Intensive nutritional care for patients treated with radiotherapy in head and neck cancer: a randomized study and meta-analysis

Abstract

Nutritional care improves quality of life (QOL) in head and neck cancer patients treated with radiotherapy. The aim of our study was to determine whether intensive nutritional care (INC) would further improve QOL. In addition to a control group based on European and American guidelines, patients included in the INC group received six meetings with a dietitian. QOL was measured after radiotherapy using the EORTC QLQ-C30. We performed a meta-analysis to determine the best nutritional care. In the 87 patients, the QOL scores, weight, energy, and protein intakes were similar between the INC group (n = 43) and the control group (n = 44). The meta-analysis revealed no heterogeneity and significant differences in QOL (three studies) (p = 0.46) or weight changes after radiotherapy (four studies) (p = 0.06). The nutritional care specified in the European and American guidelines is composed of well-defined recommendations, and appears sufficient to maintain QOL without further intervention.

Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis

“…Two of the full scale RCTs studies [ 23 , 26 ] were considered as high quality (eight to 10 points) ( Table 3 ), four were considered of moderate quality (five to seven points) [ 22 , 27 , 29 , 30 ] and three as low quality [ 21 , 24 , 25 ]. Two of the pilot RCTs [ 28 , 31 ] were of high quality and two of moderate quality [ 9 , 32 ].…”

“…Four pilot RCTs ( Table 2 ) investigated effects of interventions combining nutrition and physical exercise [ 9 , 28 , 31 , 32 ] with sample sizes between 15 [ 28 ] and 60 participants [ 32 ]. Seven studies investigated the effects of nutritional interventions only [ 21 , 23 , 24 , 25 , 26 , 27 , 29 ] with sample sizes varying from 31 [ 24 ] to 159 participants [ 23 ] and study duration ranging from six weeks during treatment [ 26 ] up to six months due to follow up after the intervention period [ 21 ] ( Table 2 and Table 4 ). One study had three arms [ 27 ], i.e., one group received individualized dietary counselling, one ONS and the last group was advised to eat ad libitum.…”

“…Nine studies were included in the quantitative synthesis of effects on body composition ( Figure 2 a) [ 9 , 23 , 24 , 25 , 26 , 28 , 29 , 31 , 32 ]. Absolute weight or weight change were used as outcome variable for body composition in all studies except for three [ 28 , 31 , 32 ] were change in BMI was used.…”

“…The most frequent nutritional intervention (six of 11 studies) was individualized dietary counselling based on regular food with or without ONS aiming to meet estimated individual needs for energy and protein [ 23 , 25 , 27 , 28 , 29 , 31 ]. In three of the studies [ 23 , 25 , 29 ], dietary counselling was considered as standard care and therefor applied in the control group but with less monitoring and feedback than in the intervention group. In one study, participants in both groups received dietary counselling by a dietitian before initiation of CRT, and then again at discretion of the attending physician, if the participants experienced a decrease in BMI of 5 to 10% [ 31 ].…”

“…Four studies [ 25 , 30 , 31 , 32 ] did not present data regarding nutritional interventions adherence. Three studies evaluated adherence in relation to how well the patients met their energy and protein needs [ 23 , 27 , 29 ]. In two of these studies [ 23 , 29 ] intake in accordance with estimated needs was reported during the intervention and follow-up both in the intervention and control group.…”