Evaluation of a novel pre‐treatment model of nutrition care for patients with head and neck cancer receiving chemoradiotherapy

Abstract

Weight loss and malnutrition occur frequently in patients with head and neck cancer and are associated with reduced survival. This pragmatic study aimed to determine the effect of a novel pre-treatment model of nutrition care on nutrition outcomes for patients with head and neck cancer receiving chemoradiotherapy. Methods: This health service evaluation consisted of an evaluation of the new model of care implementation (Phase 1) and an evaluation of patient outcomes (Phase 2) in pre-and post-implementation cohorts (n = 64 and n = 47, respectively). All Phase 2 patients received a prophylactic gastrostomy. The new model of care consisted of dietary counselling and commencement of proactive supplementary enteral nutrition via a prophylactic gastrostomy, in addition to normal oral intake, prior to treatment commencement. Nutrition outcomes were collected at baseline (pre-treatment) and 3 months post-radiotherapy completion.Results: The new model of care was successfully incorporated into practice with high referral (96.5%) and attendance (91.5%) rates to the counselling session, and high adherence rates to proactive tube feeding (80.9%). Patients in the postimplementation cohort had less weight-loss (1.2%; p = 0.338) and saw less of a decline in nutritional status compared to patients in the pre-implementation cohort (23% vs. 30%, respectively; p = 0.572), deemed clinically important. However, patients still experienced critical weight loss overall (mean 9.9%). Conclusion: Pre-treatment nutrition care was feasible in standard clinical practice and demonstrated clinically relevant outcome improvements for patients. Future high-quality research is warranted to investigate further multidisciplinary strategies to attenuate weight-loss further, inclusive of patient-reported barriers and enablers to nutrition interventions.

Nutritional prehabilitation strategies for patients undergoing head and neck cancer: a scoping review

“…This review included 12 nutritional prehabilitation studies published between 2004 and 2023 (Table 1). Of these, 75% (n = 9) were randomized controlled trials 24,[27][28][29][30][31][33][34][35] , 17% (n = 2) were prospective cohort studies 25,26 , and 8% (n = 1) were quasi-experiments 32 . At present, research on nutritional prehabilitation is mainly conducted in Asia (n = 8), followed by North Europe (n = 1), South America (n = 1), North America (n = 1), and Oceania (n = 1); 58% (n = 7) of the studies were from China.…”

“…The nutritional prehabilitation intervention strategy included in the review follows the principles of assessment, type, goal, frequency, and re-evaluation, although it is not comprehensive. The most common nutritional prehabilitation strategy was enteral nutrition rich in protein supplements (n = 6) 25,29,[31][32][33]35 . The types of nutritional prehabilitation in other literature were as follows: eicosapentaenoic acid-enriched products (n = 2) 27,28 , dietary advice and enteral nutrition (n = 8) 25,26,[29][30][31][32][33][34] , dietary advice and ONSs (n = 1) 24 , and only dietary advice (n = 3) 26,30,34 .…”

“…The total nutritional prehabilitation durations were categorized as <2 weeks (n = 3), ≥ 2 weeks (n = 5), and not described (n = 6). Five studies monitored patient compliance 24,25,[27][28][29] . Self-reported adherence using booklets/dairies (n = 3) 24,27,29 , telephone (n = 1) 28 , and medical records (n = 1) 25 were reported.…”

“…Five studies monitored patient compliance 24,25,[27][28][29] . Self-reported adherence using booklets/dairies (n = 3) 24,27,29 , telephone (n = 1) 28 , and medical records (n = 1) 25 were reported. Of all the studies, 58% (n = 7) did not describe the monitoring methods for patient compliance 26,[30][31][32][33][34][35] .…”

Evidence as foundation of practice

“…The clinical context is therefore a rich environment for translational studies, action research, and implementation science. The study by Blake et al 4 in this issue exemplifies this, evaluating a novel model of dietetic care with a prophylactic gastrostomy tube in patients being treated for head and neck cancers. By looking at practical considerations such as adherence, in addition to clinical outcomes, the authors can show the value of familiarising patients with tube management earlier in their journey, as part of a prehabilitation process, and justify this new approach to patient care.…”