Nutritional Counseling for Head and Neck Cancer Patients Undergoing (Chemo) Radiotherapy—A Prospective Randomized Trial

Abstract

Background: Locally advanced head and neck cancer is managed either by combined surgery and (chemo) radiotherapy or definitive (chemo) radiotherapy, which may deteriorate nutritional status. Previous data have shown that intensive nutritional intervention by a dietician reduces radiation-induced adverse events including weight loss.Objective: To determine if on-demand nutritional counseling (ODC, control group) would be as efficacious as intensive nutritional counseling (INC, experimental group) in patients undergoing (chemo) radiotherapy.Methods: Fifty-eight patients were randomly assigned to receive INC (n = 26) or ODC (n = 32). Outcome measures were nutritional status (PG-SGA), weight loss, handgrip strength (HGS), body composition, and survival.Results: Weight loss and impaired nutritional parameters during oncological treatment were seen equally in both groups (NS). Leaner patients at baseline maintained their weight, while overweight patients lost both weight and handgrip strength during treatment. Disease-free survival (DFS) (median = 43 months) was not affected by weight loss during treatment. Lower baseline HGS and malnutrition were associated with worse DFS (low vs. normal HGS: 15 vs. 42 months; p = 0.05 and malnutrition vs. good nutrition status: 17 vs. 42 months; p = 0.014, respectively). Survival according to low vs. normal HGS in the INC group was 4 vs. 44 months (p = 0.007) and in the ODC group 28 vs. 40 months (p = 0.944). According to malnutrition vs. good nutritional status in the INC group, DFS was 21 vs. 43 months (p = 0.025) and in the ODC group 15 vs. 41 months (p = 0.03).Conclusions: As for our primary endpoint, individualized on-demand nutritional counseling was as efficacious as intensive counseling in preventing deterioration of nutritional status and incidence of malnutrition during (chemo) radiotherapy. This should be verified with larger number of patients. Additional findings were that overweight patients had more severe weight loss, but not poorer survival. Low HGS and malnutrition at baseline were associated with poor survival.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02159508.

Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

“…Similar to other studies [15,16,19], we observed that those who used ONS showed less weight loss (except of the overweight) and consumed more protein (0.14 g/kg/day). Additionally, malnourished patients lost less weight, while overweight patients lost more weight, showing that the initial BMI defines the BWC.…”

“…An additional finding was an accumulated deficit of weight loss that was found before the start of treatment. Corroborating these findings, Orell et al [16] found that overweight patients lost more weight due to symptoms such as anorexia and nausea. According to the Aspen Guideline [48], critically ill patients with obesity have greater complications when compared to patients with normal weight classified by BMI and have an indication for assessment and early nutritional support.…”

“…Thus, when oral nutrition is inadequate, ONS use and tube feeding are indicated. HNC patients who receive nutritional counseling and use nutritional support show improvement in weight loss, quality of life and survival [14][15][16][17].…”

A Study on Challenges to Health Care Delivery Faced by Cancer Patients in India During the COVID-19 Pandemic

“…The guidelines framed by expert committees stress on the core treatment modalities. But the importance of keeping the supportive care ongoing in the form of nutritional support which is an integral part of cancer care and is particularly of importance for patients with head and neck cancers and gastrointestinal tract cancers, 20,21 psychological and peer group support 22 have not found importance. The strategies adopted by the organizations providing cancer care also did not spell out clearly their standpoint to keep these services running.…”

Prognostic Role of Muscle Depletion in Palliative Care Patients With Incurable Cancer: A Retrospective Study

“…In the evaluation of muscle strength in patients with cancer, hand grip strength measurement has been widely used as a standard approach [30]. Previous studies showed that reduced hand grip strength is associated with worse prognosis [31,32] and poor treatment outcome [33,34]. However, these studies involved patients with cancer with a longer prognosis who are receiving anticancer treatment.…”