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


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).


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.
Paccagnella
Agostino
A
Department of Medicine, Treviso Hospital, Treviso, Italy. apaccagnella@ulss.tv.it
Morello
Michela
M
Da Mosto
Maria C
MC
Baruffi
Carla
C
Marcon
Maria L
ML
Gava
Alessandro
A
Baggio
Vittorio
V
Lamon
Stefano
S
Babare
Roberta
R
Rosti
Giovanni
G
Giometto
Marta
M
Boscolo-Rizzo
Paolo
P
Kiwanuka
Edward
E
Tessarin
Michele
M
Caregaro
Lorenza
L
Marchiori
Carlo
C
D003131:Combined Modality Therapy; D019587:Dietary Supplements; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss