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Nutritional management during treatment for head and neck cancer

Nutritional management during treatment for head and neck cancer short review memo (2020) 13:405–408 https://doi.org/10.1007/s12254-020-00613-0 Nutritional management during treatment for head and neck cancer Christina Wagner Received: 2 March 2020 / Accepted: 23 April 2020 / Published online: 14 May 2020 © The Author(s) 2020 Summary Head and neck cancer is the sixth most common can- Background The majority of patients who suffer from cer worldwide. Annually 1200 new cases are diag- head and neck cancer are malnourished even prior nosed in Austria [1, 2]. Up to 60% of patients be- to treatment initiation. In addition, side effects from ing treated for locally advanced head and neck squa- cancer therapy including change in taste, mucositis, mous cell cancer suffer from malnutrition prior to nausea or diarrhea increase patients’ malnutrition. even starting treatment [3]. Unintentional weight loss Therefore, early management is crucial to improve is a result of reduced food intake, systemic inflam- nutritional status, prognosis and quality of life of mation and persistent catabolism [4]. Malnutrition patients. with a weight loss up to 10% of baseline body mass Methods A literature research was performed in often leads to more adverse effects, reduced progno- PubMed, Medline and other available databases. sis and reduced quality of life of patients. Therefore, The guidelines of the German Society for Nutritional early management is essential to improve nutritional Medicine, the European Society for Clinical Nutrition status, patient outcome and quality of life [4]. and Metabolism and common recommendations of other countries were selected, analyzed and summa- Adverse effects of malnutrition rized. Results Early screening for malnutrition is recom- Cancer patients are at risk of malnutrition due to dis- mended for all cancer patients. Adequate intake of ease progress and antitumor therapy. The risk for pa- energy and protein should be ensured which may be tients with head and neck cancer is even higher due achieved by consumption of oral nutritional supple- to the location of their tumor. The development of ments or enteral nutrition such as tube feeding. difficulties in chewing and dysphagia is increased [5]. Conclusion It is important to determine the best Chemotherapy, radiotherapy and surgery mostly af- course of management to maintain body weight and fect nutritional intake and may cause side effects. The reduce typical adverse effects of malnutrition to im- most common adverse events in head and neck can- prove quality of life. All patients at any stage of their cer after initiation of treatment are mucositis, xeros- treatment should receive intensive dietary counseling. tomy, changes in taste, pain, nausea and vomiting. As a result, they lead to reduced food intake [5]. Keywords Nutrition · Oncological dietetics · Dietary Lifestyle factors such as consumption of alcohol deficiency · Malnutrition · Cachexia · Head and neck and tobacco use also contribute to malnutrition. Alco- oncology hol provides empty calories and suppresses appetite. Alshadwi et al. [3] have indicated that head and neck cancer patients with a history of alcohol misuse have a much lower intake of fresh fruits and vegetables. Thus, the probability of malnutrition is increase in C. Wagner, MSc () this population group compared to other tumor enti- Department of Medicine I, Division of Oncology, Medical ties [3]. University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, A weight loss of more than 10% of the baseline Austria christina.wagner@meduniwien.ac.at body mass may lead to various adverse effects such K Nutritional management during treatment for head and neck cancer 405 short review as an increased risk of infection, delayed wound heal- tients should be followed up at least 6 months post- ing, muscle waste, depression and a reduced response treatment by nutritional experts [11]. to chemo- or radiotherapy [4]. Unintentional weight Further factors to be protocolled frequently are the loss may lead to cachexia which in turn results in de- ability to chew and swallow, changes in appetite and creased appetite, fat and muscle loss and metabolic gastrointestinal functions. Furthermore, daily medi- alterations [5]. cation, general physical examination and blood chem- istry parameters should be included in the nutritional assessment [4, 9]. Nutritional assessment Nutritional screening at the time of diagnosis is an Treatment of malnutrition essential aim to identify patients who are at risk of becoming malnourished. Several screening tools exist Nutritional support is recommended for all cancer to detect