Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy - A Prospective Observational Study from North East India.

Head and neck cancer (HNC) patients undergoing curative radiotherapy (RT) are at risk of malnutrition due to disease process as well as effects of therapy. Identifying the nutritional status of these patients at the earliest, helps to introduce adequate and timely interventions that can improve compliance and outcomes of treatment. Various tools for nutritional assessment in cancer patients have been proposed. In this prospective observational study we used the Subjective Global Assessment (SGA) questionnaire in a cohort of HNC patients receiving definitive RT at a regional cancer center of North East India. Recording of data was done at baseline, at two weekly intervals during treatment, at end of radiotherapy (EORT) and at follow-up upto 6 months. We observed that despite proper nutrition counseling, our patients suffered from malnutrition throughout their course of RT, which was at its peak by EORT but gradually improved over six months of follow-up. Pain on eating and swallowing were the most debilitating symptoms which caused significant decline of nutrient intake, body fat and muscle mass among patients together with deteriorating SGA ratings. Our results will hopefully help us design better strategies for nutrition management while delivering curative (chemo)radiotherapy for HNC patients of this region- which has one of the highest incidences of HNC in the world.

A Non-Randomised Matched-Pair Prospective Study to Evaluate Nutritional Assessment and Its Impact on Postoperative Outcome in Head and Neck Cancer.

Introduction: Nutrition plays a significant role in the life of every individual and helps in recovering from any injury including surgery. Pre-treatment malnutrition is found in 15%-40% of cases and can influence treatment outcome. The study aims to determine the impact of nutritional status on the post-operative outcome after head and neck cancer surgery. Materials and Methods: This study was carried out in the Department of Head and Neck Surgery for a period of one year from May 1, 2020 to April 30, 2021. Only surgical cases were taken up for the study. The cases (Group A) had a thorough nutritional assessment and dietary intervention if necessary. The dietician did the assessment via Subjective Global Assessment (SGA) questionnaire. After the evaluation, they were again subdivided into two subgroups depending on their nutritional status - well nourished (SGA-A) and malnourished (SGA-B and C). Dietary counselling was given for minimum 15 days preoperatively. The cases were compared with a matched control group (Group B). Results: Both the groups were well matched in terms of the site of primary tumour and duration of surgery. Around 70% were found to be malnourished in Group A. With dietary counselling, there has been a significant improvement in various parameters of post-operative outcome (P < 0.05). Discussion: This study highlights the close association and the importance of nutritional assessment for all head and neck cancer cases planned for surgery for an uneventful post-operative outcome. Adequate nutritional assessment and dietary intervention in the pre-operative period can go a long way in reducing post-operative morbidity in surgical patients.