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Adherence to intensive nutrition care in head and neck cancer patients undergoing radiotherapy

  • Head and Neck
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Abstract

Purpose

The aim of this study was to determine the prevalence and effect of adherence to intensive nutritional care on nutritional outcomes and survival in head and neck cancer patients undergoing radiotherapy.

Methods

Three-hundred and seventeen head and neck cancer patients referred to intensive nutrition support during radiotherapy were retrospectively analyzed. Patients who missed less than 25% of their appointments with the dietitian were considered adherent. Primary outcome was percentage weight loss during treatment. Secondary outcomes were overall survival and patients' capacity to accomplish their caloric and protein recommendations. Logistic regression was used to examine predictors of weight loss and Kaplan–Meier to estimate survival.

Results

Less than half of the patients (n = 145, 45.7%) were adherent. Statistically significant less weight loss in the adherent group (42.8% vs 55.8%; p = 0.02) was found, despite no difference in energy or protein intake. Logistic regression models after adjusting for other variables demonstrated that adherence resulted in 43% protection from significant weight loss (odds ratio 0.57, 95% CI 0.34–0.97). Overall survival was not different between groups.

Conclusion

Findings demonstrated that patients who were adherent to weekly contacts with the dietitian had less weight loss, but not better survival or nutritional intake. Additional investigation of factors that may act as barriers or enablers for adherence could help improve the outcomes in this population.

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References

  1. Kaderbay A, Atallah I, Fontaine E et al (2018) Malnutrition and refeeding syndrome prevention in head and neck cancer patients: from theory to clinical application. Eur Arch Otorhinolaryngol 275:1049–1058

    Article  Google Scholar 

  2. Langius JAE, Doornaert P, Spreeuwenberg MD, Langendijk JA, Leemans CR, Schueren MAEB (2010) Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiother Oncol 97(1):80–85

    Article  Google Scholar 

  3. Arribas L, Hurtos L, Taberna M, Peiro I, Vilajosana E, Lozano A et al (2017) Nutritional changes in patients with locally advanced head and neck cancer during treatment. Oral Oncol 71:67–74

    Article  CAS  Google Scholar 

  4. Kubrak C, Martin L, Gramlich L, Scrimger R, Jha N, Debenham B et al (2020) Prevalence and prognostic significance of malnutrition in patients with cancers of the head and neck. Clin Nutr 39(3):901–909

    Article  Google Scholar 

  5. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A et al (2008) Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck 30(4):503–508

    Article  Google Scholar 

  6. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP et al (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36(5):1187–1196

    Article  CAS  Google Scholar 

  7. Crowder SL, Douglas KG, Yanina Pepino M, Sarma KP, Arthur AE (2018) Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv 12(4):479–494

    Article  Google Scholar 

  8. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F et al (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48

    Article  Google Scholar 

  9. Talwar B, Donnelly R, Skelly R, Donaldson M (2016) Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 130(S2):S32-s40

    Article  CAS  Google Scholar 

  10. Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452

    Article  CAS  Google Scholar 

  11. Findlay M, Bauer J, Brown T. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. https://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines. Accessed 28 Apr 2020

  12. Hofto S, Abbott J, Jackson JE, Isenring E (2018) Investigating adherence to Australian nutritional care guidelines in patients with head and neck cancer. Cancers Head Neck 3(1):6

    Article  Google Scholar 

  13. Jeffery E, Young P, Sherriff J (2018) Nutritional outcomes with radiotherapy for head and neck cancer: a before and after comparison of “best practice guidelines” implementation. Asia Pac J Clin Nutr 27(5):955–961

    PubMed  Google Scholar 

  14. Kiss NK, Krishnasamy M, Loeliger J, Granados A, Dutu G, Corry J (2012) A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer. Support Care Cancer 20(9):2111–2120

    Article  Google Scholar 

  15. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A et al (2010) Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Supportive Care Cancer 18(7):837–845

    Article  Google Scholar 

  16. Cases MG, Frugé AD, Daniel M (2015) Head and neck cancer adherence to dietary recommendations using theory-based tools: future research directions. J Food Nutr Disor 4(5):181

    Article  Google Scholar 

  17. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z (2014) Patient involvement in health care decision making: a review. Iran Red Crescent Med J 16(1):e12454

    Article  Google Scholar 

  18. Beck AK, Britton B, Baker A, Odelli C, Wratten C, Bauer J et al (2017) Preliminary report: training head and neck cancer dietitians in behaviour change counselling. Psychooncology 26(3):405–407

    Article  Google Scholar 

  19. Rogers LQ, Verhulst S, Rao K, Malone J, Robbs R, Robbins KT (2015) Developing theory-based measurement tools for improving diet compliance in head and neck cancer patients. J Food Nutr Disor 4(2):1–9. https://doi.org/10.4172/2324-9323.1000166

    Article  Google Scholar 

  20. Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H et al (2010) Nutrition impact symptoms: Key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck 32(3):290–300

    PubMed  Google Scholar 

  21. McDonough EM, Boyd JH, Varvares MA, Maves MD (1996) Relationship between psychological status and compliance in a sample of patients treated for cancer of the head and neck. Head Neck 18(3):269–276

    Article  CAS  Google Scholar 

  22. Kabarriti R, Bontempo A, Romano M, McGovern KP, Asaro A, Viswanathan S et al (2018) The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy. Support Care Cancer 26(9):3307–3313

    Article  Google Scholar 

  23. World Health Organization-WHO (2004) ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd edn. World Health Organization, Geneva

    Google Scholar 

  24. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK et al (2017) The Eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67(2):93–99

    Article  Google Scholar 

  25. World Health Organization-WHO (2000) Obesity: preventing and managing the global epidemic. World Health Organization—WHO, Geneva

    Google Scholar 

  26. PNUD Brasil. Atlas do Desenvolvimento Humano no Brasil. http://www.atlasbrasil.org.br/2013/pt/consulta/. Accessed 13 March 2020

  27. Kansara S, Wang T, Koochakzadeh S, Liou NE, Graboyes EM, Skoner JM et al (2019) Prognostic factors associated with achieving total oral diet following osteocutaneous microvascular free tissue transfer reconstruction of the oral cavity. Oral Oncol 98:1–7

    Article  Google Scholar 

  28. Chen DW, Wang T, Ni JSS, Sandulache VC, Graboyes EM, Worley M et al (2019) Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction. Oral Oncol 92:59–66

    Article  Google Scholar 

  29. Volpe S, Marvaso G, Alterio D, Ciardo D, Sabbatini A, Zagallo E et al (2018) Nutritional intervention for nonsurgical head and neck cancer patients treated with radiation therapy: results from a prospective stepped-wedge clinical protocol. Nutr Cancer 70(7):1051–1059

    Article  Google Scholar 

  30. Beck AK, Baker A, Britton B, Wratten C, Bauer J, Wolfenden L et al (2015) Fidelity considerations in translational research: eating as treatment—a stepped wedge, randomised controlled trial of a dietitian delivered behaviour change counselling intervention for head and neck cancer patients undergoing radiotherapy. Trials 16(1):465

    Article  Google Scholar 

  31. Mathes T, Jaschinski T, Pieper D (2014) Adherence influencing factors—a systematic review of systematic reviews. Arch Public Health 72(1):37

    Article  Google Scholar 

  32. Cahill NE, Suurdt J, Ouellette-Kuntz H, Heyland DK (2010) Understanding adherence to guidelines in the intensive care unit. JPEN J Parenter Enteral Nutr 34(6):616–624

    Article  Google Scholar 

  33. McCarter K, Baker AL, Britton B, Beck AK, Carter G, Bauer J et al (2018) Effectiveness of clinical practice change strategies in improving dietitian care for head and neck cancer patients according to evidence-based clinical guidelines: a stepped-wedge, randomized controlled trial. Transl Behav Med 8(2):166–174

    Article  Google Scholar 

  34. Chen J, Gemming L, Hanning R, Allman-Farinelli M (2018) Smartphone apps and the nutrition care process: current perspectives and future considerations. Patient Educ Couns 101(4):750–757. https://doi.org/10.1016/j.pec.2017.11.011

    Article  PubMed  Google Scholar 

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Funding

This study was supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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Authors and Affiliations

  1. Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr Arnaldo, 455 2ºandar, Sao Paulo, SP, 01246-903, Brazil

    Sheilla de Oliveira Faria & José Eluf Neto

  2. Princess Margaret Cancer Centre Research Institute, Toronto, ON, Canada

    Sheilla de Oliveira Faria & Doris Howell

  3. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Sheilla de Oliveira Faria & Doris Howell

  4. Head and Neck Surgery, Barretos Cancer Hospital, Barretos, SP, Brazil

    André Lopes Carvalho

  5. Departamento de Engenharia Agrícola, Universidade Federal de Lavras, Lavras, MG, Brazil

    Rafael de Oliveira Faria

Authors
  1. Sheilla de Oliveira Faria
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  2. Doris Howell
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  3. André Lopes Carvalho
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  4. Rafael de Oliveira Faria
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  5. José Eluf Neto
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Contributions

SOF and JEN contributed to the study conception and design. DH and ALC revised it critically for important intellectual content. Material preparation, data collection and analysis were performed by SOF and ROF. The first draft of the manuscript was written by SOF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sheilla de Oliveira Faria.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Research Center of Instituto do Câncer do Estado de São Paulo (NP 1313/18) and the Committee for Ethics in Research of School of Medicine of the University of São Paulo (CEP-FMUSP—CAAE 93676618.0.0000.0065) approved this study.

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de Oliveira Faria, S., Howell, D., Lopes Carvalho, A. et al. Adherence to intensive nutrition care in head and neck cancer patients undergoing radiotherapy. Eur Arch Otorhinolaryngol 278, 3507–3514 (2021). https://doi.org/10.1007/s00405-020-06550-2

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  • DOI: https://doi.org/10.1007/s00405-020-06550-2

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