those who require early nutritional counsel- patients at any stage of their treatment. Nutritional ing [4, 5], for example, the Nutrition Risk Screening treatment prevents both disease- and treatment-re- 2002 (NRS-2002) which was developed for inpatients lated weight loss. The main aim is to improve patients’ to predict postoperative complications and the length quality of life to reduce therapy-related adverse events of hospitalization. and to minimize side effects due to malnutrition. For The Malnutrition Universal Screening Tool (MUST) nutrition counseling three methods are used in clini- – a five-step screening instrument to identify mal- cal practice: oral, enteral and parenteral nutrition [4, nourished outpatients [4] – measures height, weight, 9]. BMI and unintentional weight loss over a period of 6 months. A high MUST score results in an elevated Oral nutrition risk of malnutrition. The MUST was developed by the British Association for Parenteral and Enteral Nu- Until now no prospective studies have been con- trition who provides management guidelines for pa- ducted for the optional energy and nutrition intake tients at medium or high risk of malnutrition [6]. forcancerpatients. Nutritional requirements are The Subjective Global Assessment (SGA) is one of based on general recommendations. Patient should the first validated screening tools often used in clini- be encouraged to eat a balanced diet to meet the nu- cal trials and therefore at present it is the most used tritional requirements. The main emphasis for mild assessment tool to evaluate weight history, physical malnutrition should be on a high caloric and high examination, muscle wasting, fat loss and gastroin- protein diet [3, 11]. According to the ESPEN guide- testinal symptoms. Nutritional status is assessed by lines of nutrition the energy intake ranges from 25 to a clinical member through anthropometric measure- 30 kcal/kg/day. Protein supply is recommended with ments. Measurements of waist, chest and arms are 1.2 to 1.5 g/kg/day. In cases of systematic inflamma- performed to assess body fat mass and muscle mass tion the protein intake can be adapted to 2 g/kg/day, including muscle strength [7]. Similar to the SGA is however only in patients with normal kidney function the Patient Generated Subjective Global Assessment [4, 9]. (PG-SGA). The PG-SGA includes an additional ques- Primary advice for increased caloric intake is to use tionnaire to be completed by the patients themselves whole dairy products instead of fat-free alternatives or [3, 4]. mayonnaise instead of dressing, butter to cook instead However, the most frequently used methods of as- of oils or crème soup instead of bouillon. However, sessing nutritional status are evaluation of patients’ this is often difficult and additional intake of supple- weight history and physical examination in the clinic ments is required. For patients with mild or moderate [5]. Body mass index (BMI) has been found to be malnutrition, it can be helpful to start oral nutrition a useful measurement that sets body weight in rela- support. To achieve a high caloric-protein diet oral tion to height. The BMI estimates the normal body nutritional supplementation (ONS) can be started at weight. A BMI under 18.5 kg/m is considered as un- any point from diagnosis [4, 11]. ONS are enteral for- derweight [3, 8]. mulas which provide necessary macro- and micronu- Nutritional assessment should be repeated weekly. trients. They are commercially available, can be used Weight should be recorded every time a patient vis- as a simple drink or to enrich traditional fare [3, 4]. its the hospital. Patients with a weight loss of 2 kg or For patients with dysphagia, ONS can improve oral more within a 2-week period are required to adapt intake due to the soft texture [12]. nutritional counseling. According to the guidelines of ESPEN and DGEM, nutritional screening should be Enteral nutrition repeated at least every 8 weeks [4, 9]. The majority of patients have difficulties in implementation of the Enteral nutrition is recommended for subjects who planned nutritional counseling due to adverse events are unable to meet their nutrition requirements [10]. In order to avoid long-term consequences pa- through oral diet despite nutritional advice and ONS. If a patient eats inadequately or has not been eating 406 Nutritional management during treatment for head and neck cancer K short review for more than one week, artificial nutrition is indi- It is important to determine the best course of nu- cated. Arends et al. recommend enteral nutrition trition intake to avoid malnutrition. All patients at if food intake is less than 60% of the individual re- any stage of their treatment should receive intensive quirement for more than 2 weeks [4, 9]. In general, dietary counseling. patients are at high risk for malnutrition [3]. Clini- cal consideration for enteral nutrition should include Take home message the location of tumor, the actual treatment plan and the predicted duration of enteral feeding. Various Early nutritional screening is important for patients at types of feeding tubes are available. If a patient only high risk of malnutrition. needs a short-term use of enteral feeding, the recom- Nutritional management should be provided to each mended tubes are nasogastric or nasojejunal tubes. patient at any stage of their treatment. These kinds of tubes can be used less than 4 weeks. Oral or enteral nutrition should be initiated as early as Enteral feeding with gastrostomy, gastrojejunostomy required. and jejunostomy tubes is recommended for long- Good nutritional status improves quality of life, pa- term use [11]. tient outcome and survival. Alshadwi et al. describe that gastrostomy tubes Dieticians should be an important part in healthcare should be used as prophylaxis before radiotherapy to team during oncological treatment and rehabilitation. prevent weight loss, treatment interruption and dehy- Funding Open access funding provided by Medical University dration. Evidence from clinical studies suggests that of Vienna. starting early enteral feedings prior to major surgery is an advantage, especially for improved wound heal- Conflict of interest C. Wagner declares that she has no com- ing [3]. Early pre- and postoperative enteral nutrition peting interests. was shown to significantly reduce the length of hos- Open Access This article is licensed under a Creative Com- pitalization in patients with severe malnutrition [10]. mons Attribution 4.0 International License, which permits Arends et al. specify that percutaneous endoscopic use, sharing, adaptation, distribution and reproduction in gastrostomies are to be preferred to nasogastric feed- any medium or format, as long as you give appropriate credit ing [4, 9]. to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article Parenteral nutrition are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material Parenteral nutrition is rarely used in cancer patients is not included in the article’s Creative Commons licence and and should be consider as last feeding choice due to your intended use is not permitted by statutory regulation or increased complications including infections, sepsis exceeds the permitted use, you will need to obtain permis- and metabolic derangements. Parenteral nutrition is sion directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. only considered if enteral nutrition is insufficient or contraindicated [3]. For patients who need immedi- ate metabolic treatment and suffer from severe intesti- References nal insufficiency, total parenteral nutrition is recom- 1. StatistikAustria. Kopf,Hals. 2020. https://www.statistik.at/ mended [4, 9]. web_de/statistiken/menschen_und_gesellschaft/ gesundheit/krebserkrankungen/kopf_hals/index.html. Conclusion Accessed29Jan2020. 2. World Health Organization. Locally advanced squa- Numerous side effects of anticancer treatment like mous carcinoma of the head and neck. 2020. https:// changes in taste, mucositis, nausea or diarrhea en- www.who.int/selection_medicines/committees/expert/ hance malnutrition and have a significant negative 20/applications/HeadNeck.pdf. Accessed29Jan2020. 3. Alshadwi A, Nadershah M, Carlson E, et al. Nutritional impact on mortality, morbidity and quality of life. It consideration for head and neck cancer patients: a review is important to maintain body weight and nutritional of the literature. J Oral Maxillofac Surg. 2013;71:1853–60. status throughout oncologic treatment. Most com- https://doi.org/10.1016/j.joms.2013.04.028. mon methods for this are the evaluation of weight his- 4. Arends J, Bertz H, Bischoff SC, et al. Klinische Ernährung tory, physical examination and measurement of BMI. in der Onkologie. Aktuel Ernahrungsmed. 2015;40:e1–e74. Nutritional needs of each patient are often very https://doi.org/10.1055/s-0035-1552741. 5. Sandmael JA, Sand K, Bye A, et al. Nutritional experiences complex and have to be adapted during the course of in head and neck cancer patients. Eur J Cancer Care. cancer therapy. Oral nutrition should be encouraged 2019;28(6):e13168. https://doi.org/10.1111/ecc.13168. at all times. However, administration of oral nutri- 6. BAPEN. Introducing ’MUST’. 2016. https://www.bapen. tional supplements may be required if oral feeding is org.uk/screening-and-must/must/introducing-must.Ac- inadequate to maintain body weight. cessed5Feb2020. Enteral and parenteral nutrition via tube feeding 7. DeutscheGesellschaftfürErnährungsmedizine. V.. Screen- should be considered for further weight loss. ing. 2020. http://dgem.de/screening. Accessed5Feb2020. 