The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients

Abstract

Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side‐effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.

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

“…The ESPEN guideline recommends tube feeding in RT-induced severe mucositis or in obstructive tumors resulting in dysphagia, anticipating inadequate energy intake [14]. According to the systemic review, the provision of enteral nutrition support via a tube inserted is suggested once oral intake declines below 50% from the energy requirements or once >5 kg of weight loss has occurred from the baseline [33].…”

Comparison of the Outcomes of Three Different Nutritional Supports in Patients with Oral and Maxillofacial Malignant Tumors following Surgery

“…Consideration of the psychological factors is increasing in the field of gastric tube implantation [ 13 ]. Incorrect stomach tube insertion causes physical pain as well as great mental tension and psychological fear [ 31 ].…”

“…Correct nutritional support can help patients improve their nutritional status, prevent complications, facilitate recovery from inflammation, increase the survival rate of the flap, and shorten the hospitalization time [ 13 ].…”

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

“…Ideally, a rapid screening method for muscle mass such as bioelectrical impedance instead of more advanced imaging methods would be suitable for this purpose. Nowadays standard nutritional intervention includes the administration of tube feeding (TF) to stabilize weight loss when oral intake is impaired throughout the total course of HNC therapy . It is expected that TF partially limits loss in FM.…”

“…Nowadays standard nutritional intervention includes the administration of tube feeding (TF) to stabilize weight loss when oral intake is impaired throughout the total course of HNC therapy. 11 It is expected that TF partially limits loss in FM. However, optimizing and maintaining muscle mass might require additional anabolic and/or anti-catabolic ingredients and/or interventions besides TF.…”