PathologyNutritional Considerations for Head and Neck Cancer Patients: A Review of the Literature
Section snippets
Etiology and Types of Malnutrition
Formerly, the definition of malnutrition was based on population and individual patient anthropomorphic and laboratory values. The American Society of Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics have recently developed standardized definitions for malnutrition based on a patient's degree of inflammation.6 There are 3 major categories: simple starvation with no underlying inflammation; mild to moderate inflammation, which would include conditions such as cancer
Impact of Malnutrition
The impact of malnutrition on patients is profound and directly affects outcomes. Mick et al13 studied a group of patients with stage III and IV head and neck cancer treated with multiple modalities. The strongest independent predictor of survival was pretreatment weight loss. Bertrand et al14 showed that 7 to 10 days of preoperative nutrition resulted in a significant improvement in postoperative quality of life and led to a 10% decrease in postoperative infectious complications. Van
Nutritional Assessment
Because of the risks associated with malnutrition, it is important to be able to identify before treatment begins those patients with head and neck cancer most at risk for malnutrition. Multiple assessment tools for malnutrition have been proposed. A complete history and physical examination are probably the most commonly used and best methods of evaluating nutritional status. Components of the history that must be elicited include recent unintentional weight loss, loss of appetite, and changes
Treatment of Malnutrition
Patients with difficulty eating secondary to pain and anorexia are treated easily with simple medical interventions. Mucositis is common in patients receiving radiation therapy and chemotherapy. Treatment is generally with topical medications (analgesics, antifungals, coating agents, and antihistamines) and gentle local care. Dental care can address pain of dental origin and frequent sips of water, synthetic saliva, and pilocarpine can address problems of xerostomia. Patients with
Methods of Nutritional Administration
Feeding tubes are placed into the gastrointestinal system, effectively bypassing the most common areas of feeding difficulty for the patient with upper aerodigestive tract cancer. Dysphagia, odynophagia, and aspiration are usually not a concern once feeding is started through a nasogastric, gastrostomy, or jejunostomy tube. If a patient is cachectic or unable to satisfy maintenance caloric needs by oral intake, the patient is a candidate for supplemental tube feeds. Gastrostomy tube placement
Modalities of Nutritional Support
Patients who are judged at high risk and cannot eat by mouth should be provided enteral feedings. There are 2 main routes of nutritional support: enteral and parenteral nutrition. Enteral nutrition is well tolerated and effective. There are many enteral formulas available (Table 3). Osmolality affects the patient's ability to tolerate the formula.33 High osmolality (>1,000 mOsm/kg) refers to a hypertonic formula that should be infused into the stomach to take advantage of the dilutional effects
Looking to the Future
Dietary causes for cancers are being found in certain populations (oral cancer with betel nuts, esophageal cancer with smoked foods) and to prevent such cancers by altering the diet is one of the most exciting new oncologic concepts. Some researchers have investigated food-related substances to identify which foods might offer a protective value against head and neck cancer. Low serum levels of vitamin A or β-carotene have been associated with cancer of the head and neck and gastric cancer.50
References (55)
- et al.
A review of post-operative feeding in patients undergoing resection and reconstruction for oral malignancy and presentation of a pre-operative scoring system
Br J Oral Maxillofac Surg
(2012) - et al.
Nutrition management of patients with malignancies of the head and neck
Surg Clin North Am
(2011) - et al.
Nutritional deterioration in cancer: The role of disease and diet
Clin Oncol (R Coll Radiol)
(2003) - et al.
Prevalence of malnutrition and nutritional risk factors in patients undergoing alcohol and drug treatment
Nutrition
(2012) - et al.
A return to ''normal eating'' after curative treatment for oral cancer. What are the long-term prospects?
Eur J Cancer B Oral Oncol
(1994) - et al.
Predictors of weight loss during radiation therapy
Otolaryngol Head Neck Surg
(2001) - et al.
Nutritional considerations in the surgical patient
Dent Clin North Am
(2003) - et al.
The relationship between measures of nutritional status and masticatory function in untreated patients with head and neck cancer
J Oral Maxillofac Surg
(2008) - et al.
Nutritional aspects of care
Oral Maxillofac Surg Clin North Am
(2006) - et al.
Serum prealbumin predicts survival in hemodialysis and peritoneal dialysis: 10 Years of prospective observation
Am J Kidney Dis
(2001)
Metastasis to the percutaneous endoscopic gastrostomy site in the patient with head and neck cancer: A case report and review of the literature
J Oral Maxillofac Surg
Gastric versus postpyloric feeding
Gastrointest Endosc Clin North Am
Percutaneous endoscopic gastrostomy in patients with head and neck malignancies
Am J Surg
Effects of arginine supplementation on mucosal immunity in rats with septic peritonitis
Clin Nutr
Glutamine supplementation enhances mucosal immunity in rats with gut-derived sepsis
Nutrition
A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer
Int J Oral Maxillofac Surg
Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: Systemic review and meta-analysis of controlled trials
BMJ
Parenteral nutrition and nutritional support of surgical patients: Reflections, controversies, and challenges
Surg Clin North Am
Early supplemental parenteral nutrition is associated with increased infectious complications in critically ill trauma patients
J Am Coll Surg
Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature
Nutrition
The impact of nutritional status on the prognoses of patients with advanced head and neck cancer
Cancer
Effects of cigarette smoke on the human oral mucosal transcriptome
Cancer Prev Res
Consensus statement: Academy of Nutrition and Dietetics and American Society of Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition)
JPEN J Parenter Enteral Nutr
New frontiers in endocrinology of eating disorders
Curr Top Behav Neurosci
Cancer cachexia syndrome in head and neck cancer patients: Part II. Pathophysiology
Head Neck
Prognostic factors in advanced head and neck cancer patients undergoing multimodality therapy
Otolaryngol Head Neck Surg
Preoperative nutritional support at home in head and neck cancer patients: From nutritional benefits to the prevention of the alcohol withdrawal syndrome
Curr Opin Clin Nutr Metab Care
Cited by (0)
Conflict of Interest Disclosures: None of the authors reported any disclosures.