When Eating Becomes Torturous: Understanding Nutrition-Related Cancer Treatment Side Effects among Individuals with Cancer and Their Caregivers.

Individuals living with cancer often experience multiple nutrition-related side effects from cancer treatment, including changes in taste and smell, nausea, diarrhea, loss of appetite, and pain during eating. These side effects can profoundly impact nutritional status and quality of life. The purpose of this study was to explore experiences with nutrition-related cancer treatment side effects among cancer patients and their family caregivers, the way they manage such side effects, and the resulting changes in food preferences and behaviors. Structured surveys and in-depth interviews were conducted. Interviews focused on the presence and management of treatment side effects, how those changes influenced food preferences, and the extent to which they interfered with quality of life. Most patients (72%) reported treatment side effects; 61% reported that these side effects impacted their eating and drinking. Common side effects included fatigue (58%), dry mouth (30%), nausea (24%), constipation (20%) and diarrhea (20%). Six overarching qualitative themes were identified: Spiral of side effects; Pain of eating; Burden of eating; Loss of taste/change in taste; Symptom management; and Solutions. The authors conclude with implications for food and nutrition practice-moving beyond traditional recommendations of what to eat or avoid-to consider the overall patient and caregiver experience.

Stressful Life Changes and Their Relationship to Nutrition-Related Health Outcomes Among US Army Soldiers.

Stressful life changes may tax people's adaptive capacity. We sought to determine if and when experiences of stressful life changes were associated with increased odds of adverse nutrition-related health outcomes among US Army soldiers relative to those who did not experience the same stressful life change. An additional aim was to determine which stressful life changes had the greatest association with these outcomes and if there were gender differences in the magnitude of the associations. Stressful life changes studied included: changes in marital status, combat deployment or return from deployment, relocation, adding a child, change in rank, change in occupation, and development of a physical limitation to duty. Using longitudinal data from the Stanford Military Data Repository, which represents all active-duty soldiers aged 17-62 between 2011 and 2014 (n = 827,126), we employed an event history analysis to examine associations between stressful life changes and a subsequent diagnosis of hyperlipidemia, substantial weight gain, and weight-related separation from the Army. Marriage was associated with an increase in the odds of substantial weight gain 3 months later for both men and women. Developing a physical duty limitation was associated with an increase in the odds of a hyperlipidemia diagnosis 2 months later for both men and women, as was substantial weight gain 2 months later. Stressful life changes were also associated with increased odds of nutrition-related health outcomes, although we found gender differences in the magnitude of the associations. Findings could be used to mitigate the effects of stress on health by health professionals.

Nutrition problems in a severe burn patient with schizophrenia: a case report.

Hypermetabolic conditions with nutrition deficiencies are common in patients with extensive burns. Balanced nutrition status is required to achieve adequate wound healing. Mental disorder, which tended to make a patient uncooperative, complicates the management. We report the case of a 35-year-old man with schizophrenia who suffered full- and partial-thickness burns in approximately 38% of total body surface area due to attempted suicide. The patient was hospitalized for 66 days and underwent multiple surgeries. His body mass index (BMI) was continuously low. Tissue injuries provoked inflammatory responses that contributed to metabolic disarrangement, meanwhile the presence of psychiatric disorder complicated the means of nutrition assessment and therapy needed to compensate for the high nutrition demand during the treatment period. Nutrition support should be assessed and adjusted continuously.

Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition.

OBJECTIVE: To describe the relationship between adherence to distinct dietary patterns and nutrition literacy. DESIGN: We identified distinct dietary patterns using principal covariates regression (PCovR) and principal components analysis (PCA) from the Diet History Questionnaire II. Nutrition literacy was assessed using the Nutrition Literacy Assessment Instrument (NLit). Cross-sectional relationships between dietary pattern adherence and global and domain-specific NLit scores were tested by multiple linear regression. Mean differences in diet pattern adherence among three predefined nutrition literacy performance categories were tested by ANOVA. SETTING: Metropolitan Kansas City, USA. PARTICIPANTS: Adults (n 386) with at least one of four diet-related diseases. RESULTS: Three diet patterns of interest were derived: a PCovR prudent pattern and PCA-derived Western and Mediterranean patterns. After controlling for age, sex, BMI, race, household income, education level and diabetes status, PCovR prudent pattern adherence positively related to global NLit score (P < 0·001, ß = 0·36), indicating more intake of prudent diet foods with improved nutrition literacy. Validating the PCovR findings, PCA Western pattern adherence inversely related to global NLit (P = 0·003, ß = -0·13) while PCA Mediterranean pattern positively related to global NLit (P = 0·02, ß = 0·12). Using predefined cut points, those with poor nutrition literacy consumed more foods associated with the Western diet (fried foods, sugar-sweetened beverages, red meat, processed foods) while those with good nutrition literacy consumed more foods associated with prudent and Mediterranean diets (vegetables, olive oil, nuts). CONCLUSIONS: Nutrition literacy predicted adherence to healthy/unhealthy diet patterns. These findings warrant future research to determine if improving nutrition literacy effectively improves eating patterns.