8. ElmadfaI.Ernährungslehre. Stuttgart: EugenUlmer;2004. K Nutritional management during treatment for head and neck cancer 407 short review 9. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines Publisher’s Note Springer Nature remains neutral with regard on nutrition in cancer patients. Clin Nutr. 2017;36:11–48. to jurisdictional claims in published maps and institutional https://doi.org/10.1016/j.clnu.2016.07.015. affiliations. 10. Orell H, Schwab U, Saarilahti K, et al. Nutritional counseling for head and neck cancer patients undergo- ing(chemo)radiotherapy—Aprospectiverandomizedtrial. FrontNutr. 2019;https://doi.org/10.3389/fnut2019.00022. For latest news from interna- 11. Talwar B, Donnelly R, Skelly R, et al. Nutritional management in head and neck cancer: United King- tional oncology congresses see: dom National Multidisciplinary Guidelines. J Laryngol http://www.springermedizin.at/ Otol. 2016;130(S2):S32–S40. https://doi.org/10.1017/ memo-inoncology s0022215116000402. 12. Kristensen MB, Isenring E, Brown B. Nutrition and swal- lowing therapy strategies for patients with head and neck cancer. Nutrition. 2020;69:110548. https://doi.org/10. 1016/j.nut.2019.06.028. 408 Nutritional management during treatment for head and neck cancer K http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png memo - Magazine of European Medical Oncology Springer Journals

Nutritional management during treatment for head and neck cancer

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Springer Journals
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1865-5041
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10.1007/s12254-020-00613-0
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Abstract

short review memo (2020) 13:405–408 https://doi.org/10.1007/s12254-020-00613-0 Nutritional management during treatment for head and neck cancer Christina Wagner Received: 2 March 2020 / Accepted: 23 April 2020 / Published online: 14 May 2020 © The Author(s) 2020 Summary Head and neck cancer is the sixth most common can- Background The majority of patients who suffer from cer worldwide. Annually 1200 new cases are diag- head and neck cancer are malnourished even prior nosed in Austria [1, 2]. Up to 60% of patients be- to treatment initiation. In addition, side effects from ing treated for locally advanced head and neck squa- cancer therapy including change in taste, mucositis, mous cell cancer suffer from malnutrition prior to nausea or diarrhea increase patients’ malnutrition. even starting treatment [3]. Unintentional weight loss Therefore, early management is crucial to improve is a result of reduced food intake, systemic inflam- nutritional status, prognosis and quality of life of mation and persistent catabolism [4]. Malnutrition patients. with a weight loss up to 10% of baseline body mass Methods A literature research was performed in often leads to more adverse effects, reduced progno- PubMed, Medline and other available databases. sis and reduced quality of life of patients. Therefore, The guidelines of the German Society for Nutritional early management is essential to improve nutritional Medicine, the European Society for Clinical Nutrition status, patient outcome and quality of life [4]. and Metabolism and common recommendations of other countries were selected, analyzed and summa- Adverse effects of malnutrition rized. Results Early screening for malnutrition is recom- Cancer patients are at risk of malnutrition due to dis- mended for all cancer patients. Adequate intake of ease progress and antitumor therapy. The risk for pa- energy and protein should be ensured which may be tients with head and neck cancer is even higher due achieved by consumption of oral nutritional supple- to the location of their tumor. The development of ments or enteral nutrition such as tube feeding. difficulties in chewing and dysphagia is increased [5]. Conclusion It is important to determine the best Chemotherapy, radiotherapy and surgery mostly af- course of management to maintain body weight and fect nutritional intake and may cause side effects. The reduce typical adverse effects of malnutrition to im- most common adverse events in head and neck can- prove quality of life. All patients at any stage of their cer after initiation of treatment are mucositis, xeros- treatment should receive intensive dietary counseling. tomy, changes in taste, pain, nausea and vomiting. As a result, they lead to reduced food intake [5]. Keywords Nutrition · Oncological dietetics · Dietary Lifestyle factors such as consumption of alcohol deficiency · Malnutrition · Cachexia · Head and neck and tobacco use also contribute to malnutrition. Alco- oncology hol provides empty calories and suppresses appetite. Alshadwi et al. [3] have indicated that head and neck cancer patients with a history of alcohol misuse have a much lower intake of fresh fruits and vegetables. Thus, the probability of malnutrition is increase in C. Wagner, MSc () this population group compared to other tumor enti- Department of Medicine I, Division of Oncology, Medical ties [3]. University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, A weight loss of more than 10% of the baseline Austria christina.wagner@meduniwien.ac.at body mass may lead to various adverse effects such K Nutritional management during treatment for head and neck cancer 405 short review as an increased risk of infection, delayed wound heal- tients should be followed up at least 6 months post- ing, muscle waste, depression and a reduced response treatment by nutritional experts [11]. to chemo- or radiotherapy [4]. Unintentional weight Further factors to be protocolled frequently are the loss may lead to cachexia which in turn results in de- ability to chew and swallow, changes in appetite and creased appetite, fat and muscle loss and metabolic gastrointestinal functions. Furthermore, daily medi- alterations [5]. cation, general physical examination and blood chem- istry parameters should be included in the nutritional assessment [4, 9]. Nutritional assessment Nutritional screening at the time of diagnosis is an Treatment of malnutrition essential aim to identify patients who are at risk of becoming malnourished. Several screening tools exist Nutritional support is recommended for all cancer to detect those who require early nutritional counsel- patients at any stage of their treatment. Nutritional ing [4, 5], for example, the Nutrition Risk Screening treatment prevents both disease- and treatment-re- 2002 (NRS-2002) which was developed for inpatients lated weight loss. The main aim is to improve patients’ to predict postoperative complications and the length quality of life to reduce therapy-related adverse events of hospitalization. and to minimize side effects due to malnutrition. For The Malnutrition Universal Screening Tool (MUST) nutrition counseling three methods are used in clini- – a five-step screening instrument to identify mal- cal practice: oral, enteral and parenteral nutrition [4, nourished outpatients [4] – measures height, weight, 9]. BMI and unintentional weight loss over a period of 6 months. A high MUST score results in an elevated Oral nutrition risk of malnutrition. The MUST was developed by the British Association for Parenteral and Enteral Nu- Until now no prospective studies have been con- trition who provides management guidelines for pa- ducted for the optional energy and nutrition intake tients at medium or high risk of malnutrition [6]. forcancerpatients. Nutritional requirements are The Subjective Global Assessment (SGA) is one of based on general recommendations. Patient should the first validated screening tools often used in clini- be encouraged to eat a balanced diet to meet the nu- cal trials and therefore at present it is the most used tritional requirements. The main emphasis for mild assessment tool to evaluate weight history, physical malnutrition should be on a high caloric and high examination, muscle wasting, fat loss and gastroin- protein diet [3, 11]. According to the ESPEN guide- testinal symptoms. Nutritional status is assessed by lines of nutrition the energy intake ranges from 25 to a clinical member through anthropometric measure- 30 kcal/kg/day. Protein supply is recommended with ments. Measurements of waist, chest and arms are 1.2 to 1.5 g/kg/day. In cases of systematic inflamma- performed to assess body fat mass and muscle mass tion the protein intake can be adapted to 2 g/kg/day, including muscle strength [7]. Similar to the SGA is however only in patients with normal kidney function the Patient Generated Subjective Global Assessment [4, 9]. (PG-SGA). The PG-SGA includes an additional ques- Primary advice for increased caloric intake is to use tionnaire to be completed by the patients themselves whole dairy products instead of fat-free alternatives or [3, 4]. mayonnaise instead of dressing, butter to cook instead However, the most frequently used methods of as- of oils or crème soup instead of bouillon. However, sessing nutritional status are evaluation of patients’ this is often difficult and additional intake of supple- weight history and physical examination in the clinic ments is required. For patients with mild or moderate [5]. Body mass index (BMI) has been found to be malnutrition, it can be helpful to start oral nutrition a useful measurement that sets body weight in rela- support. To achieve a high caloric-protein diet