Advertisement

Nutrition Management for the Head and Neck Cancer Patient

  • Denise Ackerman
  • Meghan Laszlo
  • Arlene Provisor
  • Adern Yu
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 174)

Abstract

Head and neck cancer (HNC) patients often face multiple nutritional challenges before, during, and after treatment due to the close proximity of the cancer to organs that are vital for normal eating function. Common treatment-related side effects, such as dysphagia, odynophagia, dysgeusia, xerostomia, thick saliva, mucositis, nausea, and vomiting, all further impair the patient’s ability to maintain adequate oral intake. Malnutrition and unintentional weight loss in HNC patients during and after treatment are associated with poorer treatment outcomes, increased morbidity and mortality, and poor quality of life, even in overweight and obese patients whose Body Mass Index (BMI) is not suggestive of malnutrition. The main nutrition goal for HNC patients is thus to maximize nutrition intake either orally or through nutrition support therapy in order to prevent or limit weight loss, preserve lean body mass, minimize treatment delays and unplanned hospitalizations, and improve treatment outcomes. This chapter will discuss nutrition interventions to manage common symptoms before, during, and after treatment for HNC. Guidelines will be provided for patients that require enteral nutrition or less commonly, parenteral nutrition.

Keywords

Head and neck cancer Malnutrition Dysphagia Mucositis Xerostomia Nasogastric tube Percutaneous endoscopic gastrostomy Enteral nutrition Parenteral nutrition 