Couples coping with nutrition-related problems in advanced cancer: A qualitative study in primary care.

PURPOSE: Nutrition-related problems are common in patients with advanced cancer. They can disrupt daily life and routines. This study aimed to explore how couples cope with this source of distress. METHODS: A qualitative descriptive study design was adopted using semi-structured interviews. Seven couples, each consisting of an advanced cancer patient and his or her co-habiting life partner, participated. The Qualitative Analysis Guide of Leuven (QUAGOL) was used as a guide to facilitate the analysis process. RESULTS: When a patient communicates nutrition-related problems to the partner, individual coping is often complemented by interactive couple-coping pathways, serving two resilient coping strategies: maintaining normality and creating a new normality. These pathways can have either a practical, an emotional or a distant orientation. Different couple-coping pathways can be observed in the same couple when they are dealing with either one or multiple nutrition-related problems. Some couples, however, seem to cope more rigidly, often those with less observed 'we-ness'. CONCLUSIONS: Nutrition-related problems are inherent to advanced cancer and are perceived as health-threatening. Couple-coping with nutrition-related problems is a dynamic and interactive process leaning on different coping pathways. There is no evidence that one pathway is superior to another, as they all serve a resilient coping strategy. Our findings can assist homecare nurses and other professional caregivers in providing psychological support and advice to couples confronted with nutrition-related problems in advanced cancer. Future research should shed light on whether an unsuitable match in coping styles within a couple is one of the precursors of non-resilient outcomes.

Nutrition Support Therapy.

In most addictions, serious nutritional deficiencies of major proteins, fats, vitamins and minerals exist which prevent their capability to digest carbohydrates efficiently. This review aims to point out some treatment approaches in nutrition management for alcohol addiction, drug addiction, food addiction, Internet addiction and sex addiction, according to existing literatures.

The Emerging Nutritional Problems of School Adolescents: Overweight/Obesity and Associated Factors in Jimma Town, Ethiopia.

BACKGROUND: Globally, overweight is rapidly becoming one of the most important medical and public health problems. Adolescent obesity is a multisystem disease with potentially devastating consequences that persist into adulthood. However, there is a paucity of available information regarding the adolescent overweight and obesity in Ethiopia, particularly in the study area. METHODS: A school-based cross-sectional study was conducted from March to April/2015 among 546 adolescents. Study participants were selected using a multi-stage, stratified random sampling method. An interviewer administered questionnaire was used to collect data. Multivariable logistic regression analysis was used to identify independent predictors of overweight and obesity at 95% confidence intervals. RESULTS: The mean dietary diversity score of school adolescents was 6.97±1.15. Cereal based diets (99.6%) and vegetables (73.9%) are the two common foods of adolescents. The prevalence of overweight/obesity was 13.3%. Overweight/Obesity was significantly associated with being a female (AOR=3.57 [95% CI:1.28-9.9]), attending private schools (AOR=7.53 [2.51-22.3]), lack of paternal education (AOR=5.57 [95% CI:1.53-20.26]), wealthy households (AOR=3 [95% CI:1.09-8.26]) and not being a vegetarian (AOR=9.23 [95% CI:1.68-50.8]). Adolescents who are physically inactive (AOR=3.7 [95% CI:1.06-13.02]) and those with sedentary lifestyles (AOR=3.64 [95% CI:1.39-9.5]) were more obese compared to their counter peers. CONCLUSIONS: The proportion of overweight/obesity among school adolescent was considerably high. Being a female, learning in private school, high household economic status, not being a vegetarian and having a sedentary life were significantly associated with overweight/obesity. PRACTICE IMPLICATIONS: Findings of this study can be used to guide the development of programs aimed at preventing overweight/obesity in Ethiopia by informing policymakers and other stakeholders about this emerging nutrition-related problem among school adolescents.

