title: Weight loss in head and neck cancer patients little noticed in general practice.
abstract: BACKGROUND
  In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors.
  
  
  OBJECTIVE
  We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs).
  
  
  METHODS
  From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n = 24) and medical records from the year before referral (n = 45) and after HNOC care (n = 26). An impaired nutritional status was assigned to weight loss > or = 10% within six months or Body Mass Index (BMI) < 18.5 kg/m2 and 'at risk' to weight loss > or = 5% but < 10% within six months.
  
  
  RESULTS
  Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI.
  
  
  CONCLUSIONS
  Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care.
authors.affiliation: Department of Primary Care, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. c.vanwayenburg@elg.umcn.nl
authors.forename: Caroline A M
authors.initials: CA
authors.lastname: van Wayenburg
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Rasmussen-Conrad
authors.forename: Manon G A
authors.initials: MG
authors.lastname: van den Berg
authors.forename: Matthias A W
authors.initials: MA
authors.lastname: Merkx
authors.forename: Wija A
authors.initials: WA
authors.lastname: van Staveren
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: van Binsbergen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002100:Cachexia / Q000175:diagnosis* / Q000178:diet therapy / Q000209:etiology*; D002983:Clinical Competence; D005194:Family Practice; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D044623:Nutrition Therapy; D011446:Prospective Studies; D012017:Referral and Consultation; D015431:Weight Loss