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
Malnutrition occurs frequently in patients with cancer of the gastrointestinal (GI) or head and neck area and can lead to negative outcomes. The aim of this study is to determine the impact of early and intensive nutrition intervention (NI) on body weight, body composition, nutritional status, global quality of life (QoL) and physical function compared to usual practice in oncology outpatients receiving radiotherapy to the GI or head and neck area. Outpatients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were randomised to receive intensive, individualised nutrition counselling by a dietitian using a standard protocol and oral supplements if required, or the usual practice of the centre (general advice and nutrition booklet). Outcome parameters were measured at baseline and 4, 8 and 12 weeks after commencing radiotherapy using valid and reliable tools. A total of 60 patients (51 M : 9 F; mean age 61.9+/-14.0 years) were randomised to receive either NI (n=29) or usual care (UC) (n=31). The NI group had statistically smaller deteriorations in weight (P<0.001), nutritional status (P=0.020) and global QoL (P=0.009) compared with those receiving UC. Clinically, but not statistically significant differences in fat-free mass were observed between the groups (P=0.195). Early and intensive NI appears beneficial in terms of minimising weight loss, deterioration in nutritional status, global QoL and physical function in oncology outpatients receiving radiotherapy to the GI or head and neck area. Weight maintenance in this population leads to beneficial outcomes and suggests that this, rather than weight gain, may be a more appropriate aim of NI.
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Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy. The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to standard nutritional care (SC). A prospective study, conducted between 2005 and 2007, compared individual dietary counselling (IDC, optimal energy and protein requirement) to SC by an oncology nurse (standard nutritional counselling). Endpoints were weight loss, BMI and malnutrition (5 % weight loss/month) before, during and after the treatment. Thirty-eight patients were included evenly distributed over two groups. A significant decrease in weight loss was found 2 months after the treatment ( P = 0·03) for IDC compared with SC. Malnutrition in patients with IDC decreased over time, while malnutrition increased in patients with SC ( P = 0·02). Therefore, early and intensive individualised dietary counselling by a dietitian produces clinically relevant effects in terms of decreasing weight loss and malnutrition compared with SC in patients with head and neck cancer undergoing radiotherapy.
Medical nutrition therapy
Nutritional Supplementation
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Background & Aims: We compared the screening nutritional data of patients with malignant and non-malignant disease, and classified their nutritional risk according to the primary tumor’s site. Methods: Subjective Global Assessment was applied to 3008 patients within 48 h of admission to a public university. Subjects were divided into Oncologic Group (n = 576) or Non-Oncologic Group (n = 2432) according to the presence of neoplasms or other diseases respectively. These data were compared by the t-student test and classic chi-square test, with statistical significance set at p < 0.05. Results: The Oncologic Group presented a higher prevalence of weight loss (60.3% vs. 49.3%), quantitative (40.7% vs. 28.5%) and qualitative (16.4% vs. 7.6%) alterations in the food intake pattern, gastrointestinal symptoms and muscle waste (23.2% vs. 13.2%) as compared to the Non-Oncologic Group. Also, there was a higher prevalence of nutritional disturbances in the Oncologic Group, with 49.5% of the subjects moderately (or suspected to be malnourished) and 12.7% severely mal-nourished. Severe malnourishment was mainly observed in patients with head and neck (25%), upper digestive tract (21.9%) and soft tissue and bones (17.9%) tumors. Conclusion: When compared to other hospitalized patients, patients with neoplastic disease were in higher nutritional risk.
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To measure the prevalence of malnutrition, risk factors for poor dietary intake and body composition in patients with brain tumours admitted to hospital for surgical resection.In this study, 316 patients admitted for brain tumour resection to the Neurosurgical service at St. Michael's Hospital were screened. Assessment tools included the Subjective Global Assessment (SGA) for nutritional status and Bioelectrical Impedance Analysis (BIA) for body composition. All measurements were performed by one research dietitian. Information regarding medical history, symptomology, and tumour pathology was recorded.One hundred and nine participants were recruited. Malnutrition was present in 17.6% of patients, of whom 94.7% were moderately malnourished (SGA-B) and 5.3% severely malnourished (SGA-C). Key symptoms contributing to malnutrition included weight loss, nausea, vomiting, dysphagia, headaches, and fatigue. Patients with malignant tumors were more likely to have weight loss and lower fat mass.This study demonstrated that patients admitted for brain tumour resection have a low prevalence of malnutrition compared with other cancer populations. Useful parameters for nutritional screening of inpatient admissions include weight loss >5% of usual weight, nausea, vomiting, dysphagia, and headaches.
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To identify the incidence of obstructive sleep apnea (OSA) in patients treated for head and neck cancer. Obstructive sleep apnea is a relatively common and highly morbid condition that affects 9.1% of male and 4% of female middle-aged adults.1 Patients who have been successfully treated for head and neck cancer may often have a partially obstructed upper airway which is functional during the day, but collapses during sleep.Twenty-four patients successfully treated for tumors of the tongue-base, pharynx, or supraglottic larynx were enrolled. Through OSA-related questionnaires, physical examination, and polysomnography, the incidence of OSA in this patient population was determined and compared with that of the general population.The incidence of OSA (91.7%) in this head and neck cancer patient population was found to be significantly (P =.001) higher than that of the general population. (In a random sampling of middle-aged adult males between the ages of 30 and 60 years old with a respiratory disturbance index (RDI) >15, the prevalence was previously reported to be 9.1%.1) Sixteen of 24 patients (72.7%) had clinically defined symptoms of sleep apnea. Ten of 24 patients (41.7%) received radiation therapy; all had an RDI >15. Eleven of the 14 patients (78.5%) who did not receive radiation therapy also had an RDI >15. Eight patients (33.3%) continue to regularly use continuous positive airway pressure with significant improvement in symptoms.Identification and treatment of OSA may be an important factor in improving quality of life for patients with head and neck cancer.