Capital psicológico y su relación con el estilo de vida de universitarios mexicanos / Psychological capital and its relationship with lifestyle of Mexican university students

Introducción: en algunos estudios se ha reportado que los universitarios no tienen un estilo de vida saludable (EVS) por lo que es necesario identificar no solo las variables psicosociales negativas, sino también las variables de Psicología Positiva que pueden favorecerlo. Objetivo: Determinar la relación entre el capital psicológico (CapPsi) y el estilo de vida (EV) de estudiantes universitarios mexicanos. Método: se realizó un estudio transversal y correlacional con 320 estudiantes de una universidad pública. La muestra fue no probabilística por cuotas. Para evaluar los factores del CapPsi se utilizaron los instrumentos Escala General de Autoeficacia, Escala de Esperanza para Adultos, Cuestionario de Resiliencia y Test de Orientación en la Vida (optimismo); para evaluar el EV se usó el Cuestionario Fantástico. Resultados: las variables del CapPsi mostraron una correlación estadísticamente significativa con el EV; resiliencia (r = 0,505, p < 0,01); esperanza (r = 0,432, p < 0,01); optimismo (r = 0,412, p < 0,01); autoefi cacia (r = 0,400, p < 0,01). El 33,3 de la varianza total del EV es explicado por el CapPsi (R2 = 0,333). Conclusiones: con base en los resultados, se asume que el CapPsi favorece el EVS; no obstante, es necesario que futuras investigaciones detallen si la influencia es en la adopción y/o mantenimiento del EVS, así como identificar cómo influye particularmente en cada factor del EV. El CapPsi tiene un porcentaje representativo de predicción del EV saludable. Es necesario que los programas de promoción y prevención en salud incorporen el abordaje del CapPsi para lograr un EV saludable en los universitarios (AU)

Background: University students don’t have a healthy lifestyle so it is necessary to identify psychosocial variables that can increase it. Objective: To determine the relationship between the psychological capital (CapPsi) and lifestyle (EV) of Mexican university students. Method: A cross-sectional and correlational study was carried out among 320 students of a public university. The sample was non probabilistic by quotas. To assess the factors of CapPsi were used the General Scale of Self-effi cacy, the Scale of Hope for Adults, Questionnaire of Resilience, the Life Orientation Test and; to assess the lifestyle was used the Fantastic questionnaire. Results: The variables of the CapPsi correlated with the healthy lifestyle; resilience (r = 0.505, p < 0.01); hope (r = 0.432, p < 0.01); optimism (r = 0.412, p < 0.01); and self-effi cacy (r = 0.400, p < 0.01). The 33.3 of the total variance of the lifestyle was explained by the CapPsi (R2 = 0.333). Conclusions: Based on the results, it is assumed that the CapPsi improve lifestyle; however, further research is necessary to determine if the infl uence of CapPsi is in the adoption and / or maintenance of healthy lifestyle and identify how each one of its factors influences it particularly. The CapPsi has a representative percentage of prediction of healthy lifestyle. It is necessary that health promotion and prevention programs incorporate the approach of CapPsi to achieve a healthy lifestyle in the university students (AU)

Measuring orthorexia nervosa: psychometric limitations of the ORTO-15

Orthorexia nervosa has recently been defined as excessive preoccupation with healthy eating, causing significant nutritional deficiencies and social and personal impairments. The ORTO-15 is the most widely used instrument to evaluate orthorexia nervosa, although previous studies obtained inconsistent results about its psychometric properties, and there are no data on the Spanish version. Thus, the main objective of the present study was to analyze the psychometric properties of the Spanish adaptation of the ORTO-15. In order to cross-validate the results, two independent samples were used (Sample 1: n = 807, 74.1% women; Sample 2: n = 242, 63.2% women). The results did not support the original recoding and reversal of the items; thus, the original scores were maintained. The analysis of the internal structure showed that the best interpretable solution was unidimensional, and due to low loadings, four items were removed. The internal consistency (α = .74) and temporal stability (r = .92; p < .001) of the final ORTO-11 version were adequate, higher than the 15-item version. The questionnaire showed significant associations with eating psychopathology (EAT-26 and SR-YBC-EDS; range r = .64 - .29; p < .05). However, this result should be interpreted with caution due to the redundancy observed between the ORTO- 15 and the EAT-26. Our results suggest that the psychometric properties of the Spanish version of the ORTO-15 are not adequate. Moreover, the instrument detects people who are on diets, but it is not efficient in detecting the severity of orthorexic behaviors and attitudes. New instruments are needed to continue the study of orthorexia nervosa (AU)

