Supportive Care in Cancer

, Volume 16, Issue 3, pp 285–289 | Cite as

Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma

  • Haidy Lee
  • Carole Havrila
  • Vikki Bravo
  • Kellie Shantz
  • Kellie Diaz
  • James Larner
  • Paul Read
Original Article



Malnutrition in the head and neck cancer population is a widely recognized factor contributing to negative outcomes. The goal of this study was to determine if providing complimentary oral nutritional supplementation for patients undergoing definitive radiation therapy for oropharyngeal carcinoma reduced weight loss and the need for percutaneous endoscopic gastrostomy (PEG) tube placement.

Materials and methods

The data from 79 patients undergoing radiotherapy for oropharyngeal cancer were extracted and analyzed retrospectively from an institutional Human Investigation Committee approved database for the study of advanced radiation therapy techniques for head and neck cancer. Forty patients were treated before the initiation of a nutritional supplementation program, and 39 patients received supplementation. Patients were stratified by type of treatment (radiation alone or chemoradiation) and whether or not they had a PEG tube.


All patient groups receiving supplementation manifested a significant decrease in weight loss compared to those who did not receive it. Nutritional supplementation was associated with a 40% relative reduction in weight loss in patients treated with radiotherapy alone (6.1 vs 10.1%, p = 0.008) and a 37% reduction in weight loss in patients treated with chemoradiotherapy (6.7 vs 10.7%, p = 0.007). When patients were stratified by the presence or absence of a PEG tube, both groups experienced a 39% relative reduction in weight loss (with PEG, 5.7 vs 9.3%, p = 0.028; without PEG, 6.9 vs 11.2%, p = 0.002). Supplementation was associated with a decreased need for PEG tube placement (31% decreased to 6%) in patients treated with radiotherapy alone.


Providing complimentary oral nutritional supplementation significantly decreases weight loss and the need for PEG tube placement in patients undergoing radiation therapy for oropharyngeal cancer.


Nutrition Oropharynx Radiotherapy Weight loss PEG tube 



This program was funded by the University of Virginia Auxiliary, the University of Virginia Cancer Center, and private donations.


  1. 1.
    Baredes S, Behin D, Deitch E (2004) Percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer. Ear Nose Throat J 83(6):417–419PubMedGoogle Scholar
  2. 2.
    Brookes GB (1985) Nutritional status-a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg 93(1):69–74PubMedGoogle Scholar
  3. 3.
    Callahan CM, Buchanan NN, Stump TE (2001) Healthcare costs associated with percutaneous endoscopic gastrostomy among older adults in a defined community. J Am Geriatr Soc 49(11):1525–1529PubMedCrossRefGoogle Scholar
  4. 4.
    Cruz I, Mamel JJ, Brady PG, Cass-Garcia M (2005) Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer. Gastrointest Endosc 62(5):708–711PubMedCrossRefGoogle Scholar
  5. 5.
    Ehrsson YT, Languis-Eklof A, Bark T, Laurell G (2004) Percutaneous endoscopic gastrostomy (PEG)—a long term follow-up study in head and neck cancer patients. Clin Otolaryngol Allied Sci 29(6):740–746PubMedCrossRefGoogle Scholar
  6. 6.
    Fietkau R (2000) Nutritional support of patients during radiotherapy. In: Mason JB, Nitenberg G (eds) Cancer and nutrition: prevention and treatment. Nestle Nutrition Workshop Series Clinical Performance Program. Karger, Basel 4:225–238Google Scholar
  7. 7.
    Hearne BE, Dunaj JM, Daly JM et al (1985) Enteral nutrition support in head and neck cancer: tube vs oral feeding during radiation therapy. J Am Diet Assoc 85(6):669–674PubMedGoogle Scholar
  8. 8.
    Isenring E, Capra S, Bauer J (2004) Patient satisfaction is rated higher by radiation oncology outpatients receiving nutritional intervention compared with usual care. J Hum Nutr Diet 17(2):145–152PubMedCrossRefGoogle Scholar
  9. 9.
    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 91:447–452PubMedCrossRefGoogle Scholar
  10. 10.
    Larsson M, Hedelin B, Johansson I, Athlin E (2005) Eating problems and weight loss for patients with head and neck cancer. Cancer Nursing 28(6):425–435PubMedCrossRefGoogle Scholar
  11. 11.
    McCarthy D, Weihofen D (1999) The effect of nutritional supplements on food intake in patients undergoing radiotherapy. Oncol Nurs Forum 26(5):897–900PubMedGoogle Scholar
  12. 12.
    Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P (2001) Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube. Cancer 91(9):1785–1790PubMedCrossRefGoogle Scholar
  13. 13.
    Nayel H, el-Ghoneimy E, el-Haddad S (1992) Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Nutrition 8(1):13–18PubMedGoogle Scholar
  14. 14.
    Ollenschlanger G, Viell B, Thomas W et al (1991) Tumor anorexia: causes, assessment, treatment. Recent Results Cancer Research 121:249–259Google Scholar
  15. 15.
    Ottery FD (1995) Supportive nutrition to prevent cachexia and improve quality of life. Semin Oncol 22(2):98–111PubMedGoogle Scholar
  16. 16.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2003) Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol) 15(8):443–450Google Scholar
  17. 17.
    Ravasco P, Monteiro-Grillo I, Camilo ME (2003) Does nutrition influence quality of life in cancer patients undergoing radiotherapy. Radiot Oncol 67:213–220CrossRefGoogle Scholar
  18. 18.
    Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27(8):659–668PubMedCrossRefGoogle Scholar
  19. 19.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2005) Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 23:1431–1438PubMedCrossRefGoogle Scholar
  20. 20.
    Raynor EM, Williams MF, Martindale RG, Porubsky ES (1999) Timing of percutaneous endoscopic gastrostomy tube placement in head and neck cancer patients. Otolaryngol Head Neck Surg 120(4):479–482PubMedCrossRefGoogle Scholar
  21. 21.
    Rickman J (1998) Percutaneous endoscopic gastrostomy: psychological effects. Br J Nurs 7(12):723–729PubMedGoogle Scholar
  22. 22.
    Stern JM, Bremmer B, Moinpour CM, Sullivan KM, Lenssen P, Aker SN (2000) Impact of a randomized, controlled trial of liberal vs conservative hospital discharge criteria on energy, protein, and fluid intake in patients who received marrow transplants. J Amer Diet Assoc 100(9):1015–1022CrossRefGoogle Scholar
  23. 23.
    Toomey D, Redmond HP, Bouchier-Hayes D (1995) Mechanisms mediating cancer cachexia. Cancer 76(12):2418–2426PubMedCrossRefGoogle Scholar
  24. 24.
    van Bokhorst-de van der Schuer MA, von Blomberg-van der Flier BM, Riezebos RK et al (1998) Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 17(3):107–111PubMedCrossRefGoogle Scholar
  25. 25.
    van Bokhorst-de van der Schuer MA, van Leeuwen PA, Kuik DJ et al (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86(3):519–527PubMedCrossRefGoogle Scholar
  26. 26.
    Whitman MM (2000) The starving patient: supportive care for people with cancer. Clin J Oncol Nurs 4:121–125PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Haidy Lee
    • 1
  • Carole Havrila
    • 2
  • Vikki Bravo
    • 2
  • Kellie Shantz
    • 1
  • Kellie Diaz
    • 1
  • James Larner
    • 1
  • Paul Read
    • 1
  1. 1.Department of Radiation OncologyUniversity of Virginia Medical CenterCharlottesvilleUSA
  2. 2.University of Virginia Cancer CenterCharlottesvilleUSA

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