Efeito do atendimento nutricional intensivo em pacientes com câncer de cabeça e pescoço submetidos à radioterapia

Abstract

Faria SO. Effect of intensive nutritional care in patients with head and neck cancer undergoing radiotherapy [thesis]. São Paulo: "Faculdade de Medicina, Universidade de São Paulo"; 2020.Guidelines recommend frequent contacts with dietitians during the treatment of head and neck cancer (HNC) to increase food intake and prevent weight loss. However, few studies have examined the effectiveness of implementing nutritional guidelines recommendations and the role of adherence to nutritional prescription. Four manuscripts composed this thesis. In January 2013, the Instituto do Câncer do Estado de São Paulo implemented a protocol of intensive nutritional care during HNC radiotherapy. The objectives of this research were to verify the effect of the implementation of the protocol of intensive nutritional care on the nutritional status and quality of life (QOL) of patients with HNC undergoing radiotherapy, the importance of adhering to the protocol, as well as investigating factors associated with adherence. The research was divided into a retrospective part, with analysis of data from medical records, and a prospective part.Patients with HNC submitted to radiotherapy were included. The outcomes were nutritional status (weight loss and subjective global assessment), food intake, QOL and survival. Patients who missed more than 25% of appointments with the dietitian during radiotherapy were considered non-adherent. An analysis of the data, in a retrospective study with 472 patients, comparing the outcomes before and after the implementation of the intensive nutritional care protocol (first manuscript), showed greater weight loss before (-6.7%; interquartile range (IQR) -10.5 / -1.9) than after the implementation of the protocol (-5.0%; IQR -9.8 / -0.7), although not statistically significant (p = 0.06). There was also no significant difference in terms of capacity to accomplish nutritional intake recommendations. In a second analysis, limited to 317 patients after the implementation of the protocol (second manuscript), it was found that less than half of the patients (45.7%) were adherent. There was less significant weight loss in the group of adherents (42.8% vs 55.8%, p = 0.02), although there was no difference in nutritional intake. Overall survival was not different between groups. In a logistic regression model, adherence to the protocol resulted in 43% (odds ratio 0.57, 95% confidence interval 0.34 -0.97) of protection for significant weight loss. In the third manuscript, a scoping review was carried out to map the evidence on adherence to oral nutritional intervention in patients with HNC. The review showed that there is no robust evidence base on this topic. In the fourth manuscript, with prospective data from 80 patients after implementing the protocol of intensive nutritional care, most patients reported stable or better QOL in all domains, except for fatigue, pain and senses during radiotherapy. Only non-adherent patients had a significant clinical worsening in physical, cognitive and social function, and showed a...