Multimodal cancer treatment and its association with nutrition care practices in patients with head and neck and esophageal cancer: an international prospective cohort study

Main Article Content

Leah Gramlich Rupinder Dhaliwal Narisorn Lakananurak Vickie Baracos Merran Findlay http://orcid.org/0000-0001-6964-1533 Judith D. Bauer http://orcid.org/0000-0002-3830-5147 Marian de van der Schueren Alessandro Laviano Adrianne Wideman Andrew G. Day Lisa Martin

Abstract

Background: Both cancer and its’ treatment contribute to the development of malnutrition, particularly in cancers that impact nutrition intake such as head and neck (HNC) and esophageal (EC) cancers. This study was undertaken to explore the relationship between cancer treatment and nutrition care in patients with HNC and EC.


Methods: Adult patients (≥18 years) with newly diagnosed head and neck (HN) or esophageal (ESO) cancers scheduled to receive cancer treatment were enrolled between 2016 and 2018 in the INFORM study, a longitudinal multi-centre prospective cohort study. Baseline clinical characteristics of patients, cancer characteristics, treatment type (chemotherapy/radiotherap y /surgery) and frequency, nutrition risk (Patient Generated Subjective Global Assessment Short Form (PG-SGA SF) and nutrition care were recorded.


Results: 100 HNC and 51 EC patients were included. Data were collected across 4 time periods from baseline to 6 months at 11 sites in Canada, Australia Italy, The Netherlands and the United States. Seventy-nine percent of the patients were male with a mean (SD) age of 63 (10) years. At admission, the mean (SD) BMI was 27 (5) kg/m2 and 30% were current smokers. Baseline PGA-SGA SF was ≥ 4 indicating nutrition risk for 59% of the HNC and 77% of the EC patients. The number of cancer treatments was positively associated with increases in enteral (EN) and parenteral nutrition (PN). In HNC patients receiving a single cancer treatment, 39% required EN and with 3 cancer treatment types, 78% required EN. In EC requiring a single cancer treatment, 50% required EN and in patients with 3 cancer treatments 94% required EN.


Conclusion: The number of cancer treatment modalities is associated with the intensity of nutrition therapy required to sustain the patients through their cancer journey.

Keywords: nutrition care, head and neck cancer, esophageal cancer, cancer treatment

Article Details

How to Cite
GRAMLICH, Leah et al. Multimodal cancer treatment and its association with nutrition care practices in patients with head and neck and esophageal cancer: an international prospective cohort study. Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4591>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i11.4591.
Section
Research Articles

References

1. Bullock AF, Greenley SL, McKenzie GAG, Paton LW, Johnson MJ. Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. Eur J Clin Nutr. 2020 Nov;74(11):1519-1535. doi: 10.1038/s41430-020-0629-0. Epub 2020 May 4. PMID: 32366995; PMCID: PMC7606134.

2. Aprile G, Basile D, Giaretta R et al. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients. 2021 Apr 5; 13(4):1196. doi: 10.3390/ nu13041196. PMID: 33916385; PMCID: PMC8065908.

3. Pressoir M, Desné S, Berchery D et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer. 2010 Mar 16; 102(6):966-71. doi: 10.1038/ sj.bjc.6605578. Epub 2010 Feb 16. PMID: 20160725; PMCID: PMC2844030.

4. Neoh MK, Abu Zaid Z, Mat Daud ZA, et al. Changes in Nutrition Impact Symptoms, Nutritional and Functional Status during Head and Neck Cancer Treatment. Nutrients. 2020; 12.

5. Jeffery E, Sherriff J, Langdon C. A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy. The Australasian medical journal. 2012;5:8-13.

6. Kubrak C, Martin L, Gramlich L, et al. Prevalence and prognostic significance of malnutrition in patients with cancers of the head and neck. Clinical nutrition. 2020; 39: 901-909.

7. Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of laryngology and otology. 2016; 130:S32-S40.