References

  1. 1.
    Van Wayenburg CAM, Rasmussen-Conrad EL, van den Berg MGA, Merkx MAW, van Staveren WA, van Weel C, van Binsbergen JJ (2010) Weight loss in head and neck cancer patients little noticed in general practice. J Prim Health Care 2:16–21PubMedGoogle Scholar
  2. 2.
    Van Der Schuer VB, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527.  https://doi.org/10.1002/(SICI)1097-0142(19990801)86:3<519:AID-CNCR22>3.0.CO;2-S CrossRefGoogle Scholar
  3. 3.
    Hammerlid E, Wirblad B, Sandin C, Mercke C, Edström S, Kaasa S, Sullivan M, Westin T (1998) Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head Neck 20:540–548.  https://doi.org/10.1002/(SICI)1097-0347(199809)20:6<540:AID-HED9>3.0.CO;2-J CrossRefPubMedGoogle Scholar
  4. 4.
    Grant B (2015) Pocket guide to the nutrition care process and cancer. Academy of Nutrition and DieteticsGoogle Scholar
  5. 5.
    Platek ME (2012) The role of dietary counseling and nutrition support in head and neck cancer patients. Curr Opin Support Palliat Care 6:438–445.  https://doi.org/10.1097/SPC.0b013e32835999d5 CrossRefPubMedGoogle Scholar
  6. 6.
    Farhangfar A, Makarewicz M, Ghosh S, Jha N, Scrimger R, Gramlich L, Baracos V (2014) Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral Oncol 50:877–883.  https://doi.org/10.1016/j.oraloncology.2014.06.009 CrossRefPubMedGoogle Scholar
  7. 7.
    Hayward MC, Shea AM (2009) Nutritional needs of patients with malignancies of the head and neck. Semin Oncol Nurs 25:203–211.  https://doi.org/10.1016/j.soncn.2009.05.003 CrossRefPubMedGoogle Scholar
  8. 8.
    Mahan L, Escott-Stump S, Raymond J, Krause M (2017) Krause’s food & the nutrition care processGoogle Scholar
  9. 9.
    American Academy of Nutrition and Dietetics (2017). Nutrition care manual. https://www.nutritioncaremanual.org/faq.cfm. Accessed 21 Aug 2017
  10. 10.
    Hovan AJ, Williams PM, Stevenson-Moore P, Wahlin YB, Ohrn KEO, Elting LS, Spijkervet FKL, Brennan MT (2010) A systematic review of dysgeusia induced by cancer therapies. Support Care Cancer 18:1081–1087.  https://doi.org/10.1007/s00520-010-0902-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Mclaughlin L, Suzanne MM (2014) Taste dysfunction and eating behaviors in survivors of head and neck cancer treatment. Med Surg Nurs 23:165–184Google Scholar
  12. 12.
    Sánchez-Lara K, Sosa-Sánchez R, Green-Renner D, Rodríguez C, Laviano A, Motola-Kuba D, Arrieta O (2010) Influence of taste disorders on dietary behaviors in cancer patients under chemotherapy. Nutr J 9:15.  https://doi.org/10.1186/1475-2891-9-15 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Elliott L, Levin R, Mclver J (2013) The complete resource kit for oncology nutrition. American Academy of Nutrition and Dietetics. https://publications.webauthor.com/pubs/oncology/. Accessed 19 Aug 2017
  14. 14.
    Halyard MY, Jatoi A, Sloan JA, Bearden JD, Vora SA, Atherton PJ, Perez EA, Soori G, Zalduendo AC, Zhu A, Stella PJ, Loprinzi CL (2007) Does zinc sulfate prevent therapy-ınduced taste alterations in head and neck cancer patients? Results of phase III double-blind, placebo-controlled trial from the north central cancer treatment group (N01C4). Int J Radiat Oncol Biol Phys 67:1318–1322.  https://doi.org/10.1016/j.ijrobp.2006.10.046 CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar NB (2012) Nutritional management of cancer treatment effects. Nutr Manag Cancer Treat Eff.  https://doi.org/10.1007/978-3-642-27233-2 Google Scholar
  16. 16.
    Sideras K, Hallemeier CL, Loprinzi CL (2014) Oral complications. Abeloff’s Clin Oncol 43:635–647.e4Google Scholar
  17. 17.
    Mosel DD, Bauer RL, Lynch DP, Hwang ST (2011) Oral complications in the treatment of cancer patients. Oral Dis 17:550–559.  https://doi.org/10.1111/j.1601-0825.2011.01788.x CrossRefPubMedGoogle Scholar
  18. 18.
    Noé JE (2009) l-glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective. Integr Cancer Ther 8:409–415.  https://doi.org/10.1177/1534735409348865 CrossRefPubMedGoogle Scholar
  19. 19.
    Tsujimoto T, Yamamoto Y, Wasa M, Takenaka Y, Nakahara S, Takagi T, Tsugane M, Hayashi N, Maeda K, Inohara H, Uejima E, Ito T (2015) l-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial. Oncol Rep 33:33–39.  https://doi.org/10.3892/or.2014.3564 CrossRefPubMedGoogle Scholar
  20. 20.
    Silverman S (2007) Diagnosis and management of oral mucositis. J Support Oncol 5:13–21.  https://doi.org/10.1016/j.otc.2010.09.010 PubMedGoogle Scholar
  21. 21.
    Chang PH, Wang CH, Huang JS, Lai CH, Wu TH, Lan YJ, Tsai JCS, Chen EYC, 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 122:2193–2198.  https://doi.org/10.1002/lary.23450 CrossRefPubMedGoogle Scholar
  22. 22.
