[Good clinical practice in nutritional management of head and neck cancer patients].
BACKGROUND
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.


OBJECTIVE
To develop clinical practice guidelines according to the definitions of Standards, Options and Recommandations for the nutritional management of the head and neck cancer patients.


METHODS
Data have been identified by literature search using Medline and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to 121 independent reviewers, and to the medical committees of the 20 French Cancer Centres.


RESULTS
The main recommendations for the nutritional management of head and neck cancer patients are that: 1) Nutritional management prevents undernutrition, improves quality of life, reduces adverse effects of the treatment and prevents treatment delay; 2) The nutritional management of the head and neck cancer patient must be done before, during and after cancer treatment; 3) Before treatment, the weight of the patient must be assessed: 10% of weight loss in 6 months requires to an urgent nutritional intervention; 4) During radiation therapy, feeding should be adapted to various characteristics such as swallowing mechanism, side effects of the treatment, age; 5) During chemotherapy, nutrition must be checked and assessed at each cycle; 6) During surgery, enteral feeding must be stopped and nasogastric feeding progressively introduced starting on day 1 post-operatively. The quality of feed must be adequate during all the healing period. Close surveillance of fever and regurgitation allows regular review of the amount and nature of enteral feed to be given; 7) The patients are given individualised and written advice at the end of treatment and the nutritional follow-up must be planned.
Meuric
J
J
Institut Curie, Paris.
Garabige
V
V
Blanc-Vincent
M P
MP
Lallemand
Y
Y
Bachmann
P
P
D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects; D001835:Body Weight; D003376:Counseling; D003679:Deglutition / Q000528:radiation effects; D004750:Enteral Nutrition; D005248:Feeding Methods; D005334:Fever / Q000517:prevention & control; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015337:Multicenter Studies as Topic; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000517:prevention & control; D052756:Nutritional Sciences / Q000193:education; D018529:Nutritional Support; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016896:Treatment Outcome; D014839:Vomiting / Q000517:prevention & control; D015431:Weight Loss
D000970:Antineoplastic Agents