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Household Food Insecurity Is Associated with Adverse Mental Health Indicators and Lower Quality of Life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012-2013.

Food insecurity is an ongoing public health issue and contributes to mental health status. We investigated whether food insecurity is associated with inadequate nutrient intake and whether it affects mental health indicators (perceived stress/experience of depressive symptom/suicidal ideation) and quality of life (QOL) among Koreans (n = 5862, 20-64 years) using data from the Korea National Health and Nutritional Examination Survey (2012-2013). Household food security status was categorized as "food-secure household", "food-insecure household without hunger", and "food-insecure household with hunger". Data on food insecurity, sociodemographic factors, nutrient intake, mental health indicators, and QOL were used. A logistic regression model was conducted to determine odds ratios (ORs) for psychological health. A greater proportion of food-insecure participants were nutritionally deficient compared with expectations of the 2015 Korean Dietary Reference Intakes. These deficiencies were generally higher in both "food-insecure household" groups. Both "food-insecure household" groups, particularly the "food-insecure household with hunger" group showed significantly adverse mental health status (ORs: 1.52-3.83) and lower QOL (ORs: 1.49-3.92) than did the "food-secure household" group before and after adjusting for sex, age, education, household income, smoking/alcohol consumption, physical activity, marital status, and receiving food assistance. In conclusion, food insecurity may be significantly associated with adverse mental health indicators and decreased QOL in young/middle-aged Koreans.

La anorexia nerviosa en adolescentes. A propósito de un caso / Anorexia nervosa. A propos of a case

La incidencia de los trastornos de la conducta alimentaria (TCA) es ahora más alta que nunca. La edad promedio de inicio de la anorexia nerviosa está en los 17 años. La prevalencia encontrada es preocupante. En las chicas escolarizadas de 12 a 21 años, parece que el 4-5 % padece algún TCA (diagnosticado por psiquiatra). En este trabajo se pretende reflejar, mediante un caso clínico, los cuidados de enfermería que se realizan en una unidad de psiquiatría infanto-juvenil a los usuarios que ingresan con diagnóstico de anorexia nerviosa. Se trata de una adolescente que ingresa en la unidad con diagnóstico de anorexia nerviosa. Inicialmente, se realiza una valoración mediante los patrones funcionales de Gordon, para posteriormente determinar las esferas sobre las que se va a actuar y enunciar los diagnósticos principales, con sus respectivos objetivos e intervenciones. La atención de enfermería en la Unidad de Psiquiatría Infanto-Juvenil es primordial. Las enfermeras son las que están en constante contacto con los pacientes y las que limitan las conductas de estos. También actúan como confesores y mantienen una relación estrecha con ellos (AU)

The incidence of eating disorder (ED) is now higher than ever. The average age of onset of anorexia nervosa is 17 years. The prevalence found is worrying. In the girls in school 12 to 21 years, it seems to suffer from a 4-5 % ED (diagnosed by a psychiatrist). This work intends to reflect, through a clinical case, the nursing care performed in a unit of child and adolescent psychiatry users admitted with diagnosis of anorexia nervosa. The teenager joined the unit with a diagnosis of anorexia nervosa. Initially, an evaluation is performed by the functional patterns of Gordon, later to identify areas on which it will act and state the principal diagnoses, with their respective objectives and interventions. The nursing care at the Adolescent Psychiatry Unit is paramount. Nurses are the ones that are in constant contact with patients and limiting these behaviors. They also act as confessors and maintain a close relationship with them (AU)

[Food addiction]. / L'addiction à la nourriture.

Food addiction is a common term used in everyday language by obese patients. Although the neurobiological evidence points to some similarities between addictive mechanisms and the consumption of certain foods, this diagnosis is not yet officially recognized. After a brief history of food addiction compared to other eating disorders, we review the neurobiological processes underlying this concept. A food addiction assessment tool is presented and discussed with the current literature and new classifications of the DSM-5. The concept of food addiction needs to be rethought and requires further research.

Risk of mental health and nutritional problems for left-behind children of international labor migrants.

BACKGROUND: One-in-ten Sri Lankans are employed abroad as International Labor Migrants (ILM), mainly as domestic maids or low-skilled laborers. Little is known about the impact their migration has on the health status of the children they 'leave behind'. This national study explored associations between the health status of 'left-behind' children of ILM's with those from comparative non-migrant families. METHODS: A cross-sectional study design with multi-stage random sampling was used to survey a total of 820 children matched for both age and sex. Socio-demographic and health status data were derived using standardized pre-validated instruments. Univariate and multivariate analyses were used to estimate the differences in mental health outcomes between children of migrant vs. non-migrant families. RESULTS: Two in every five left-behind children were shown to have mental disorders [95%CI: 37.4-49.2, p < 0.05], suggesting that socio-emotional maladjustment and behavioural problems may occur in absence of a parent in left-behind children. Male left-behind children were more vulnerable to psychopathology. In the adjusted analyses, significant associations between child psychopathological outcomes, child gender and parent's mental health status were observed. Over a quarter (30%) of the left-behind children aged 6-59 months were 'underweight or severely underweight' compared to 17.7% of non-migrant children. CONCLUSIONS: Findings provide evidence on health consequences for children of migrant worker families in a country experiencing heavy out-migration of labour, where remittances from ILM's remain as the single highest contributor to the economy. These findings may be relevant for other labour 'sending countries' in Asia relying on contractual labor migration for economic gain. Further studies are needed to assess longitudinal health impacts on the children left-behind.

Disorders of "taste cognition" are associated with insular involvement in patients with Alzheimer's disease and vascular dementia: "memory of food is impaired in dementia and responsible for poor diet".

BACKGROUND: In dementia patients, dietary intake problems may occur despite the absence of swallowing problems. We investigated cognitive functions on food and taste in Alzheimer's disease (AD) and vascular dementia (VaD) patients. METHODS: Participants included 15 healthy controls (HC), 30 AD and 20 VaD patients. Food Cognition Test: Replicas of three popular foods in Japan with no odors were presented visually to each participant, with the instruction to respond with the name of each food. Replicas of food materials were subsequently presented to ask whether they were included in these foods. Taste Cognition Test: Replicas of 12 kinds of foods were presented to describe their expected tastes. RESULTS: The AD/VaD groups exhibited significantly lower scores on Food/Taste Cognition Tests compared with the HC group. These scores correlated inversely with Mini-Mental State Examination (MMSE) scores in the AD group. Decreased dietary intake was observed in 12 of the 50 patients; 8 of the 12 exhibited decreased Taste Cognition Test scores, higher than that of the normal-intake patients. There was no difference in the filter paper taste disc test between HC/AD/VaD groups. To test the hypothesis that the insula is associated with taste cognition, two MMSE-matched AD subgroups (n = 10 vs. 10) underwent positron emission tomography. Glucose metabolism in the right insula was lower in the low taste cognition subgroup. The VaD patients with insular lesions exhibited impaired Taste Cognition Test findings. CONCLUSIONS: It is important to consider the cognitive aspect of dietary intake when we care for dementia patients.

An exploration of individuals' preferences for nutrition care from Australian primary care health professionals.

This qualitative study explored individuals' preferences regarding the provision of nutrition care from Australian health professionals and the factors influencing their preferences. Thirty-eight individuals aged 53±8 years, living with a lifestyle-related chronic disease or risk factor for lifestyle-related chronic disease, participated in a semi-structured telephone interview. Participants were asked questions regarding their perceptions of which Australian health professionals provide nutrition care, their preferences for this care and the factors influencing their preferences. Interviews were transcribed verbatim and analysed thematically using a constant-comparison approach. General practitioners were the most recognised health professional that provided nutrition care to patients, followed by dietitians. General practitioners were regarded by most participants as the preferred provider of nutrition care because they were perceived to provide trustworthy and personalised nutrition care. Participants reported confusion regarding the professional differences between dietitians and nutritionists, and appealed for more information to be available to individuals that are considering consulting an Australian health professional for nutrition care. The findings of this study suggest that general practitioners are the preferred providers of nutrition care for many individuals living with a lifestyle-related chronic disease. Considering the increasing presentation of patients with lifestyle-related chronic disease in general practice, it is anticipated that the demand on general practitioners to provide nutrition care to patients will increase in the future.

Nutrition-related health behaviours and prevalence of overweight and obesity among Polish children and adolescents.

INTRODUCTION: An adequate mode of nutrition is among the most important environmental factors affecting the development of Man and maintenance of a good health status. An improper selection of nutrients and irregular consumption of meals may lead to overweight and obesity. OBJECTIVE: The characteristics of health behaviours of the examined population of schoolchildren, with consideration of nutrition and body weight disorders. A comparison of the opinions of schoolchildren and their parents concerning health behaviours. Development of guidelines for educational programmes carried out in the place of residence of the population of schoolchildren and their parents. MATERIALS AND METHOD: The survey covered a randomised group of schoolchildren attending elementary and secondary schools in the Kalisz Province and province of the city of Kalisz. The study was conducted in May and June 2009, in a randomly selected representative group of 1,100 boys and girls from classes V and VI of elementary schools, and 1,100 secondary school adolescents aged 16-19 and their parents. The studies of schoolchildren attending elementary and secondary schools were compared with the all-Polish studies of junior high school adolescents in the school year 2006-2007. RESULTS: The respondents most often consumed 3-4 meals; however, as many as 26% of junior high school adolescents and 27% of secondary school adolescents admitted that they consume only one meal daily. The schoolchildren show inadequate nutritional habits concerning an insufficient consumption of fruits, vegetables and fish, in favour of high calorific meals and sweet snacks and drinks. Parents improperly assess the body weight of their children and perceive them as slimmer, which is not confirmed by the BMI value for age and gender. CONCLUSIONS: Systematic monitoring and analysis of changes in the health behaviours of adolescents should be a basis for planning health education and promotion programmes. Educational programmes concerning various aspects of health should be implemented in an organized and complementary way, directed not only at schools, but also at entire families and local communities. Knowledge, beliefs, skills and attitudes towards health acquired during the period of adolescence decide about life style in adulthood.

[Orthorectic eating behaviour - nosology and prevalence rates]. / Orthorektisches Ernährungsverhalten - Nosologie und Prävalenz.

Orthorectic eating behaviour is characterised by a fixation on a healthy diet and rigidity regarding self-imposed nutrition standards. Besides malnutrition, subjective distress and social isolation might be consequences of clinical relevance. So far there are few reliable data about nosology and prevalence rates, so that it is not yet possible to evaluate the clinical significance of orthorectic eating behaviour. This article discusses nosological classifications of orthorexia and presents prevalence rates of extremely healthy eating behaviour in general population as well as in several specific subgroups. To summarise, orthorectic eating behaviour seems to be most likely an eating disorder with healthy dieting as an overvalued idea. Data on prevelance of orthorectic eating behaviour, assessed with the recently developed Düsseldorfer Orthorexie Skala, suggest a rate of 1 to 2% in general population.

Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study.

INTRODUCTION: Symptom experiences and their interference with life are not well-researched in head and neck cancer patients. The aim of the study was to explore and understand the experience of receiving treatment for head and neck cancer with particular focus on symptom experiences over a one year period from diagnosis. METHODS: A qualitative study design was used with a heterogeneous sample of 16 patients with head and neck cancer. Interviews, conducted at four time points over 12 months, provided a total of 50 interview datasets. RESULTS: Key themes derived include nutritional concerns, tiredness, and experiences related to the radiotherapy mask and regaining normality. These data highlight issues of importance in the first year of living with head and neck cancer: impact of nutritional changes on the lives of patients, including weight loss, dysphagia, xerostomia and taste changes; debilitation from ongoing fatigue; unpreparedness for and distress from the radiotherapy mask; and attempts to maintain a normal life amidst the interference of symptoms. CONCLUSION: Multitude of symptoms impact the patients' life, particularly nutritional symptoms and fatigue, and interfere with the patients' survivorship and quality of life. The changing nature of symptoms over the first year from diagnosis in head and neck cancer patients and the identified issues in the attempt to normalize their lives need to be incorporated more fully into the supportive care of head and neck cancer patients in order to improve their experience and enhance their survivorship.