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

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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.

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Acknowledgements

We thank Prof. A. Laviano, M.D. from Department of Clinical Medicine, University La Sapienza, Rome, Italy, for the critical review of the manuscript.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Nutrition, Metabolism and Diabetes Unit, Department of Medicine, Treviso Hospital, Treviso, Italy

    Agostino Paccagnella, Carla Baruffi, Maria L. Marcon & Edward Kiwanuka

  2. Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy

    Michela Morello, Marta Giometto & Lorenza Caregaro

  3. Department of Medical and Surgical Specialities, Otolaryngology Clinic II—Regional Centre for Head and Neck Cancer, School of Medicine, Treviso Regional Hospital, University of Padua, Treviso, Italy

    Maria C. Da Mosto, Paolo Boscolo-Rizzo & Carlo Marchiori

  4. Department of Radiation Oncology, Treviso Hospital, Treviso, Italy

    Alessandro Gava & Vittorio Baggio

  5. Medical Oncology Department, Treviso Hospital, Treviso, Italy

    Stefano Lamon, Roberta Babare & Giovanni Rosti

  6. Hospital Direction, Treviso Hospital, Treviso, Italy

    Michele Tessarin

  7. Servizio di Nutrizione Clinica, Diabetologia e Malattie del Metabolismo, Ospedale Ca’ Foncello, 31100, Treviso, Italy

    Agostino Paccagnella

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  1. Agostino Paccagnella
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Correspondence to Agostino Paccagnella.

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Paccagnella, A., Morello, M., Da Mosto, M.C. et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 18, 837–845 (2010). https://doi.org/10.1007/s00520-009-0717-0

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