    Anderson PM, Schroeder G, Skubitz KM (1998) Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. Cancer 83:1429–1433.  https://doi.org/10.1002/(SICI)1097-0142(19981001)83:7<1433:AID-CNCR22>3.0.CO;2-4 CrossRefGoogle Scholar
  23. 23.
    Leung HWC, Chan ALF (2016) Glutamine in alleviation of radiation-induced severe oral mucositis: a meta-analysis. Nutr Cancer 68:734–742.  https://doi.org/10.1080/01635581.2016.1159700 CrossRefPubMedGoogle Scholar
  24. 24.
    Paterson C, Caldwell B, Porteous S, McLean A, Messow CM, Thomson M (2016) Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611. Support Care Cancer 24:629–636.  https://doi.org/10.1007/s00520-015-2823-5 CrossRefPubMedGoogle Scholar
  25. 25.
    Deasy JO, Moiseenko V, Marks L, Chao KSC, Nam J, Eisbruch A (2010) Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys.  https://doi.org/10.1016/j.ijrobp.2009.06.090 Google Scholar
  26. 26.
    Lajer C, Buchwald C, Nauntofte B, Specht L, Bardow A, Jensdottir T (2009) Erosive potential of saliva stimulating tablets with and without fluoride in irradiated head and neck cancer patients. Radiother Oncol 93:534–538.  https://doi.org/10.1016/j.radonc.2009.06.028 CrossRefPubMedGoogle Scholar
  27. 27.
    Marx W, Kiss N, McCarthy AL, McKavanagh D, Isenring L (2016) Chemotherapy-induced nausea and vomiting: a narrative review to inform dietetics practice. J Acad Nutr Diet 116:819–827.  https://doi.org/10.1016/j.jand.2015.10.020 CrossRefPubMedGoogle Scholar
  28. 28.
    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 29:183–188.  https://doi.org/10.1097/01.coc.0000198745.94757.ee CrossRefPubMedGoogle Scholar
  29. 29.
    Marian M, Roberts S (2010) Clinical nutrition for oncology patients, 1st ed. Jones and Bartlett Publishers LLCGoogle Scholar
  30. 30.
    August D, Huhmann M, A.S.P.E.N. Board of Directors (2009) A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. J Parenter Enter Nutr 33:472–500.  https://doi.org/10.1177/0148607109341804 CrossRefGoogle Scholar
  31. 31.
    Fonseca J, Santos C, Brito J (2016) Malnutrition and clinical outcome of 234 head and neck cancer patients who underwent percutaneous endoscopic gastrostomy. Nutr Cancer 68:589–597.  https://doi.org/10.1080/01635581.2016.1158297 CrossRefPubMedGoogle Scholar
  32. 32.
    Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M (2010) Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 18:433–437.  https://doi.org/10.1007/s00520-009-0681-8 CrossRefPubMedGoogle Scholar
  33. 33.
    Koretz RL, Lipman TO, Klein S (2001) AGA technical review on parenteral nutrition. Gastroenterology 121:970–1001.  https://doi.org/10.1053/gast.2001.28031 CrossRefPubMedGoogle Scholar
  34. 34.
    Simpser E, Braunschweig CL, George DE, Worthington PA, Boullata JI, Druyan ME, Compher C (2012) Clinical guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients: applying the grade system to development of A.S.P.E.N. clinical guidelines. J Parenter Enter Nutr 36:77–80.  https://doi.org/10.1177/0148607111420157 CrossRefGoogle Scholar
  35. 35.
    Mueller CM (2012) The ASPEN adult nutrition support core curriculum, 2nd edn. ASPEN, Maryland, MDGoogle Scholar
  36. 36.
    Locher JL, Bonner JA, Carroll WR, Caudell JJ, Keith JN, Kilgore ML, Ritchie CS, Roth DL, Tajeu GS, Allison JJ (2011) Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr 35:365–374. doi: https://doi.org/10.1177/0148607110377097
  37. 37.
    Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB (2015) Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients. Radiat Oncol 10:93.  https://doi.org/10.1186/s13014-015-0408-6 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Raykher A, Russo L, Schattner M, Schwartz L, Scott B, Shike M (2007) Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract 22:68–73. doi: https://doi.org/10.1177/011542650702200168
  39. 39.
    Marinella MA (2009) Refeeding syndrome: an important aspect of supportive oncology. J Support Oncol 7:11–16PubMedGoogle Scholar
  40. 40.
    Kraft MD, Btaiche IF, Sacks GS (2005) Review of the refeeding syndrome. Nutr Clin Pract 20:625–633. https://doi.org/10.1177/0115426505020006625 CrossRefPubMedGoogle Scholar
  41. 41.
    Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ, Nason KS (2012) Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 93:897–903–4. doi:https://doi.org/10.1016/j.athoracsur.2011.10.060
  42. 42.
    Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K (1980) The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc Mayo Clin 55:700–704PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Denise Ackerman
    • 1
  • Meghan Laszlo
    • 2
  • Arlene Provisor
    • 2
  • Adern Yu
    • 1
  1. 1.Department of Surgery, Division of Head and Neck SurgeryCity of Hope National Medical CenterDuarteUSA
  2. 2.Department of SurgeryCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations