Download Nutrition Support for the Head and Neck Cancer Patient

Nutrition Support for the Head and Neck Cancer Patient
Damien H. Buchkowski, RD, CSO
Registered Dietitian/Board Certified Specialist in Oncology Nutrition
St. 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 obstruction
o 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 dehydration
o Severe dysphagia
o Anorexia
o 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