title: Energy intake and sources of nutritional support in patients with head and neck cancer--a randomised longitudinal study.
abstract: OBJECTIVE
  Malnutrition decreases the cancer patient's ability to manage treatment, affects quality of life and survival, and is common among head and neck (HN) cancer patients due to the tumour location and the treatment received. In this study, advanced HN cancer patients were included and followed during 2 years in order to measure their energy intake, choice of energy sources and to assess problems with dysphagia. The main purpose was to explore when and for how long the patients had dysphagia and lost weight due to insufficient intake and if having a PEG (percutaneous endoscopic gastrostomy) in place for enteral nutrition made a difference.
  
  
  METHODS
  One hundred thirty-four patients were included and randomised to either a prophylactic PEG for early enteral feeding or nutritional care according to clinical praxis. At seven time points weight, dysphagia and energy intake (assessed as oral, nutritional supplements, enteral and parenteral) were measured.
  
  
  RESULTS
  Both groups lost weight the first six months due to insufficient energy intake and used enteral nutrition as their main intake source; no significant differences between groups were found. Problems with dysphagia were vast during the 6 months. At the 6-, 12- and 24-month follow-ups both groups reached estimated energy requirements and weight loss ceased. Oral intake was the major energy source after 1 year.
  
  
  CONCLUSIONS
  HN cancer patients need nutritional support and enteral feeding for a long time period during and after treatment due to insufficient energy intake. A prophylactic PEG did not significantly improve the enteral intake probably due to treatment side effects.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Sweden. ewa.silander@vgregion.se
authors.forename: E
authors.initials: E
authors.lastname: Silander
authors.forename: I
authors.initials: I
authors.lastname: Jacobsson
authors.forename: H
authors.initials: H
authors.lastname: Bertéus-Forslund
authors.forename: E
authors.initials: E
authors.lastname: Hammerlid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000150:complications / Q000209:etiology; D002149:Energy Intake; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000523:psychology; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000473:pathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009367:Neoplasm Staging; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D010349:Patient Compliance; D011788:Quality of Life; D013548:Sweden; D015431:Weight Loss