E.L. Rasmussen-Conrad

A prospective study on malnutrition and quality of life in patients with head and neck cancer.

The objective of this observational prospective study in patients with squamous cell carcinoma (SCC) of the oral, oropharyngeal and hypopharyngeal cavity was to look into the relation between malnutrition (>or=10% unintended weight loss within 6 months) and specific quality of life (QoL) parameters longitudinally. Bodyweight and QoL were monitored in 47 patients with SCC at diagnosis, end of treatment and six months after treatment. EORTC QoLQ-C30 and H&N 35 questionnaires were used to assess QoL. Significantly lower scores on the global QoL during treatment (p=0.01) and revalidation (p=0.02) were found for patients who had lost >or=10% compared to patients with <10% loss of weight within 6 month. Patients with radiotherapy and a treatment modality of radiotherapy with surgery or chemotherapy kept their unintended weight loss until the end of treatment. Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL. Professional preventive nutritional support is therefore already required on diagnoses.

Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy.

Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy. The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to standard nutritional care (SC). A prospective study, conducted between 2005 and 2007, compared individual dietary counselling (IDC, optimal energy and protein requirement) to SC by an oncology nurse (standard nutritional counselling). Endpoints were weight loss, BMI and malnutrition (5% weight loss/month) before, during and after the treatment. Thirty-eight patients were included evenly distributed over two groups. A significant decrease in weight loss was found 2 months after the treatment (P = 0.03) for IDC compared with SC. Malnutrition in patients with IDC decreased over time, while malnutrition increased in patients with SC (P = 0.02). Therefore, early and intensive individualised dietary counselling by a dietitian produces clinically relevant effects in terms of decreasing weight loss and malnutrition compared with SC in patients with head and neck cancer undergoing radiotherapy.

Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study.

The aim of this study was to evaluate nutritional status, food intake, and dysphagia in long‐term head and neck cancer survivors.

What you think is not what they get: significant discrepancies between prescribed and administered doses of tube feeding.

Enteral tube feeding remains an indispensible strategy to treat disease-related malnutrition. In the present study we evaluated in clinical practice whether prescribed feeding volumes correspond with administered quantities and we highlight possible causes for discrepancies. During a 4-month observation period data from all patients fully depending on tube feeding (1.5-2.5 litres/d) were collected in a Dutch 900-bed academic hospital. The range for administered feeds to be adequate was set at 100 +/- 10% of the prescribed dose. Fifty-five patients (mean age 57 (SD 30) years) were included. Tube feeding was given continuously via pump (n 37) or drip (n 3), in portions (n 14) or by combined modes (n 1). Administered tube feeding amounts were significantly lower than prescribed in 40% of all patients (P < or = 0.001). The mean ratio of administered v. prescribed energy was 87 (SD 21) % (all modes), 85 (SD 24) % (pump), 94 (SD 12) % (portions) and 88.3 (SD 18.1) % (drip), respectively. The mean energy deficit amounted to 1089 kJ/d (range -7955 to +795). Only on intensive care unit wards did feeding administration meet the set goal. Feeding interruptions because of diagnostic or therapeutic procedures were the main reason for decreased intakes. Our findings show that many patients relying on tube feeding do not meet their nutritional goals during hospital stay. This problem can be addressed by adapting feeding schedules and the use of formulations with a higher energy density.

OP002 INDIVIDUAL DIETARY COUNSELLING INDISPENSABLE IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING RADIOTHERAPY

Rationale: In today’s economic climate with a focus on limiting public spending, the provision of effective and efficient care has never been more important. A Randomised Controlled Trial (RCT) by Barlow et al (2008) concluded that the use of EEN versus standard management of nil by mouth (STD) reduced length of hospital stay (LOHS) by 3 days (16 versus 19 days; p < 0.023) and improved clinical outcomes. It is assumed that patients who have a reduce LOHS decrease healthcare expenditure (Kalish, 1995). Methods: The aim of this study was to determine the costs of two differing treatment arms of a RCT. After patients gave their consent, they were randomised to either EEN or STD. The costs of the differences in length of hospital stays, and the costs of treating the statistically significant different major complications were calculated for both groups. All other costs attributed to the development of non-significant complications were assumed to be similar for the two randomised groups. Results: Ninety-six patients were studied (EEN group (n = 54) and (STD group N = 42)). The cost for standard group per patient was £5,113 (SD £3,958 10,425) and the cost for the EEN group was £3,872 (SD £3,130 5,110) per patient. Therefore EEN led to cost reduction in the region of £1241 (SD £828 5,315) per patient. Conclusion: This study has indicated that the use of EEN when compared to traditional management, improves clinical outcome, reduces LOHS and could provide a cost benefit in the region of £1000 per patient.

Improving nutritional management within high-risk groups

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters. The GP as a central and longitudinal caretaker faces challenges in improving nutritional management.