Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy

Cereda, Emanuele; Cappello, Silvia; Colombo, Sara; Klersy, Catherine; Imarisio, Ilaria; Turri, Annalisa; Caraccia, Marilisa; Borioli, Valeria; Monaco, Teresa; Benazzo, Marco; Pedrazzoli, Paolo; Corbella, Franco; Caccialanza, Riccardo

doi:10.1016/j.radonc.2017.10.015

Cited by 129 publications

(180 citation statements)

References 43 publications

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“…Surprisingly, early nutritional assessment and early dietary intervention did not impact prognosis in term of OS. Apparently, this finding was discordant with previous data . Therefore, we evaluated which factors were associated with early dietary supplementation, and only body weight loss was associated with an early dietary supplementation.…”

Section: Discussionsupporting

confidence: 61%

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Basile

Parnofiello

Vitale

et al. 2019

J cachexia sarcopenia muscle

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Background Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. Methods This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross‐sectional areas (cm 2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. Results In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm 2 /m 2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m 2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow‐up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression‐free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23–3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30–4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil–lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06–1.61, P = 0.010). Conclusions Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.

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Section: Discussionsupporting

confidence: 61%

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Basile

Parnofiello

Vitale

et al. 2019

J cachexia sarcopenia muscle

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“…Additionally, it comprised the use of oral nutritional supplements (ONS; 1‐2 cans of energy‐dense, high protein oral formula, without any functional or immunomodulatory compound, providing approximately 300‐600 kilocalories and 20‐40 g of protein), which were prescribed when patients were unable to maintain satisfactory spontaneous food intake (<60% of estimated requirements for two consecutive weeks). Regular consultations with a registered dietician were also included, either monthly, by means of face‐to‐face interviews at the time of the scheduled follow‐up visits, or weekly by means of telephone interviews …”

Section: Methodsmentioning

confidence: 99%

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy

et al. 2019

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In recent years, whey proteins (WP) have attracted increasing attention in health and disease for their bioactive functions. The aim of this study was to evaluate the benefit of WP isolate (WPI) supplementation in addition to nutritional counseling in malnourished advanced cancer patients undergoing chemotherapy (CT). In a single‐center, randomized, pragmatic, and parallel‐group controlled trial (http://www.ClinicalTrials.gov: NCT02065726), 166 malnourished advanced cancer patients with mixed tumor entities candidate to or undergoing CT were randomly assigned to receive nutritional counseling with (N = 82) or without (N = 84) WPI supplementation (20 g/d) for 3 months. The primary endpoint was the change in phase angle (PhA). Secondary endpoints included changes in standardized PhA (SPA), fat‐free mass index (FFMI), body weight, muscle strength, and CT toxicity (CTCAE 4.0 events). In patients with the primary endpoint assessed (modified intention‐to‐treat population), counseling plus WPI (N = 66) resulted in improved PhA compared to nutritional counseling alone (N = 69): mean difference, 0.48° (95% CI, 0.05 to 0.90) (P = .027). WPI supplementation also resulted in improved SPA (P = .021), FFMI (P = .041), body weight (P = .023), muscle strength (P < .001), and in a reduced risk of CT toxicity (risk difference, −9.8% [95% CI, −16.9 to −2.6]; P = .009), particularly of severe (grade ≥ 3) events (risk difference, −30.4% [95% CI, −44.4 to −16.5]; P = .001). In malnourished advanced cancer patients undergoing CT, receiving nutritional counseling, a 3‐month supplementation with WPI resulted in improved body composition, muscle strength, body weight, and reduced CT toxicity. Further trials, aimed at verifying the efficacy of this nutritional intervention on mid‐ and long‐term primary clinical endpoints in newly diagnosed specific cancer types, are warranted.

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“…Finally, in severely malnourished patients, the ERAS committee recommends initiation of nutritional supplementation 7‐10 days prior to surgery with continuation postoperatively . This has been shown to reduce both infectious and noninfectious complications in surgical patients and improve quality of life and tolerance of radiation therapy in nonsurgical patients . Other authors have recommended at least 10‐14 days of preoperative supplementation …”

Section: Introductionmentioning

confidence: 99%

“…9 This has been shown to reduce both infectious and noninfectious complications in surgical patients [10][11][12] and improve quality of life and tolerance of radiation therapy in nonsurgical patients. 13 Other authors have recommended at least 10-14 days of preoperative supplementation. 14,15 Despite strong evidence that nutritional status significantly impacts perioperative complications, morbidity, and mortality, 3,4,[10][11][12][13] the application of this information in practice is not clear.…”

Section: Introductionmentioning

confidence: 99%

“…13 Other authors have recommended at least 10-14 days of preoperative supplementation. 14,15 Despite strong evidence that nutritional status significantly impacts perioperative complications, morbidity, and mortality, 3,4,[10][11][12][13] the application of this information in practice is not clear. Here, we set out to evaluate practice patterns of members of the American Head and Neck Society (AHNS) relating to the assessment and management of malnutrition in this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

et al. 2019

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Background Physician practice patterns regarding diagnosis and management of malnutrition in the head and neck cancer patient population are not well studied. Methods A 17‐question survey was distributed to 1392 members of the American Head and Neck Society (AHNS). The impact of hospital type, fellowship training, experience, and specialty was assessed. Results Among AHNS members, there were 124 total respondents (9% response rate), including both otolaryngologists and radiation oncologists. Respondents strongly agreed (90%) that malnutrition negatively impacts patient outcomes. The majority (63%) felt comfortable screening for malnutrition, but 13% reported no routine assessment of malnutrition; 57% were unfamiliar with relevant guidelines. Barriers to screening included lack of familiarity with screening tools/guidelines, lack of time, and lack of access to dietitian. Conclusion Although there was a strong consensus among respondents that the identification and management of malnutrition among head and neck cancer patients is critical, familiarity with relevant guidelines was poor.

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Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy

Cited by 129 publications

References 43 publications

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

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