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To identify clinical factors associated with enteral feeding tube placement in a head and neck cancer population.A self-administered survey was given to patients being treated for head and neck cancer while they were waiting to be seen in 1 of 4 otolaryngology clinics. The post hoc analysis presented here combines survey and chart review data to determine clinical and demographic variables associated with feeding tube placement.Four otolaryngology clinics.Otolaryngology clinic patients being treated for head and neck cancer.Enteral feeding tube placement.Of the 724 patients eligible for this study, 14% (n = 98) required enteral feeding tube placement. Multivariate analysis found the following variables to be independently associated with feeding tube placement: oropharynx/hypopharynx tumor site (odds ratio [OR], 2.4; P = .01), tumor stage III/IV (OR, 2.1; P = .03), flap reconstruction (OR, 2.2; P = .004), current tracheotomy (OR, 8.0; P<.001), chemotherapy (OR, 2.6; P<.001), and increased age (OR, 1.3; P = .02). In addition, there was a curvilinear relationship between time since treatment and feeding tube placement, with about 30% having a feeding tube at 1 month posttreatment, tapering down during the first 3 years to about 8% and leveling off thereafter.Identification of factors associated with an increased risk of feeding tube placement may allow physicians to better counsel patients regarding the possibility of feeding tube placement during treatment. Since feeding tube placement has been linked to decreased quality of life in head and neck cancer, such counseling is an integral part of the clinical management of these patients.
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Background. We aimed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer, specifically, nutritional outcome, morbidity, and quality of life (QOL), during and 3 months after radiotherapy. Methods. Seventy-five patients with head and neck cancer who were referred for radiotherapy (RT) were randomized to the following groups: group 1 (n = 25), patients who received dietary counseling with regular foods; group 2 (n = 25), patients who maintained usual diet plus supplements; and group 3 (n = 25), patients who maintained intake ad lib. Nutritional intake (determined by diet history) and status (determined by Ottery's Subjective Global Assessment), and QOL (determined by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 [EORTC QLQ-C30]) were evaluated at baseline, at the end of RT, and at 3 months. Results. Energy intake after RT increased in both groups 1 and 2 (p ≤ .05). Protein intake also increased in both groups 1 and 2 (p ≤ .006). Both energy and protein intake decreased significantly in group 3 (p < .01). At 3 months, group 1 maintained intakes, whereas groups 2 and 3 returned to or below baseline levels. After RT, >90% of patients experienced RT toxicity; this was not significantly different between groups, with a trend for reduced symptomatology in group 1 versus group 2/group 3 (p < .07). At 3 months, the reduction of incidence/severity of grade 1+2 anorexia, nausea/vomiting, xerostomia, and dysgeusia was different: 90% of the patients improved in group 1 versus 67% in group 2 versus 51% in group 3 (p < .0001). After RT, QOL function scores improved (p < .003) proportionally with improved nutritional intake and status in group 1/group 2 (p < .05) and worsened in group 3 (p < .05); at 3 months, patients in group 1 maintained or improved overall QOL, whereas patients in groups 2 and 3 maintained or worsened overall QOL. Conclusions. During RT, nutritional interventions positively influenced outcomes, and counseling was of similar/higher benefit; in the medium term, only counseling exerted a significant impact on patient outcomes. © 2005 Wiley Periodicals, Inc. Head Neck 27: XXX–XXX, 2005
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Abstract Background Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGTs) for nutritional support of patients with head and neck cancer undergoing curative (chemo) radiotherapy without any good scientific basis. Methods A prospective study was conducted to compare PEG tubes and NGTs in terms of nutritional outcomes, complications, patient satisfaction, and cost. Results There were 32 PEG and 73 NGT patients. PEG patients sustained significantly less weight loss at 6 weeks post‐treatment (median 0.8 kg gain vs 3.7 kg loss, p < .001), but had a high insertion site infection rate (41%), longer median duration of use (146 vs 57 days, p < .001), and more grade 3 dysphagia in disease‐free survivors at 6 months (25% vs 8%, p = .07). Patient self‐assessed general physical condition and overall quality of life scores were similar in both groups. Overall costs were significantly higher for PEG patients. Conclusion PEG tube use should be selective, not routine, in this patient population. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
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Malnutrition has been recognized as a poor prognostic indicator for cancer treatment-related morbidity and mortality in general, and it is reported to affect 30-50% of all patients with head and neck cancer. In this study, the correlation of nutritional status with 3-year survival was studied prospectively in 64 patients with T2-T4 carcinomas of the head and neck who were treated surgically with curative intent; the surgery was often followed by radiotherapy.All patients underwent nutritional screening according to six different parameters on the day prior to surgery. Overall and disease specific survival analyses were performed with a follow-up period of at least 3 years. Survival analyses were performed with the log rank test and the Cox proportional hazards model.Lymph node stage, nonradical resection margins, and occurrence of major postoperative complications were demonstrated to affect disease specific survival for the group as a whole. None of the investigated nutritional parameters were correlated with survival. When men and women were analyzed separately, however, a preoperative weight loss of >5% did have a prognostic value for men. The combination of male gender, preoperative weight loss, and major postoperative complications were related to early death.Apart from the well-known prognostic parameters lymph node status (T classification) and status of surgical margins, preoperative weight loss and occurrence of major postoperative complications were also found to have a negative effect on the survival of male patients undergoing surgery for advanced head and neck cancer.
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