Polly Fitz

Tube Feeding May Improve Adherence to Radiation Treatment Schedule in Head and Neck Cancer: An Outcomes Study

Head and neck cancer patients have a high risk of malnutrition because of lifestyle and dietary factors that may precipitate the disease, the disease itself, and therapies that often hinder feeding by mouth. Medical nutrition therapy (MNT) for the cancer patient aims to promote positive health and quality of life outcomes through provision of nutritional care. Outcomes research evaluates the effectiveness of MNT to produce these desired results. The present study determined if tube feedings, initiated prior to and continued throughout the radiation therapy, were associated with compliance with radiation therapy and weight maintenance in head and neck cancer patients. A chart review of a Tumor Registry at a metropolitan, tertiary care center from 1989–1995 identified 125 head and neck cancer patients treated with radiation therapy, 21 of whom were tube fed. Seventeen tube-fed patients with complete medical information were matched with 17 non–tube-fed patients (based on primary tumor site, disease stage, total radiation dosage, treatment with chemotherapy and/or surgery, and age) for a comparison of weight changes across the radiation therapy and number of missed treatment days. Groups did not differ on weight lost from preillness to disease presentation. The tube feeding group was associated with fewer missed treatment days and less weight loss. These concurrent findings suggest that the tube feeding supported the patients nutritional status and improved treatment adherence. Prospective studies will test this supposition empirically. Nonetheless, the chart review offers a time-efficient process to evaluate the outcomes of MNT.

Nutrition and nutritional requirements for the older adult.

Establishing reliable nutrient requirements for individuals over the age of 65 years is a difficult task. Research on nutrient requirements in the aged is sparse and often contradictory. However, there are important clues in the literature suggesting that requirements for certain nutrients are altered with age and that preventable nutrient deficiencies exist. Energy expenditure and caloric intake typically decline with age. Unless nutrient density of the diet improves, a parallel decline in vitamin and mineral intake is inevitable. Deficiencies or suboptimal intakes of water-soluble vitamins, vitamin D, calcium, zinc, copper, chromium, and water are reported in groups of older adults. Marginal nutrient deficiencies in this population may easily go undetected and contribute to morbidity.Establishing reliable nutrient requirements for individuals over the age of 65 years is a difficult task. Research on nutrient requirements in the aged is sparse and often contradictory. However, there are important clues in the literature suggesting that requirements for certain nutrients are altered with age and that preventable nutrient deficiencies exist. Energy expenditure and caloric intake typically decline with age. Unless nutrient density of the diet improves, a parallel decline in vitamin and mineral intake is inevitable. Deficiencies or suboptimal intakes of water-soluble vitamins, vitamin D, calcium, zinc, copper, chromium, and water are reported in groups of older adults. Marginal nutrient deficiencies in this population may easily go undetected and contribute to morbidity.

Enteral Feedings Are Associated With Improved Adherence To Radiation Treatment Prescription And Weight Maintenance In Head And Neck Cancer Patients.

Abstract LEARNING OUTCOME: To determine if enteral feedings maintained throughout radiation therapy unproved treatment adherence and stabilized weight in head and neck cancer patients. Nutrition support during radiation therapy may improve treatment tolerance and thus survival for head and neck cancer patients. Methods: A chart review was conducted to determine if tube fed (TF, n=19) patients had better medical outcomes (radiation treatment adherence, weight change) than non- tube fed (non-TF, n=19) patients. The TF and non-TF patients were matched for radiation dosage and cancer staging. For treatment adherence outcome, two categories were formed by comparing missed treatment days to days available for treatment (i.e., no weekend days): adherence (0-2 days missed) and non-adherence (3-18 days missed). For the weight change outcome, percent change in weight was calculated from pre-radiation to post radiation weight to form two categories: weight loss (2-26% loss) and weight stable (0-17% increase). Results: In chi-square analyses, significantly fewer patients in the TF group than the non-TF group fell into non-adherence (χ 2 =3.89. p 2 =4.05, p

A Comparative Analysis of Two Methodologies for Documentation in the Patient Medical Record by the R.D

Abstract LEARNING OUTCOME: To evaluate two formats for documentation of initial nutrition assessment in the acute-care patient medical record. Documentation of initial nutrition assessment at one institution was completed in subjective, objective, assessment, plan (SOAP) format until 1994, when an Assessment Form was initiated to streamline the standardized documentation of R.D.s. The two formats were evaluated to determine the effectiveness of dietitians documentation practice. A retrospective chart review was completed using a random sample of charts from two groups of patients (SOAP/94, n=30; FORM/95-96, n=30) with a primary discharge diagnosis of cerebrovascular accident. Initial assessment documentation was completed sooner in the FORM/95-96 group (2.61 days) than the SOAP/94 group (4.31 days). Significantly more recommendations (p=