title: Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy.
abstract: 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.
authors.affiliation: Department of Medicine, Treviso Hospital, Treviso, Italy. apaccagnella@ulss.tv.it
authors.forename: Agostino
authors.initials: A
authors.lastname: Paccagnella
authors.forename: Michela
authors.initials: M
authors.lastname: Morello
authors.forename: Maria C
authors.initials: MC
authors.lastname: Da Mosto
authors.forename: Carla
authors.initials: C
authors.lastname: Baruffi
authors.forename: Maria L
authors.initials: ML
authors.lastname: Marcon
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gava
authors.forename: Vittorio
authors.initials: V
authors.lastname: Baggio
authors.forename: Stefano
authors.initials: S
authors.lastname: Lamon
authors.forename: Roberta
authors.initials: R
authors.lastname: Babare
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosti
authors.forename: Marta
authors.initials: M
authors.lastname: Giometto
authors.forename: Paolo
authors.initials: P
authors.lastname: Boscolo-Rizzo
authors.forename: Edward
authors.initials: E
authors.lastname: Kiwanuka
authors.forename: Michele
authors.initials: M
authors.lastname: Tessarin
authors.forename: Lorenza
authors.initials: L
authors.lastname: Caregaro
authors.forename: Carlo
authors.initials: C
authors.lastname: Marchiori
mesh_terms: 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