Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status

Ho, Ya-Wen; Yeh, Kun‐Yun; Hsueh, Shun‐Wen; Hung, Chen-Yu; Lu, Chang‐Hsien; Tsang, Ngan‐Ming; Wang, Hung‐Ming; Hung, Yu‐Shin; Chou, Wen‐Chi

doi:10.1007/s00520-020-05804-3

Cited by 30 publications

(38 citation statements)

References 37 publications

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“… 1 , 5 , 43 The evidence supporting the efficacy of nutritional support in patients affected by H&N cancer is promising, but still scanty and mainly focused on nutritional endpoints, 1 , 43 – 45 while the impact on survival and treatment feasibility still requires confirmation. 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

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The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

et al. 2021

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Background: Nutritional support, including nutritional counseling and oral nutritional supplements (ONSs), has been recommended at the earliest opportunity in head and neck (H&N) cancer patients. The limited available evidence on the efficacy of immunonutrition during chemoradiotherapy (CT-RT) in H&N cancer patients is positive with regard to some secondary endpoints, but is still scanty, particularly with regard to toxicity and treatment tolerance. We hypothesize that early systematic provision of ONSs with a high-protein–high-calorie mixture containing immunonutrients (Impact) compared to standard high-calorie–high-protein nutritional blends, in addition to nutritional counseling, may be beneficial to patients with H&N cancer during CT-RT. Hence, we designed the present study to evaluate the efficacy, in terms of treatment tolerance, toxicity and response, body weight, body composition, protein-calorie intake, quality of life (QoL), fatigue, muscle strength and immunological profile of the early systematic provision of ONSs enriched in immunonutrients compared to isonitrogenous standard blends, in H&N cancer patients undergoing CT-RT. Methods: This is a pragmatic, bicentric, randomized (1:1), parallel-group, open label, controlled, pilot clinical trial. Discussion: Many efforts are still to be taken to improve the efficacy of nutritional support in oncology. Immunonutrition represents a promising approach also in H&N cancer patients, but the evidence on its efficacy in improving clinical outcomes during CT-RT is still inconclusive. The present pilot study, which guarantees the early provision of nutritional assessment and support to all the enrolled patients in accordance with the recent guidelines and recommendations, could represent one of the first proofs of the clinical effectiveness of early oral immunonutrition in cancer patients undergoing CT-RT and could stimulate further large randomized trials, potentially resulting in the improvement of supportive care quality. Trial registration: This study is registered on ClinicalTrials.gov Identifier: NCT04611113.

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Section: Discussionmentioning

confidence: 99%

“…One recent study suggested that while some H&N cancer patients may have pretreatment normal nutritional status, early nutritional counseling is nevertheless essential for the improvement of treatment tolerance and survival outcomes. 12 …”

Section: Introductionmentioning

confidence: 99%

The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

et al. 2021

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“…Systematic organization of early nutritional therapy in HNC patients is absolutely essential. Early nutritional intervention can not only prevent and treat RIOM, but also effectively improve the nutritional status of patients and improve their tolerance to chemoradiotherapy and overall survival rates ( 91 ). According to the PG-SGA score, the number of patients with good nutrition was higher in the early stage of treatment than in the late stage.…”

Section: Clinical Intervention For Riom and Malnutrition In Hnc Patiementioning

confidence: 99%

The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy

Zheng

Zhao

et al. 2021

Front. Oncol.

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Radiation-induced oral mucositis (RIOM) is a common side effect after radiotherapy (RT) in head and neck cancer (HNC) patients. RIOM patients with severe pain have difficulty in eating, which increases the incidence of malnutrition and affects patients’ quality of life and the process of RT. The mechanism of RIOM is not fully understood, and inflammatory response and oxidative stress appear to be important for RIOM occurrence and development. The nutritional status of patients is very important for their RT tolerance and recovery. Malnutrition, which can lead to anemia, low protein, decreased immunity and other problems, is an important clinical factor affecting tumor progression and treatment. Recent studies have shown that early nutritional intervention can ameliorate oral mucositis and nutritional status of patients with HNC. However, in clinical practice, early nutritional intervention for patients with HNC is not a conventional intervention strategy. Therefore, this review summarized the possible pathogenesis of RIOM, commonly used assessment tools for malnutrition in patients, and recent studies on the effects of early nutritional interventions on RIOM and nutritional status of patients with HNC. We hope to provide the basis and reference for the clinical application of early nutritional intervention models.

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“…Recently (September 2020), Hu et al [ 25 ] published an article regarding the impact of early nutritional counseling in HNC patients with normal NS. The authors analyzed 243 HNC patients with normal NS before treatment undergoing concurrent CRT at three medical centers.…”

Section: The Optimal Timing Of Nutritional Support In Hnc Patientsmentioning

confidence: 99%

“…This study showed that early nutritional counseling was associated with a significantly increased overall survival, decreased loss of weight, and decreased treatment interruption. Therefore, early nutritional counseling is necessary for HNC patients [ 25 ].…”

Section: The Optimal Timing Of Nutritional Support In Hnc Patientsmentioning

confidence: 99%

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

et al. 2020

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Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.

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Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status

Cited by 30 publications

References 37 publications

The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

The efficacy of immunonutrition in improving tolerance to chemoradiotherapy in patients with head and neck cancer, receiving nutritional counseling: study protocol of a randomized, open-label, parallel group, bicentric pilot study

The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

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