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

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.

Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: A multicentre randomised clinical trial.

BACKGROUND: Weight loss is frequent in patients with gastrointestinal (GI) cancer. Nutritional status deteriorates throughout anti-cancer treatment, mostly after major surgery, increasing complications, reducing tolerance and worsening the final prognosis. Enteral nutrition is safe and effective in malnourished patients undergoing major GI surgery. Randomised trials aimed at investigating the effects of home enteral nutrition (HEN) in post-surgical patients with GI cancer are lacking. This study compares HEN and counselling in limiting weight loss during oncologic treatment. PATIENTS AND METHODS: Patients with upper GI cancer and candidate to major surgery were included in the protocol when the nutritional risk screening (NRS 2002) score was ≥3. All patients were supported with enteral nutrition through a jejunostomy after surgery and randomly assigned to continue enteral nutrition or receiving nutritional counselling after discharge. Nutritional and performance status, quality of life (QoL) and tolerance to cancer treatment have been evaluated at 2 and 6 months after discharge. RESULTS: Seventy-nine patients were randomised; 38 continued enteral nutrition at home and 41 patients received nutritional counselling only. After 2 months, patients on HEN maintained their mean body weight, while patients in the nutritional counselling group showed a weight loss of 3.6 kg. Patients supported on HEN had a higher chance to complete chemotherapy as planned (48% versus 34%). QoL was not worsened by HEN. No complications were reported. CONCLUSIONS: HEN is a simple and feasible treatment to support malnourished patients with upper GI cancer after major surgery and during chemotherapy in order to limit further weight loss.

Importance of early nutritional screening in patients with gastric cancer.

In the present study, we evaluated the relationship between nutritional status, disease stage and quality of life (QoL) in 100 patients recently diagnosed with gastric carcinoma. The patients' nutritional status was investigated with anthropometric, biochemical, inflammatory and functional variables; and we also evaluated the nutritional risk with the Nutritional Risk Screening 2002. Oncological staging was standard. QoL was evaluated using the Functional Assessment of Anorexia/Cachexia Therapy questionnaire. The statistical correlation between nutritional risk score (NRS) and oncological characteristics or QoL was evaluated using both univariable and multivariable analyses. Weight loss and reduction of food intake were the most frequent pathological nutritional indicators, while biochemical, inflammatory and functional variables were in the normal range. According to NRS, thirty-six patients were malnourished or at risk for malnutrition. Patients with NRS ≥ 3 presented a significantly greater percentage of stage IV gastric cancer and pathological values of C-reactive protein, while no correlation was found with the site of tumour. NRS was negatively associated with QoL (P < 0·001) and this relation was independent from oncological and inflammatory variables as confirmed by multivariable analysis. In the present study, we found that in patients with gastric cancer malnutrition is frequent at diagnosis and this is likely due to reduction in food intake. Moreover, NRS is directly correlated with tumour stage and inversely correlated with QoL, which makes it a useful tool to identify patients in need of an early nutritional intervention during oncological treatments.