The Effects of Compliance with Nutritional Counselling on Body Composition Parameters in Head and Neck Cancer Patients under Radiotherapy

Abstract

Background. Radiotherapy (RT) has been associated with increased risk of malnutrition in cancer patients, particularly in those with head and neck cancer (HNC). The aim of this prospective study was to evaluate the effects of compliance of patients with individual dietary counselling on body composition parameters in HNC patients under RT. Material and Methods. Sixty-nine consecutive patients (mean age: 61.0 ± 13.8) were prospectively followed. Bioelectrical impedance analysis (BIA) was performed to determine body composition parameters before, in the middle of, and at the end of RT. All patients received nutritional counselling and majority of them (94.6%) received oral nutritional supplement (ONS) during RT or chemoradiotherapy. If a patient consumed ≥75% of the recommended energy and protein intake via ONS and regular food, he/she was considered to be “compliant” (n = 18), while those who failed to meet this criteria were considered to be “noncompliant” (n = 30). Results. Body mass index, weight, fat percentage, fat mass, fat free mass, and muscle mass did not decrease significantly over time in compliant patients, but in noncompliant patients, all of these indices decreased significantly from baseline compared to the end of treatment (p < 0.001). Hand grip strength did not differ significantly between the two groups at baseline and over time in each group. When retrospectively evaluated, heavy mucositis was less commonly observed in compliant than noncompliant patients (11.1% versus 88.9%, resp.) (p < 0.009). Conclusion. We conclude that body composition parameters were better in head and neck cancer patients considered as compliant with nutritional counselling than noncompliant ones during RT period.

Longitudinal Body Composition Changes and the Importance of Fat-Free Mass Index in Locally Advanced Nasopharyngeal Carcinoma Patients Undergoing Concurrent Chemoradiotherapy

“…Weight loss is accompanied by loss of FFM, SM, and BCM, deterioration in the QOL, more severe treatment-induced toxicity, and a shorter survival. 17 Furthermore, this study also demonstrated the beneficial value of FFMI in helping diagnose malnutrition and the association of decreased FFMI with impaired QOL, which can partially support the important role of body composition parameters in nutritional assessment.…”

Changes in Nutrition Impact Symptoms, Nutritional and Functional Status during Head and Neck Cancer Treatment

“…The cut-off points for critical weight loss during RT were based on the international consensus statement of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition [11]. A HNC patient should be weighed routinely, since any weight loss >5% (compared to their usual weight or healthy weight over six months) is a factor contributing to a poor prognosis [12].…”

Optimising nutrition support in patients with head and neck cancer

“…Further qualitative research is recommended to investigate these barriers in depth, as they are potentially modifiable and can be addressed. Improving adherence to dietary recommendations has been shown to result in improved outcomes both within this study and others (Capuano et al, 2008, Hopanci Bicakli et al, 2017. The characteristics of this patient population also suggest that adherence may be particularly challenging given the high rate of mental health problems, substance use and social issues which increases psychologic distress and depression (Kugaya et al, 2000, DiMatteo, Lepper, & Croghan, 2000.…”

“…However this did not account for adherence to the dietary advice actually provided. This has been addressed more recently, where a study defined adherence to dietary counselling as consuming ≥75% of recommended energy and protein intake, and this confirmed favourable outcomes on body composition parameters with adherence (Hopanci Bicakli et al, 2017).…”