Sheilla de Oliveira Faria1,2,3, Doris Howell4,5, André Lopes Carvalho6, Rafael de Oliveira Faria7, José Eluf Neto8. 1. Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr Arnaldo, 455 2ºandar, Sao Paulo, SP, 01246-903, Brazil. sheila.faria@usp.br. 2. Princess Margaret Cancer Centre Research Institute, Toronto, ON, Canada. sheila.faria@usp.br. 3. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. sheila.faria@usp.br. 4. Princess Margaret Cancer Centre Research Institute, Toronto, ON, Canada. 5. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 6. Head and Neck Surgery, Barretos Cancer Hospital, Barretos, SP, Brazil. 7. Departamento de Engenharia Agrícola, Universidade Federal de Lavras, Lavras, MG, Brazil. 8. Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr Arnaldo, 455 2ºandar, Sao Paulo, SP, 01246-903, Brazil.
Abstract
PURPOSE: The aim of this study was to determine the prevalence and effect of adherence to intensive nutritional care on nutritional outcomes and survival in head and neck cancer patients undergoing radiotherapy. METHODS: Three-hundred and seventeen head and neck cancer patients referred to intensive nutrition support during radiotherapy were retrospectively analyzed. Patients who missed less than 25% of their appointments with the dietitian were considered adherent. Primary outcome was percentage weight loss during treatment. Secondary outcomes were overall survival and patients' capacity to accomplish their caloric and protein recommendations. Logistic regression was used to examine predictors of weight loss and Kaplan-Meier to estimate survival. RESULTS: Less than half of the patients (n = 145, 45.7%) were adherent. Statistically significant less weight loss in the adherent group (42.8% vs 55.8%; p = 0.02) was found, despite no difference in energy or protein intake. Logistic regression models after adjusting for other variables demonstrated that adherence resulted in 43% protection from significant weight loss (odds ratio 0.57, 95% CI 0.34-0.97). Overall survival was not different between groups. CONCLUSION: Findings demonstrated that patients who were adherent to weekly contacts with the dietitian had less weight loss, but not better survival or nutritional intake. Additional investigation of factors that may act as barriers or enablers for adherence could help improve the outcomes in this population.
PURPOSE: The aim of this study was to determine the prevalence and effect of adherence to intensive nutritional care on nutritional outcomes and survival in head and neck cancerpatients undergoing radiotherapy. METHODS: Three-hundred and seventeen head and neck cancerpatients referred to intensive nutrition support during radiotherapy were retrospectively analyzed. Patients who missed less than 25% of their appointments with the dietitian were considered adherent. Primary outcome was percentage weight loss during treatment. Secondary outcomes were overall survival and patients' capacity to accomplish their caloric and protein recommendations. Logistic regression was used to examine predictors of weight loss and Kaplan-Meier to estimate survival. RESULTS: Less than half of the patients (n = 145, 45.7%) were adherent. Statistically significant less weight loss in the adherent group (42.8% vs 55.8%; p = 0.02) was found, despite no difference in energy or protein intake. Logistic regression models after adjusting for other variables demonstrated that adherence resulted in 43% protection from significant weight loss (odds ratio 0.57, 95% CI 0.34-0.97). Overall survival was not different between groups. CONCLUSION: Findings demonstrated that patients who were adherent to weekly contacts with the dietitian had less weight loss, but not better survival or nutritional intake. Additional investigation of factors that may act as barriers or enablers for adherence could help improve the outcomes in this population.
Authors: Catherine Kubrak; Kärin Olson; Naresh Jha; Louise Jensen; Linda McCargar; Hadi Seikaly; Jeffery Harris; Rufus Scrimger; Matthew Parliament; Vickie E Baracos Journal: Head Neck Date: 2010-03 Impact factor: 3.147