Nutritional Care in Patients with Head and Neck Cancer during Chemoradiotherapy (CRT) and Bioradiotherapy (BRT) Provides Better Compliance with the Treatment Plan

Abstract

The treatment of locally advanced head and neck cancer (HNC) is based on extensive resections followed by concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy; BRT). Malnutrition, which occurs in up to 60% of patients before treatment commencement, severely increases the risk of CRT/BRT drug dose reductions and the incidence of treatment-related adverse events. A prospective observational study was performed regarding the influence of nutritional care on nutritional status, compliance with the treatment‘s planned regimen, and the incidence of treatment-related complications in patients with advanced HNC during CRT and BRT. The study population encompassed 153 patients compared with a retrospective control group of 72 patients treated before nutritional care was included in the standard of oncological care. Patients enrolled in the nutritional care programme received significantly higher doses of platinum derivatives or cetuximab than patients in the control group. A significant difference between the compared populations was observed in patients below 70 years of age (92.8% of the study population), after prior surgery, and with initial weight loss lower than 10%. Nutritional care reduced final weight loss and prevented a decline within the laboratory markers of nutritional status. Weight loss was comparable in both modes of treatment—CRT and BRT. The incidence of treatment-related complications was significantly higher in patients without nutritional support in the subgroups of patients under 70 years of age and after primary surgery. Nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit, defined as preventing down-dosing, weight loss, and the incidence of complications. Platinum derivatives and cetuximab had comparable influence on weight loss.

To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients

“…A recent study from our unit has shown that an organized care program provided by the specialized nutrition team results in reduced rates of Aes, prevents down-dosing of oncological treatment and reduces weight loss in patients with HNC. 19 Another key finding in our study was that PEGs performed in patients following oncological treatment (CRT) had an almost 3-fold higher risk of major Aes than patients before such treatment (HR = 2.7, 95% CI = 1.0-7.2, p = 0.042). This finding supports the beneficial role of early ("prophylactic") PEG rather than "reactive" PEG placement.…”

“…With this in mind, it is of the utmost importance that these patients remain under the supervision of the Nutrition Clinic for regular monitoring of the PEG tube position within the first months after its placement. A recent study from our unit has shown that an organized care program provided by the specialized nutrition team results in reduced rates of Aes, prevents down‐dosing of oncological treatment and reduces weight loss in patients with HNC 19 …”

R–CSS: A clinically applicable score to classify cachexia stages in patients with cancer undergoing intensity-modulated radiation therapy

“…In our study, different stages of cachexia were significantly associated with treatment-related events. 26 The exact mechanism by which higher cachexia stages lead to an increase in the occurrence of treatment-related events is unknown, but certain factors may be involved. For example, radiation-induced fatigue is known to be associated with elevated levels of proinflammatory cytokines, including TNF-α and IL-6, both of which are elevated in cachexia patients.…”

Prevalence and Trends in Percutaneous Endoscopic Gastrostomy Placement: Results From a 10-Year, Nationwide Analysis

“…Studies show that prophylactic PEG in patients with HNC undergoing chemoradiotherapy is associated with less weight loss and hospital readmission than in the reactive placement group ( 22 ). Kapała et al proved in the Polish study that an organized nutritional care program introduced and supervised by the specialized nutrition team (NST) reduced complication rates, prevented down-dosing of oncological treatment, and weight loss of patients with HNC ( 23 ). A growing number of patients with cancer on HEN are observed in European studies.…”