Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review.

Maurizio Bossola

doi:10.3390/nu7010265

Abstract

The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC) and oral nutritional supplements (ONS) should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started), prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.

Highlights

IntroductionHead and neck cancer (HNC) (cancer of the oral cavity, oropharynx, hypopharynx and larynx) is the seventh most common malignancy in the world [1]
Head and neck cancer (HNC) is the seventh most common malignancy in the world [1]
If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube

Summary

Introduction

Head and neck cancer (HNC) (cancer of the oral cavity, oropharynx, hypopharynx and larynx) is the seventh most common malignancy in the world [1]. In many patients such toxicities may be very severe and even life threatening and may lead to treatment interruptions that are invariably associated with poorer outcome [13,14,15,16]. To this regard, it has been shown that during radiotherapy or CRT 55% of the patients may lose an additional 10% or more of body weight [11,12]

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