Nutritional intervention in head and neck cancer patients during chemo-radiotherapy

Abstract

Objective: Head and neck cancer patients experience unintentional weight loss and malnutrition at diagnosis, during oncologic treatment, and after the end of therapy because of reduction of eating ability. The aim of the present study was to assess nutrition intervention efficacy in maintaining basal nutritional conditions.

Methods: Head and neck cancer patient candidates for chemoradiotherapy and requiring enteral nutrition (EN) support through gastrostomy, according to international guidelines, were included in the study. Nutritional intervention aimed to reach 30 kcal/kg/d, considering both EN and oral intake. Adjustments were made during and after treatment, aiming to maintain stable or improving nutritional indicators. Anthropometry, body composition measured by bioelectrical impedance vector analysis, and oral and EN intake were monitored at baseline (before chemoradiotherapy) and at 1, 3, and 6 mo.

Results: A total of 54 patients were evaluated; 35 patients completed follow-up at 6 mo and were included in the analysis. At baseline, mean weight loss in the last 6 mo was 12 ± 7.9%; mean body mass index and phase angle were 20.6 ± 3.9 kg/m² and 4.8 ± 1.2°. Before chemoradiotherapy 21 patients (60%) were able to eat; the percentage decreased during and after treatment to 34.3% (P = 0.026) at 1 and 3 mo and at 51.4% at 6 mo. From the analysis, a mean daily energy intake of 35 ± 10 kcal/kg was needed to maintain stable body weight and phase angle during and after treatment.

Conclusion: To preserve body weight and composition, we identified an energy requirement greater than expected both during and after chemoradiotherapy.

Keywords: Chemoradiotherapy; Energy requirement; Enteral nutrition; Head and neck cancer; Phase angle.