Assessment and results of early active nutritional interventions during radiotherapy with or without chemotherapy of head-and-neck cancer

Abstract

Background: Patients of head-and-neck cancer (HANC) undergoing chemoradiotherapy (CRT) are at high risk of malnutrition due to acute effects of radiotherapy (RT). This study was intended to assess weight loss and change in body mass index (BMI) during CRT with active diet counseling and nutritional supplementation. Aims and Objective: The primary end point was to assess loss of weight and BMI during treatment. The secondary end point is assessment of compliance to stipulated treatment time, frequency of nasogastric tube feeding, intravenous support, and duration of hospital admission. Materials and Methods: This was a prospective observational study performed in Radiation Oncology department of a tertiary care center. Consecutive patients of HANC requiring definitive or adjuvant RT (±chemotherapy) were included. Nutritional status assessment and diet counseling were done before start of RT, and further weekly assessment of body weight and BMI was done. Results: Between December 2017 and December 2018, 128 patients were included in this study. Sitewise distribution were oral cavity, oropharynx, hypopharynx, and larynx in 69, 33, 9, and 17 patients, respectively. Weight loss and BMI comparison were done at the start and end of RT (mean weight: 53.86 kg; 95% confidence interval [CI]: ± 1.71, mean BMI: 21.52; 95% CI: ± 0.95 [at the start of RT] and mean weight: 48.30 kg; 95% CI: ± 1.58, mean BMI: 19.18; 95% CI: ± 0.88 [at the end of RT]).There was a significant reduction in weight (P < 0.0001, S) and BMI (P = 0.00034, S), respectively. During the treatment, a total of 14 patients were put on nasogastric tube feeding, and 23 patients were admitted for parenteral nutrition with median hospital stay of 3 days (range: 1–5 days). Conclusions: There is a significant weight loss and change in BMI during CRT in HANC patients. Regular assessment and active nutritional intervention are required in all patients to improve compliance.