Nutrition Support for the Head and Neck Cancer Patient Damien H. Buchkowski, RD, CSO Registered...
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Transcript of Nutrition Support for the Head and Neck Cancer Patient Damien H. Buchkowski, RD, CSO Registered...
Nutrition Support for the Head and Neck Cancer
Patient
Damien H. Buchkowski, RD, CSORegistered Dietitian/Board Certified Specialist in Oncology NutritionSt. John Providence East-Region Oncology Dietitian
April 11, 2015
OBJECTIVES
• Define the nutrition goals of individuals diagnosed with oropharyngeal cancer
• Discuss nutrition-related side-effects of various treatments for head and neck cancers as well as nutrition-related strategies to combat these side-effects
• Discuss the role of feeding tubes in individuals diagnosed with oropharyngeal cancer
• Identify nutrition goals of patients following the completion of treatment
Nutrition Goals of the Oropharyngeal Cancer Patient
• Correct pre-existing nutrition conditions prior to treatment when necessary and possible
• Prepare the patient for treatment (surgery/chemotherapy/radiation)
• Strive to achieve weight maintenance (or minimize weight loss) during treatment
• Complete the course of treatment "break-free" to maximize successful outcomes
Nutrition-Related Side-Effects and Nutrition Interventions - Surgery
• The type and extent of surgery dictates the impact upon nutrition intake
• Poor nutrition status prior to surgery can increase complications such as infection, wound dehiscence, and delayed wound healing
• Optimizing nutrition prior to surgery can be successful in both the well-nourished and malnourished populations
• Diets following surgery must often be tailored to individual limitations
Nutrition-Related Side-Effects and Nutrition Interventions - Radiation
• Stomatitis/Mucositis/Odynophagia
• Xerostomia/Thick Saliva
• Dysgeusia
• Dysphagia
• Fatigue
• Decreased appetite
Nutrition-Related Side-Effects and Nutrition Interventions - Chemotherapy
• Varies based upon agent used and individual tolerance
• Nausea/Vomiting
• Constipation
• Decreased appetite
• Diarrhea
• Dysgeusia/Metallic Taste
• Stomatitis/Mouth Sores
The Role of Feeding Tubes in Oropharyngeal Cancers
• Reasons for the placement of feeding tubes
• Prophylactic vs. reactive feeding tube placement
• National Comprehensive Cancer Center Network (NCCN) guidelines for considering prophylactic feeding tube placement
• Complications associated with feeding tubes
• Discussing feeding tubes with patients
• Overweight/obese patients and feeding tubes
• Initiating feedings
• Weaning tube feedings
National Comprehensive Cancer Center Network (NCCN) Guidelines for Nutrition in Head and Neck Cancer Patients
Global Nutrition Recommendations for patients receiving (chemo-)radiotherapy
• Utilize oral intake as much as possible while maintaining safety• Monitor for the lifetime of the patient even well after therapy
Factors predicting limited enteral feeding requirement• Very good performance status as
measured by the Eastern Cooperative Oncology Group (ECOG) Score
• No Significant…o Pre-treatment weight
loss 5% past 1 month 10% past 6 months
o Airway obstructiono Dysphagia
Factors suggesting strong consideration of prophylactic PEG• Severe weight loss prior to treatment
5% past 1 month 10% past 6 months
• Symptoms include…o Ongoing dehydrationo Severe dysphagiao Anorexiao Odynophagia interfering with oral
intake• Significant comorbidities requiring
good oral intake for health maintenance
• Severe aspiration in any patient• Any aspiration in an elderly patient or
patients with compromised cardiopulmonary function
• Patients anticipating high-dose radiation
Nutrition Goals Following Treatment
• Weight maintenance while advancing diet
• Wean tube feedings
• Alleviate persistent barriers to eating
• Repletion of lost lean body mass
• Use the diagnosis/treatment to motivate positive change
CONCLUSION
Successful nutrition interventions in individuals diagnosed with oropharyngeal cancers limit the loss of lean body mass, preserve immune function, and prevent treatment delays while maximizing treatment outcomes and quality of life