Dietary regimen compliance improves outcomes for head and neck cancer patients
Over 500,000 new cases of head and neck cancers are diagnosed each year and between 35 and 60% of patients are malnourished at the time of diagnosis. Malnourishment and subsequent sarcopenia have been found to be a negative influence on the tolerance of cancer treatment. The side-effects of radiotherapy, surgery and chemotherapy – dysphagia, odynophagia, swallowing disorders, nausea, vomiting, mucositis and taste disorders – all affect nutritional balance. Research reveals that 20% of cancer patients die of complications linked to malnutrition rather than from the disease itself. These findings encouraged a group of American scientists to test a nutritional programme on patients suffering from laryngeal and orophangeal cancer undergoing radiotherapy to assess the impact of diet on the outcome. Their work was published in the September 2018 issue of Support Care Cancer.
Weekly counselling with a dietician
Researchers identified 352 patients with non-metastatic laryngeal (146) and oropharyngeal (206) cancer treated with definitive radiotherapy between 2004 and 2013. Disease and patient characteristics, treatment information, sarcopenia, compliance with the nutritional program, and clinical outcomes data were tabulated. The median follow-up for the cohort was 22.86 months. Patients received weekly nutritional advice from a dietician concerning calories and protein and how to maintain adequate calorie intake. They were advised to increase the number of snacks or meals during the day. Supplements were advised for those who did not manage to attain a balanced diet.
Length of treatment matched dietary counselling
Of the 352 patients, 85.8% had an appointment with a dietician and 62.6% of them complied with the advised dietary regime. Most patients (81%) suffered from grade 3 or above head or neck tumours and 70.9% had sarcopenia. Researchers noted that many patients who did not follow the nutrition programme underwent longer treatment (over 49 days): 26.5%, compared to 14.8% of those who complied with the nutrition programme. Data also reveals that dietary advice reduced the risk of death by 27% and the risk of the disease progressing by 31%.
The benefits of dietary advice on energy and protein intake, nutritional status and quality of life had already been proven. This study adds to those findings by showing that compliance with a dietary regime and regular appointments with a dietician help slow down the progression of the illness.
The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy. Kabarriti R, Bontempo A, Romano M, McGovern KP, Asaro A, Viswanathan S, Kalnicki S, Garg MK. Support Care Cancer. 2018 Sep;26(9):3307-3313. DOI: 10.1007/s00520-018-4198-x