Supportive Care in Cancer

, Volume 18, Issue 7, pp 837–845

Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy

  • Agostino Paccagnella
  • Michela Morello
  • Maria C. Da Mosto
  • Carla Baruffi
  • Maria L. Marcon
  • Alessandro Gava
  • Vittorio Baggio
  • Stefano Lamon
  • Roberta Babare
  • Giovanni Rosti
  • Marta Giometto
  • Paolo Boscolo-Rizzo
  • Edward Kiwanuka
  • Michele Tessarin
  • Lorenza Caregaro
  • Carlo Marchiori
Original Article

Abstract

Goals of work

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.

Materials and 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).

Main 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.

Keywords

Chemoradiotherapy Enteral nutrition Head and neck cancer Nutrition support 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Agostino Paccagnella
    • 1
    • 7
  • Michela Morello
    • 2
  • Maria C. Da Mosto
    • 3
  • Carla Baruffi
    • 1
  • Maria L. Marcon
    • 1
  • Alessandro Gava
    • 4
  • Vittorio Baggio
    • 4
  • Stefano Lamon
    • 5
  • Roberta Babare
    • 5
  • Giovanni Rosti
    • 5
  • Marta Giometto
    • 2
  • Paolo Boscolo-Rizzo
    • 3
  • Edward Kiwanuka
    • 1
  • Michele Tessarin
    • 6
  • Lorenza Caregaro
    • 2
  • Carlo Marchiori
    • 3
  1. 1.Nutrition, Metabolism and Diabetes Unit, Department of MedicineTreviso HospitalTrevisoItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity of PaduaPaduaItaly
  3. 3.Department of Medical and Surgical Specialities, Otolaryngology Clinic II—Regional Centre for Head and Neck Cancer, School of Medicine, Treviso Regional HospitalUniversity of PaduaTrevisoItaly
  4. 4.Department of Radiation OncologyTreviso HospitalTrevisoItaly
  5. 5.Medical Oncology DepartmentTreviso HospitalTrevisoItaly
  6. 6.Hospital DirectionTreviso HospitalTrevisoItaly
  7. 7.Servizio di Nutrizione Clinica, Diabetologia e Malattie del MetabolismoOspedale Ca’ FoncelloTrevisoItaly

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