malnutrition, and this may be aggravated in these patients by other factors such as: excess of alcohol and cigarettes, anatomical location of the tumour next to the digestive tract and the application of cyto-reducing treatment applied previously. The main purpose of the present study is to analyze the possible effect of hospital diets during the postoperative period in laryngectomized patients, on the development of malnutrition. For this purpose 49 patients were studied, all diagnosed consecutively during the last year as suffering from epidermoid carcinoma of the larynx, subjected to 24 total laryngectomies, 4 partial laryngectomies and 21 supraglottic laryngectomies. A conventional diet was administered at random to 21 patients, and a commercial enteral diet to the remaining 28. The most important conclusions were as follows: a) high incidence of harmful habits, b) positive nutritional state of the patients upon admittance, c) high incidence of malnutrition one week after the operation, which was maintained virtually in the same proportion to the time spent in hospital, d) the lack of influence of the nutritional state by type of diet administered, e) the possible influence on malnutrition by type of surgery performed, location of the tumour (pyriform sinus) and high incidence of complications usually developed.
Epidermoid carcinoma
Pyriform Sinus
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In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors.We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs).From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n = 24) and medical records from the year before referral (n = 45) and after HNOC care (n = 26). An impaired nutritional status was assigned to weight loss > or = 10% within six months or Body Mass Index (BMI) < 18.5 kg/m2 and 'at risk' to weight loss > or = 5% but < 10% within six months.Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI.Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care.
Medical record
Weight management
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The purpose of this study was to determine the influence of weight loss on outcome in patients with head and neck cancer undergoing concomitant chemoradiotherapy (CCRT): treatment interruption, infections, mortality, and hospital readmission rate.Forty patients with head and neck cancer were enrolled. All patients were counseled to follow a nutritional program during CCRT. Body weight was evaluated at baseline, at the end, and 30 days after radiochemotherapy.Ninety percent of compliant patients with nutritional program maintained body weight (mean, 1 +/- 2.4 kg) and 100% of noncompliant patients continued to lose weight (mean, -9 +/- 4 kg; p < .001). A reduction greater than 20% of prediagnosis weight significantly correlated with treatment interruption (p = .003), infections (p = .002), early mortality (p = .011), hospital readmission rate (p = .001), and survival (log-rank test: z = -2.722, p = .006).In patients with head and neck cancer undergoing CCRT, the early nutritional management reduces weight loss and improve outcome.
Concomitant
Chemoradiotherapy
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