Teresa Brown1, Lynda Ross, Lee Jones, Brett Hughes, Merrilyn Banks. 1. Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Level 2, James Mayne Building, Butterfield St, Herston, Brisbane, QLD, 4029, Australia, teresa.brown@health.qld.gov.au.
Abstract
PURPOSE: Head and neck cancer patients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients. METHODS: This study is a prospective observational audit in patients treated for head and neck cancer at a tertiary hospital from 2007 to 2008 (n = 539). Nutrition outcomes (weight, nutritional status and type of nutrition support) were compared for each nutrition risk category. Primary outcome was 10 % or more weight loss at 3 months post-treatment (n = 219). RESULTS: Overall adherence to the guideline tube feeding recommendations was 81 %. High risk patients had mean weight loss of 6 % on completion of treatment and 9 % at 3 months post-treatment, despite the majority having a proactive gastrostomy tube. Medium and low risk patients also lost weight over this time. Univariate analysis found that non-adherence to the guidelines was associated with weight loss at 3 months (p = 0.013). Multivariate analysis found overweight patients had 1.82 greater odds, and obese patients had 3.49 greater odds of losing weight (p = 0.021). Patients with significant weight loss at diagnosis had decreased odds of losing weight later (p = 0.011). CONCLUSION: Clinically significant weight loss was still prevalent in this population despite proactive interventions. Predictors of weight loss support the evidence-based guidelines' risk categories, and adherence was important to improve outcomes. Further research is required to determine the impact of significant weight loss in patients with high body mass index (BMI).
PURPOSE: Head and neck cancerpatients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients. METHODS: This study is a prospective observational audit in patients treated for head and neck cancer at a tertiary hospital from 2007 to 2008 (n = 539). Nutrition outcomes (weight, nutritional status and type of nutrition support) were compared for each nutrition risk category. Primary outcome was 10 % or more weight loss at 3 months post-treatment (n = 219). RESULTS: Overall adherence to the guideline tube feeding recommendations was 81 %. High risk patients had mean weight loss of 6 % on completion of treatment and 9 % at 3 months post-treatment, despite the majority having a proactive gastrostomy tube. Medium and low risk patients also lost weight over this time. Univariate analysis found that non-adherence to the guidelines was associated with weight loss at 3 months (p = 0.013). Multivariate analysis found overweight patients had 1.82 greater odds, and obesepatients had 3.49 greater odds of losing weight (p = 0.021). Patients with significant weight loss at diagnosis had decreased odds of losing weight later (p = 0.011). CONCLUSION: Clinically significant weight loss was still prevalent in this population despite proactive interventions. Predictors of weight loss support the evidence-based guidelines' risk categories, and adherence was important to improve outcomes. Further research is required to determine the impact of significant weight loss in patients with high body mass index (BMI).
Authors: Samuel G Shiley; Christopher A Hargunani; Judith M Skoner; John M Holland; Mark K Wax Journal: Otolaryngol Head Neck Surg Date: 2006-03 Impact factor: 3.497
Authors: B R Pauloski; A W Rademaker; J A Logemann; D Stein; Q Beery; L Newman; C Hanchett; S Tusant; E MacCracken Journal: Head Neck Date: 2000-08 Impact factor: 3.147
Authors: M G A van den Berg; E L Rasmussen-Conrad; G M Gwasara; P F M Krabbe; A H J Naber; M A Merkx Journal: Clin Nutr Date: 2006-05-15 Impact factor: 7.324
Authors: S Tyldesley; F Sheehan; P Munk; V Tsang; D Skarsgard; C A Bowman; S E Hobenshield Journal: Int J Radiat Oncol Biol Phys Date: 1996-12-01 Impact factor: 7.038
Authors: Marie-Astrid Piquet; Mahmut Ozsahin; Isabelle Larpin; Abderrahim Zouhair; Pauline Coti; May Monney; Philippe Monnier; René-Olivier Mirimanoff; Michel Roulet Journal: Support Care Cancer Date: 2002-08-02 Impact factor: 3.603
Authors: Julia R Van Liew; Rebecca L Brock; Alan J Christensen; Lucy Hynds Karnell; Nitin A Pagedar; Gerry F Funk Journal: Head Neck Date: 2016-10-05 Impact factor: 3.147
Authors: May Kay Neoh; Zalina Abu Zaid; Zulfitri Azuan Mat Daud; Nor Baizura Md Yusop; Zuriati Ibrahim; Zuwariah Abdul Rahman; Norshariza Jamhuri Journal: Nutrients Date: 2020-04-26 Impact factor: 5.717