8. Bozzetti F. Nutritional support in patients with oesophageal cancer. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2010; 18 Suppl 2:S41-50.

9. Ordan T, Mastnak DM, Palamar N, Kozjek NR. Nutritional Therapy for Patients with Esophageal Cancer. Nutrition and cancer. 2018; 70:23-29.

10. Farhangfar A, Makarewicz M, Ghosh S, et al. Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral oncology. 2014;50:877-883.

11. Findlay M, Purvis M, Venman R, Luong R, Carey S. Nutritional management of patients with oesophageal cancer throughout the treatment trajectory: benchmarking against best practice. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2020.

12. Langius JA, Doornaert P, Spreeuwenberg MD, Langendijk JA, Leemans CR, van Bokhorst-de van der Schueren MA. Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2010; 97:80-85.

13. Carvalho HA, Villar RC. Radiotherapy and immune response: the systemic effects of a local treatment. Clinics. 2018;73:e557s.

14. Arends, J., et al. (2017). "ESPEN guidelines on nutrition in cancer patients." Clinical Nutrition 36(1): 11-48.

15. Findlay, M., et al. (2011, 19 June 2016). "Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Cancer Council Australia". Retrieved 12 Dec 2022, from http://wiki.cancer.org.au/australia/COSA:Head_and_neck_cancer_nutrition_guidelines

16. Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet. 2020 Sep; 77(4):416-425. doi: 10.1111/1747-0080.12631. Epub 2020 Aug 17. PMID: 32803904; PMCID: PMC7540290.

17. Findlay, M., et al. (2020). "Translating Evidence-Based Guidelines into Practice-Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM)." Nutrients 12(12): 3808.

18. Jung HK, Tae CH, Lee HA, et al. Treatment pattern and overall survival in esophageal cancer during a 13-year period: A nationwide cohort study of 6,354 Korean patients. PloS one. 2020; 15:e0231456.

19. Byrne K, Hallworth P, Monfared AAT, Moshyk A, Shaw JW. Real-world systemic therapy treatment patterns for squamous cell carcinoma of the head and neck in Canada. Current oncology. 2019; 26:e167-e174.

20. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):322-329. doi: 10.1097/MCO. 0000000000000389. PMID: 28562490.

21. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987 Jan-Feb;11(1):8-13. doi: 10.1177/014860718701100108. PMID: 3820522.

22. Martin L, Findlay M, Bauer, J, Dhaliwal R, de van der Scheuren M, LavianoA, Widaman A, Baracos, V, Day AG, Gramlich L. A multisite, International Audit of Malnutrition risk and Energy and Protein Intakes in Patients undergoing treatment for head neck and esophageal cancer: Resluts from INFORM.Nutrients 2022 dec 10;14(24):5272

23. PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2): 377-81.

24. 2PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]

25. Meng Q, Tan S, Jiang Y, Han J, Xi Q, Zhuang Q, Wu G. Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer. A randomized clinical trial. Clin Nutr. 2021 Jan:40(1):40-46

26. McClelland S, 3rd, Andrews JZ, Chaudhry H, Teckie S, Goenka A. Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review. Oral oncology. 2018;87:77-81.

27. Ye X, Chang YC, Findlay M, Brown T, Bauer J. The effect of timing of enteral nutrition support on feeding outcomes and dysphagia in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review. Clin Nutr ESPEN. 2021; 44:96-104.

28. Mellors K, Ye X, Van Den Brande J, et al. Comparison of prophylactic percutaneous endoscopic gastrostomy with reactive enteral nutrition in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review. Clin Nutr ESPEN. 2021; 46:87-98.

29. Tunzi L, Funk T, Brown T, Findlay M, Bauer J. Optimal frequency of individualised nutrition counselling in patients with head and neck cancer receiving radiotherapy: A systematic review. J Hum Nutr Diet. 2022; 35(1):223-233.