Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 7/2010

01-07-2010 | Original Article

Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy

Authors: Agostino Paccagnella, Michela Morello, Maria C. Da Mosto, Carla Baruffi, Maria L. Marcon, Alessandro Gava, Vittorio Baggio, Stefano Lamon, Roberta Babare, Giovanni Rosti, Marta Giometto, Paolo Boscolo-Rizzo, Edward Kiwanuka, Michele Tessarin, Lorenza Caregaro, Carlo Marchiori

Published in: Supportive Care in Cancer | Issue 7/2010

Login to get access

Abstract

Goals of work

Patients with head and neck cancer (HNC) undergoing chemoradiotherapy are at high risk of malnutrition, which is related to complication rate. The aim of this study was to investigate the impact of an early intensive nutritional intervention on nutritional status and outcomes in patients undergoing chemoradiotherapy for HNC.

Materials and methods

We analysed retrospectively the clinical documentation of 33 HNC patients who were referred for early nutritional intervention (nutrition intervention group, NG) before they were submitted to chemoradiotherapy. The outcome of these patients was compared to that of 33 patients who received chemoradiotherapy without receiving a specifically designed early nutrition support programme (control group, CG).

Main results

NG patients lost less weight during chemoradiotherapy compared to CG patients (−4.6 ± 4.1% vs −8.1 ± 4.8% of pre-treatment weight, p < 0.01, at the completion of treatment). Patients in the NG experienced fewer radiotherapy breaks (>5 days) for toxicity (30.3% vs 63.6%, p < 0.01); the mean number of days of radiation delayed for toxicity was 4.4 ± 5.2 in NG vs 7.6 ± 6.5 in CG (p < 0.05); a linear correlation was found between percentage of weight lost from baseline to chemoradiotherapy completion and days of radiation delays (p < 0.01). There were less patients who had an unplanned hospitalisation in the NG relative to the CG (16.1% vs 41.4%, p = 0.03). In the NG, symptoms having an effect on the nutritional status developed early and were present in the nearly totality of patients at chemotherapy completion; 60.6% of NG patients needed tube feeding.

Conclusions

Early nutrition intervention in patients with HNC receiving chemoradiotherapy resulted in an improved treatment tolerance and fewer admissions to hospital. This result suggests that nutritional intervention must be initiated before chemoradiotherapy, and it needs to be continued after treatment completion.
Literature
1.
Adelson RT, Ducic Y (2005) Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site. Head Neck 27:339–343CrossRefPubMed
2.
Al-Othman MO, Amdur RJ, Morris CG, Hinerman RW, Mendenhall WM (2003) Does feeding tube placement predict for long-term swallowing disability after radiotherapy for head and neck cancer? Head Neck 25:741–747CrossRefPubMed
3.
Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509CrossRefPubMed
4.
Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de, van der Schueren MA, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A, DGEM (German Society for Nutritional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 25:245–259CrossRefPubMed
5.
Barak N, Wall-Alonso E, Sitrin MD (2002) Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN J Parenter Enteral Nutr 26:231–238CrossRefPubMed
6.
Beaver ME, Matheny KE, Roberts DB, Myers JN (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125:645–648CrossRefPubMed
7.
Bieri S, Bentzen SM, Huguenin P, Allal AS, Cozzi L, Landmann C, Monney M, Bernier J (2003) Early morbidity after radiotherapy with or without chemotherapy in advanced head and neck cancer. Experience from four nonrandomized studies. Strahlenther Onkol 179:390–395PubMed
8.
Boscolo-Rizzo P, Maronato F, Marchiori C, Gava A, Da Mosto MC (2008) Long-term quality of life after total laryngectomy and postoperative radiotherapy versus concurrent chemoradiotherapy for laryngeal preservation. Laryngoscope 118:300–306CrossRefPubMed
9.
Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, George SL, Huang AT, Prosnitz LR (1998) Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 338:1798–1804CrossRefPubMed
10.
Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M (2008) Influence of weight loss on outcomes in patients with head and neck cancer undergoing concurrent chemoradiotherapy. Head Neck 30:503–508CrossRefPubMed
11.
Chencharick JD, Mossman KL (1983) Nutritional consequences of the radiotherapy of head and neck cancer. Cancer 51:811–815CrossRefPubMed
12.
Choong N, Vokes E (2008) Expanding role of the medical oncologist in the management of head and neck cancer. CA Cancer J Clin 58:32–53CrossRefPubMed
13.
Chua KS, Reddy SK, Lee MC, Patt RB (1999) Pain and loss of function in head and neck cancer survivors. J Pain Symptom Manage 18:193–202CrossRefPubMed
14.
Collins MM, Wight RG, Partridge G (1999) Nutritional consequences of radiotherapy in early laryngeal carcinoma. Ann R Coll Surg Engl 81:376–381PubMed
15.
Cox JD, Pajak TF, Marcial VA, Coia L, Mohiuddin M, Fu KK, Selim HM, Byhardt RW, Rubin P, Ortiz HG et al (1992) Interruptions adversely affect local control and survival with hyperfractionated radiation therapy of carcinomas of the upper respiratory and digestive tracts. New evidence for accelerated proliferation from Radiation Therapy Oncology Group Protocol 8313. Cancer 69:2744–2748CrossRefPubMed
16.
de Luis DA, Izaola O, Cuellar L, Terroba MC, Martin T, Aller R (2006) Clinical and biochemical outcomes after a randomized trial with a high dose of enteral arginine formula in postsurgical head and neck cancer patients. Eur J Clin Nutr 61:200–204CrossRefPubMed
17.
Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G (2004) Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concurrent radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22:69–76CrossRefPubMed
18.
Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497CrossRefPubMed
19.
El-Sayed S, Nelson N (1996) Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials. J Clin Oncol 14:838–847PubMed
20.
Fung K, Lyden TH, Lee J, Urba SG, Worden F, Eisbruch A, Tsien C, Bradford CR, Chepeha DB, Hogikyan ND, Prince ME, Teknos TN, Wolf GT (2005) Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. Int J Radiat Oncol Biol Phys 63:1395–1399CrossRefPubMed
21.
Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA (1996) Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 96:361–366CrossRefPubMed
22.
Gillison ML (2007) Current topics in the epidemiology of oral cavity and oropharyngeal cancers. Head Neck 29:779–792CrossRefPubMed
23.
Gritz ER, Carmack CL, de Moor C, Coscarelli A, Schacherer CW, Meyers EG, Abemayor E (1999) First year after head and neck cancer: quality of life. J Clin Oncol 17:352–360PubMed
24.
Harris JA, Benedict FG (1918) A biometric study of human basal metabolism. Proc Natl Acad Sci USA 4:370–373CrossRefPubMed
25.
Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452CrossRefPubMed
26.
Kwong DL, Sham JS, Chua DT, Choy DT, Au GK, Wu PM (1997) The effect of interruptions and prolonged treatment time in radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 39:703–710PubMed
27.
Langius A, Björvell H, Lind MG (1993) Oral- and pharyngeal-cancer patients' perceived symptoms and health. Cancer Nurs 16:214–221PubMed
28.
Larsson M, Hedelin B, Johansson I, Athlin E (2005) Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment. Cancer Nurs 28:425–435CrossRefPubMed
29.
Lavertu P, Adelstein DJ, Saxton JP, Secic M, Eliachar I, Strome M, Larto MA, Wood BG (1999) Aggressive concurrent chemoradiotherapy for squamous cell head and neck cancer: an 8-year single-institution experience. Arch Otolaryngol Head Neck Surg 125:142–148PubMed
30.
Lee JH, Machtay M, Unger LD, Weinstein GS, Weber RS, Chalian AA, Rosenthal DI (1998) Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:871–875PubMed
31.
Lees J (1997) Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit: a two year study. Eur J Cancer Care (Engl) 6:45–49CrossRef
32.
Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) 8:133–136CrossRef
33.
Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS, Penn Cancer Center Clinical Trials Group (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial. J Clin Oncol 20:3964–3971CrossRefPubMed
34.
Matthews TW, Lampe HB, Dragosz K (1995) Nutritional status in head and neck cancer patients. J Otolaryngol 24:87–91PubMed
35.
Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P (2001) Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91:1785–1790CrossRefPubMed
36.
Naber TH, Schermer T, de Bree A, Nusteling K, Eggink L, Kruimel JW, Bakkeren J, van Heereveld H, Katan MB (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 66:1232–1239PubMed
37.
Naik AD, Abraham NS, Roche VM, Concato J (2005) Predicting which patients can resume oral nutrition after percutaneous endoscopic gastrostomy tube placement. Aliment Pharmacol Ther 21:1155–1161CrossRefPubMed
38.
39.
Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, Robbins KT (1998) Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 124:589–592PubMed
40.
Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168CrossRefPubMed
41.
Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J, Collins CE (2005) Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol) 17:639–645
42.
O'Gorman P, McMillan DC, McArdle CS (1998) Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients. Nutr Cancer 32:76–80CrossRefPubMed
43.
Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:S15–S19PubMed
44.
Pignon JP, Bourhis J, Domenge C, Designé L (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355:949–955PubMed
45.
Piquet MA, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M, Monnier P, Mirimanoff RO, Roulet M (2002) Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer 10:502–504CrossRefPubMed
46.
Ravasco P, Monteiro-Grillo I, Camilo ME (2003) Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiother Oncol 67:213–220CrossRefPubMed
47.
Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668CrossRefPubMed
48.
Raykher A, Russo L, Schattner M, Schwartz L, Scott B, Shike M (2007) Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract 22:68–73CrossRefPubMed
49.
Reilly JJ Jr, Hull SF, Albert N, Waller A, Bringardener S (1988) Economic impact of malnutrition: a model system for hospitalized patients. JPEN J Parenter Enteral Nutr 12:371–376CrossRefPubMed
50.
Rose-Ped AM, Bellm LA, Epstein JB, Trotti A, Gwede C, Fuchs HJ (2002) Complications of radiation therapy for head and neck cancers. The patient's perspective. Cancer Nurs 25:461–467CrossRefPubMed
51.
Rubin P, Wasserman TH (1988) International Clinical Trials in Radiation Oncology. The late effects of toxicity scoring. Int J Radiat Oncol Biol Phys 14:S29–S38PubMed
52.
Schattner M (2003) Enteral nutritional support of the patient with cancer: route and role. J Clin Gastroenterol 36:297–302CrossRefPubMed
53.
Scolapio JS, Spangler PR, Romano MM, McLaughlin MP, Salassa JR (2001) Prophylactic placement of gastrostomy feeding tubes before radiotherapy in patients with head and neck cancer: is it worthwhile? J Clin Gastroenterol 33:215–217CrossRefPubMed
54.
Sobin L, Ch W (1997) UICC TNM classification of malignant tumours. Wiley, New York
55.
Stableforth WD, Thomas S, Lewis SJ (2009) A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer. Int J Oral Maxillofac Surg 38:103–110CrossRefPubMed
56.
The Royal College of Surgeons of England (2005) Nutrition support in adults: oral supplements, enteral and parenteral feeding. Full guideline DRAFT
57.
Trotti A, Bellm LA, Epstein JB et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262CrossRefPubMed
58.
van Bokhorst-de, van der Schueren MA, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527CrossRef
59.
Van den Bogaert W, Van der Leest A, Rijnders A, Delaere P, Thames H, van der Schueren E (1995) Does tumor control decrease by prolonging overall treatment time or interrupting treatment in laryngeal cancer? Radiother Oncol 36:177–182CrossRefPubMed
60.
Wiggenraad RG, Flierman L, Goossens A, Brand R, Verschuur HP, Croll GA, Moser LE, Vriesendorp R (2007) Prophylactic gastrostomy placement and early tube feeding may limit loss of weight during chemoradiotherapy for advanced head and neck cancer, a preliminary study. Clin Otolaryngol 32:384–390PubMed
61.
Wilson PR, Herman J, Chubon SJ (1991) Eating strategies used by persons with head and neck cancer during and after radiotherapy. Cancer Nurs 14:98–104CrossRefPubMed
Metadata
Title
Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy
Authors
Agostino Paccagnella
Michela Morello
Maria C. Da Mosto
Carla Baruffi
Maria L. Marcon
Alessandro Gava
Vittorio Baggio
Stefano Lamon
Roberta Babare
Giovanni Rosti
Marta Giometto
Paolo Boscolo-Rizzo
Edward Kiwanuka
Michele Tessarin
Lorenza Caregaro
Carlo Marchiori
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 7/2010
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-009-0717-0

Other articles of this Issue 7/2010

Supportive Care in Cancer 7/2010 Go to the issue

Original Article

Anxiety, depression, and pain: differences by primary cancer

Original Article

Implementation of a pharmacist-initiated pharmaceutical handover for oncology and haematology patients being transferred to critical care units

Original Article

Promoting evidence-based management of anemia in cancer patients: concurrent and discriminant validity of RESPOND, a web-based clinical guidance system based on the EORTC guidelines for supportive care in cancer

Review Article

Coping with sexual concerns after cancer: the use of flexible coping

Short Communication

A role for intravenous lidocaine in severe cancer-related neuropathic pain at the end-of-life

Original Article

End-of-life experiences in adolescents dying with cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits