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Nutrition outcomes following implementation of validated swallowing and nutrition guidelines for patients with head and neck cancer

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Abstract

Purpose

Head and neck cancer patients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients.

Methods

This study is a prospective observational audit in patients treated for head and neck cancer at a tertiary hospital from 2007 to 2008 (n = 539). Nutrition outcomes (weight, nutritional status and type of nutrition support) were compared for each nutrition risk category. Primary outcome was 10 % or more weight loss at 3 months post-treatment (n = 219).

Results

Overall adherence to the guideline tube feeding recommendations was 81 %. High risk patients had mean weight loss of 6 % on completion of treatment and 9 % at 3 months post-treatment, despite the majority having a proactive gastrostomy tube. Medium and low risk patients also lost weight over this time. Univariate analysis found that non-adherence to the guidelines was associated with weight loss at 3 months (p = 0.013). Multivariate analysis found overweight patients had 1.82 greater odds, and obese patients had 3.49 greater odds of losing weight (p = 0.021). Patients with significant weight loss at diagnosis had decreased odds of losing weight later (p = 0.011).

Conclusion

Clinically significant weight loss was still prevalent in this population despite proactive interventions. Predictors of weight loss support the evidence-based guidelines’ risk categories, and adherence was important to improve outcomes. Further research is required to determine the impact of significant weight loss in patients with high body mass index (BMI).

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Acknowledgments

Thanks to A/Prof Judith Bauer for advice on manuscript preparation. The authors would also like to thank the following staff members and groups of the Royal Brisbane and Women’s Hospital: the staff of the Combined Head and Neck Clinic for their support and access to their patients, Ann-Louise Spurgin and Jane Crombie from Speech Pathology for their assistance in developing the H&N guidelines, Lee Tripcony and Jacqui Keller from Cancer Care Services for their assistance with establishment of initial database and the dietetic staff for assistance with data collection.

This work was supported by a Royal Brisbane and Women’s Hospital Research Advisory Committee project grant in 2011.

Ethics committee

Ethical approval for this study was granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC/09/QRBW/221). It was confirmed as meeting the criteria for a quality assurance study and conforming to the ethical principles of the National Health and Medical Research Council.

Conflict of interest

The authors declare that they have no competing interests. They have full control of all primary data and, subject to research ethics committee approval, agree to allow the journal to review anonymous data if requested.

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Authors and Affiliations

  1. Department of Nutrition & Dietetics, Royal Brisbane and Women’s Hospital, Level 2, James Mayne Building, Butterfield St, Herston, Brisbane, QLD, 4029, Australia

    Teresa Brown, Lynda Ross & Merrilyn Banks

  2. Queensland Institute of Medical Research, Brisbane, QLD, Australia

    Lee Jones

  3. Department of Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Brett Hughes

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  1. Teresa Brown
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Correspondence to Teresa Brown.

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Brown, T., Ross, L., Jones, L. et al. Nutrition outcomes following implementation of validated swallowing and nutrition guidelines for patients with head and neck cancer. Support Care Cancer 22, 2381–2391 (2014). https://doi.org/10.1007/s00520-014-2180-9

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  • DOI: https://doi.org/10.1007/s00520-014-2180-9

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