Nutrition Support for the Head and Neck Cancer

Patient

Damien H. Buchkowski, RD, CSORegistered Dietitian/Board Certified Specialist in Oncology NutritionSt. John Providence East-Region Oncology Dietitian

April 11, 2015

OBJECTIVES

• Define the nutrition goals of individuals diagnosed with oropharyngeal cancer

• Discuss nutrition-related side-effects of various treatments for head and neck cancers as well as nutrition-related strategies to combat these side-effects

• Discuss the role of feeding tubes in individuals diagnosed with oropharyngeal cancer

• Identify nutrition goals of patients following the completion of treatment

Nutrition Goals of the Oropharyngeal Cancer Patient

• Correct pre-existing nutrition conditions prior to treatment when necessary and possible

• Prepare the patient for treatment (surgery/chemotherapy/radiation)

• Strive to achieve weight maintenance (or minimize weight loss) during treatment

• Complete the course of treatment "break-free" to maximize successful outcomes

Nutrition-Related Side-Effects and Nutrition Interventions - Surgery

• The type and extent of surgery dictates the impact upon nutrition intake

• Poor nutrition status prior to surgery can increase complications such as infection, wound dehiscence, and delayed wound healing

• Optimizing nutrition prior to surgery can be successful in both the well-nourished and malnourished populations

• Diets following surgery must often be tailored to individual limitations

Nutrition-Related Side-Effects and Nutrition Interventions - Radiation

• Stomatitis/Mucositis/Odynophagia

• Xerostomia/Thick Saliva

• Dysgeusia

• Dysphagia

• Fatigue

• Decreased appetite

Nutrition-Related Side-Effects and Nutrition Interventions - Chemotherapy

• Varies based upon agent used and individual tolerance

• Nausea/Vomiting

• Constipation

• Decreased appetite

• Diarrhea

• Dysgeusia/Metallic Taste

• Stomatitis/Mouth Sores

The Role of Feeding Tubes in Oropharyngeal Cancers

• Reasons for the placement of feeding tubes

• Prophylactic vs. reactive feeding tube placement

• National Comprehensive Cancer Center Network (NCCN) guidelines for considering prophylactic feeding tube placement

• Complications associated with feeding tubes

• Discussing feeding tubes with patients

• Overweight/obese patients and feeding tubes

• Initiating feedings

• Weaning tube feedings

National Comprehensive Cancer Center Network (NCCN) Guidelines for Nutrition in Head and Neck Cancer Patients

Global Nutrition Recommendations for patients receiving (chemo-)radiotherapy

• Utilize oral intake as much as possible while maintaining safety• Monitor for the lifetime of the patient even well after therapy

Factors predicting limited enteral feeding requirement• Very good performance status as

measured by the Eastern Cooperative Oncology Group (ECOG) Score

• No Significant…o Pre-treatment weight

loss 5% past 1 month 10% past 6 months

o Airway obstructiono Dysphagia

Factors suggesting strong consideration of prophylactic PEG• Severe weight loss prior to treatment

5% past 1 month 10% past 6 months

• Symptoms include…o Ongoing dehydrationo Severe dysphagiao Anorexiao Odynophagia interfering with oral

intake• Significant comorbidities requiring

good oral intake for health maintenance

• Severe aspiration in any patient• Any aspiration in an elderly patient or

patients with compromised cardiopulmonary function

• Patients anticipating high-dose radiation

Nutrition Goals Following Treatment

• Weight maintenance while advancing diet

• Wean tube feedings

• Alleviate persistent barriers to eating

• Repletion of lost lean body mass

• Use the diagnosis/treatment to motivate positive change

CONCLUSION

Successful nutrition interventions in individuals diagnosed with oropharyngeal cancers limit the loss of lean body mass, preserve immune function, and prevent treatment delays while maximizing treatment outcomes and quality of life