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Supportive Care in Cancer

, Volume 28, Issue 1, pp 341–349 | Cite as

Nutritional parameters associated with hospital admissions in patients being treated for head and neck cancer

  • Amanda M. DuffyEmail author
  • Mark Halaki
  • Allan Spigelman
  • Venessa Chin
  • Richard M. Gallagher
  • Victoria M. Flood
Original Article

Abstract

Purpose

This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)).

Methods

A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject’s diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment.

Results

Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was − 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p < 0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n = 10) (p = 0.011) compared with those without critical weight loss (n = 2). EN use was associated with a higher number of nutrition-related admissions; however, it did not predict length of stay among those admitted.

Conclusion

Critical weight loss during radiotherapy was associated with unplanned nutrition-related hospital admissions. Higher BMI was associated with greater weight loss during radiotherapy, whilst EN use assisted in weight preservation. Further research around patient selection for nutritional interventions aimed at preventing critical weight loss and unplanned hospital admissions is needed.

Keywords

BMI Weight loss Enteral nutrition Hospital admissions Head and neck 

Notes

Acknowledgements

The authors thank Dr. Ian Nivison-Smith for his assistance with statistical analysis.

Authors’ contribution

The authors’ contributions are as follows: AD was the principal investigator and contributed to the study design, conducted the data collection and analysis, interpretation of the findings and wrote the first draft of the manuscript. VF and MH contributed to the study design, data analysis, interpretation of the findings, and drafts of the manuscript. AS contributed to study support and design. RG and VC reviewed the medical treatment plans and contributed to the interpretation of findings.

Funding

This work was supported by funding from The Kinghorn Cancer Centre (TKCC) Trust Fund and had no role in the design, analysis or writing of this article.

Compliance with ethical standards

Conflict of interest

The authors have no financial or personal conflicts of interest to declare. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

All authors read and approved the final version of the manuscript. The authors have no financial or personal conflicts of interest to declare.

Supplementary material

520_2019_4826_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

References

  1. 1.
    Barnhart MK, Robinson RA, Simms VA, Ward EC, Cartmill B, Chandler SJ, Smee RI (2018) Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study. Support Care Cancer 26:1–11.  https://doi.org/10.1007/s00520-018-4076-6 CrossRefGoogle Scholar
  2. 2.
    Findlay M, Baeur J, Brown T, Head and Neck steering committee (2014) Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Cancer Council Australia, Sydney https://wiki.cancer.org.au/australiawiki/index.php?oldid=116710. Accessed 13 Jan 2018Google Scholar
  3. 3.
    Langius JAE, Doornaert P, Spreeuwenberg MD, Langendijk J, Leemans R, van Bokhorst-de van der Schueren MA (2010) Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiother Oncol 97(1):80–85.  https://doi.org/10.1016/j.radonc.2010.02.017 CrossRefPubMedGoogle Scholar
  4. 4.
    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
  5. 5.
    Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29(2):183–188.  https://doi.org/10.1097/01.coc.0000198745.94757.ee CrossRefPubMedGoogle Scholar
  6. 6.
    White JV, Guenter P, Jensen G, Malone A, Schofield M (2012) Consensus statement: academy of nutrition and dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enter Nutr 38:275–283CrossRefGoogle Scholar
  7. 7.
    Langius JAE, Bakker S, Rietveld DHF, Kruizenga HM, Langendijk JA, Weijs PJM, Leemans CR (2013) Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer 109(5):1093–1099.  https://doi.org/10.1038/bjc.2013.458 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bahig H, Fortin B, Alizadeh M, Lambert L, Filion E, Guertin L, Ayad T, Christopoulos A, Bissada E, Soulières D, Gaba Idiamey F, Nguyen-Tan PF (2015) Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer. Oral Oncol 51(5):521–528.  https://doi.org/10.1016/j.oraloncology.2015.02.097 CrossRefPubMedGoogle Scholar
  9. 9.
    Langius JAE, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR, Weijs PJM, Verdonck-de Leeuw IM (2013) More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer 65(1):76–83.  https://doi.org/10.1080/01635581 CrossRefPubMedGoogle Scholar
  10. 10.
    Chang PH, Wang CH, Huang JS, Lai CH, Wu TH, Lan YJ, Tsai JC, Chen EY, Yang SW, Yeh KY (2012) Low body mass index at 3 months following adjuvant chemoradiation affects survival of postoperative locally advanced oral cavity cancer patients. Laryngoscope 122(10):2193–2198.  https://doi.org/10.1002/lary.23450 CrossRefPubMedGoogle Scholar
  11. 11.
    Beaver ME, Matheny KE, Roberts DB, Myers JN (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125(6):645–648.  https://doi.org/10.1067/mhn.2001.120428 CrossRefPubMedGoogle Scholar
  12. 12.
    Clavel S, Fortin B, Després P, Donath D, Soulières D, Khaouam N, Charpentier D, Bélair M, Guertin L, Nguyen-Tan PF (2011) Enteral feeding during chemoradiotherapy for advanced head-and-neck cancer: a single-institution experience using a reactive approach. Int J Radiat Oncol Biol Phys 79(3):763–769CrossRefGoogle Scholar
  13. 13.
    Hughes BGM, Jain VK, Brown T, Spurgin AL, Hartnett G, Keller J, Tripcony L, Appleyard M, Hodge R (2013) Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high-risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution. Head Neck 35(3):436–442.  https://doi.org/10.1002/hed.22992 CrossRefPubMedGoogle Scholar
  14. 14.
    Grant DG, Bradley PT, Pothier DD, Bailey D, Caldera S, Baldwin DL, Birchall MA (2009) Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 34(2):103–112.  https://doi.org/10.1111/j.1749-4486.2009.01889.x CrossRefPubMedGoogle Scholar
  15. 15.
    Mansoor H, Masood MA, Yusuf MA (2014) Complications of percutaneous endoscopic gastrostomy tube insertion in cancer patients: a retrospective study. Journal of Gastrointestinal Cancer 45(4):452–459CrossRefGoogle Scholar
  16. 16.
    Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, Hoey BA, Stawicki SP (2007) Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 16(4):407PubMedGoogle Scholar
  17. 17.
    Nugent B, Lewis S, O’Sullivan JM (2013) Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev (1).  https://doi.org/10.1002/14651858.CD007904.pub3
  18. 18.
    Prabhakaran S, Doraiswamy VA, Nagaraja V, Cipolla J, Ofurum U, Evans DC, Lindsey DE, Seamon MJ, Kavuturu S, Gerlach AT, Jaik NP (2012) Nasoenteric tube complications. Scand J Surg 101(3):147–155.  https://doi.org/10.1177/145749691210100302 CrossRefPubMedGoogle Scholar
  19. 19.
    Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J (2009) A.S.P.E.N. enteral nutrition practice recommendations. J Parenter Enter Nutr 33(2):122–167 https://onlinelibrary.wiley.com/doi/abs/10.1177/0148607108330314CrossRefGoogle Scholar
  20. 20.
    Hearne BE, Dunaj JM, Daly JM, Strong EW, Vikram B, LePorte BJ, DeCosse JJ (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
  21. 21.
    Lee H, Havrila C, Bravo V, Shantz K, Diaz K, Larner J, Read P (2008) Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Care Cancer 16(3):285–289.  https://doi.org/10.1007/s00520-007-0313-0 CrossRefPubMedGoogle Scholar
  22. 22.
    Langius JAE, Twisk J, Kampman M, Doornaert P, Kramer MHH, Weijs PJM, Leemans CR (2016) Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo) radiotherapy. Oral Oncol 52:91–96.  https://doi.org/10.1016/j.oraloncology.2015.10.021 CrossRefPubMedGoogle Scholar
  23. 23.
    Yathiraj PH, Ghosh-Laskar S, Datta D, Rangarajan V, Purandare N, Gupta T, Budrukkar A, Murthy V, Kannan S, Agarwal JP (2014) Randomized controlled trial to compare 3-dimensional conformal radiation therapy (3DCRT) to intensity modulated radiation therapy (IMRT) in head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 90(1):S98CrossRefGoogle Scholar
  24. 24.
    Brown T, Banks M, Hughes BG, Lin C, Kenny LM, Bauer JD (2015) New radiotherapy techniques do not reduce the need for nutrition intervention in patients with head and neck cancer. Eur J Clin Nutr 69(10):1119–1124.  https://doi.org/10.1038/ejcn.2015.141 CrossRefPubMedGoogle Scholar
  25. 25.
    van der Linden NC, Kok A, Leermakers-Vermeer MJ, de Roos NM, de Bree R, van Cruijsen H, Terhaard CHJ (2017) Indicators for enteral nutrition use and prophylactic percutaneous endoscopic gastrostomy placement in patients with head and neck cancer undergoing chemoradiotherapy. Nutr Clin Pract 32(2):225–232.  https://doi.org/10.1177/0884533616682684 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Nutrition Services DepartmentSt Vincent’s HospitalSydneyAustralia
  2. 2.Faculty of Health SciencesThe University of SydneySydneyAustralia
  3. 3.St Vincent’s Hereditary Cancer ClinicThe Kinghorn Cancer CentreSydneyAustralia
  4. 4.St Vincent’s Clinical SchoolUNSWSydneyAustralia
  5. 5.Department of Medical OncologyThe Kinghorn Cancer CentreSydneyAustralia
  6. 6.Department of Otolaryngology- Head and Neck SurgerySt Vincent’s HospitalSydneyAustralia
  7. 7.The Garvan Institute of Medical ResearchSydneyAustralia
  8. 8.Allied Health Research Unit, Westmead HospitalWestern Sydney Local Health DistrictSydneyAustralia

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