Nutrition in Patients with Head and Neck Cancer

Overview

Introduction:
Nutrition and nutritional status assessment in head and neck cancer patients are an inseparable part of oncologic treatment and follow-up. The aim of the study was an evaluation of Nutritional Risk Screening 2002 (NRS) assessment tool use in oncologic follow-up checks, assessment of nutritional status changes in patients after head and neck cancer treatment and according to the results potential introduction of the NRS tool into the clinical practice.

Methods:
The patients followed-up after oncologic and combined surgical and oncologic treatment of head and neck cancer were included into the study. By means of NRS tool and purposeful questioning by the nurse the weight loss and per cent change in food intake was assessed and the Nutritional status (NS) 0–3 points was scored. In cooperation with the physician the activity, localization of disease, type and extent of oncologic treatment were evaluated and the Risk emerging from basic disease and treatment (R) scored 0–3 points was classified. Final NRS score was counted according to formula NRS = NS + R (0–6 points). The high nutritional risk is considered to come in scores 4 and more points. As a part of NRS the Body Mass Index (BMI) was counted. Retrospectively by medical records data mining weight preceding oncologic treatment, diagnosis, date of start and type of treatment were obtained.

Results:
Into the study 129 patients, 26 female and 103 male, were included. An average age was 62 years (minimum 32 years, maximum 88 years). Eighty-one patients were evaluated twice in a period 1 to 7 months, mostly after 3 and 6 months. Any weight loss occurred in 75.2% of patients, more than 5% of weight lost 62% of patients, >10% lost 41.9% of patients, >15% lost 27.1% of patients, >20% lost 17% and >25% lost 9.3% of patients. In between the follow-up checks 86.4% of patients were in range ±5% of their weight (45.7% lost up to 5% of their weight, 40.7% gained up to 5% of weight), 8.6% lost more that 5% of weight. Only 26% of patients after treatment were not in nutritional risk (NRS score 1–2), three quarters were in high and very high malnutrition risk (NRS score 3–6). Despite recommended care and nutritional intervention in 22.3% of patients worsening of NRS score 1–2 points occurred. In high risk of malnutrition (NRS score 4–6) the patients with oropharyngeal cancer (palatine tonsil and base of tongue), hypo- and epipharyngeal cancer were present, low score was found in patients with oncologic diseases of ear, parotid gland and larynx.

Discussion:
The authors consider study to be a pilot one. The results are limited by small number of patients and low representation of some oncologic diagnoses. Yet inadequate monitoring and solution of nutrition and poor nutritional status of head and neck cancer patients can be presumed. Further research in the field will be necessary. The paper includes recommended guideline for monitoring and nutrition solution of those patients.

Keywords:
nutrition, malnutrition, head and neck cancer, Nutritional Risk Screening, NRS 2002.