oral tion to height. The BMI estimates the normal body nutritional supplementation (ONS) can be started at weight. A BMI under 18.5 kg/m is considered as un- any point from diagnosis [4, 11]. ONS are enteral for- derweight [3, 8]. mulas which provide necessary macro- and micronu- Nutritional assessment should be repeated weekly. trients. They are commercially available, can be used Weight should be recorded every time a patient vis- as a simple drink or to enrich traditional fare [3, 4]. its the hospital. Patients with a weight loss of 2 kg or For patients with dysphagia, ONS can improve oral more within a 2-week period are required to adapt intake due to the soft texture [12]. nutritional counseling. According to the guidelines of ESPEN and DGEM, nutritional screening should be Enteral nutrition repeated at least every 8 weeks [4, 9]. The majority of patients have difficulties in implementation of the Enteral nutrition is recommended for subjects who planned nutritional counseling due to adverse events are unable to meet their nutrition requirements [10]. In order to avoid long-term consequences pa- through oral diet despite nutritional advice and ONS. If a patient eats inadequately or has not been eating 406 Nutritional management during treatment for head and neck cancer K short review for more than one week, artificial nutrition is indi- It is important to determine the best course of nu- cated. Arends et al. recommend enteral nutrition trition intake to avoid malnutrition. All patients at if food intake is less than 60% of the individual re- any stage of their treatment should receive intensive quirement for more than 2 weeks [4, 9]. In general, dietary counseling. patients are at high risk for malnutrition [3]. Clini- cal consideration for enteral nutrition should include Take home message the location of tumor, the actual treatment plan and the predicted duration of enteral feeding. Various Early nutritional screening is important for patients at types of feeding tubes are available. If a patient only high risk of malnutrition. needs a short-term use of enteral feeding, the recom- Nutritional management should be provided to each mended tubes are nasogastric or nasojejunal tubes. patient at any stage of their treatment. These kinds of tubes can be used less than 4 weeks. Oral or enteral nutrition should be initiated as early as Enteral feeding with gastrostomy, gastrojejunostomy required. and jejunostomy tubes is recommended for long- Good nutritional status improves quality of life, pa- term use [11]. tient outcome and survival. Alshadwi et al. describe that gastrostomy tubes Dieticians should be an important part in healthcare should be used as prophylaxis before radiotherapy to team during oncological treatment and rehabilitation. prevent weight loss, treatment interruption and dehy- Funding Open access funding provided by Medical University dration. Evidence from clinical studies suggests that of Vienna. starting early enteral feedings prior to major surgery is an advantage, especially for improved wound heal- Conflict of interest C. Wagner declares that she has no com- ing [3]. Early pre- and postoperative enteral nutrition peting interests. was shown to significantly reduce the length of hos- Open Access This article is licensed under a Creative Com- pitalization in patients with severe malnutrition [10]. mons Attribution 4.0 International License, which permits Arends et al. specify that percutaneous endoscopic use, sharing, adaptation, distribution and reproduction in gastrostomies are to be preferred to nasogastric feed- any medium or format, as long as you give appropriate credit ing [4, 9]. to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article Parenteral nutrition are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material Parenteral nutrition is rarely used in cancer patients is not included in the article’s Creative Commons licence and and should be consider as last feeding choice due to your intended use is not permitted by statutory regulation or increased complications including infections, sepsis exceeds the permitted use, you will need to obtain permis- and metabolic derangements. Parenteral nutrition is sion directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. only considered if enteral nutrition is insufficient or contraindicated [3]. For patients who need immedi- ate metabolic treatment and suffer from severe intesti- References nal insufficiency, total parenteral nutrition is recom- 1. StatistikAustria. Kopf,Hals. 2020. https://www.statistik.at/ mended [4, 9]. web_de/statistiken/menschen_und_gesellschaft/ gesundheit/krebserkrankungen/kopf_hals/index.html. Conclusion Accessed29Jan2020. 2. World Health Organization. Locally advanced squa- Numerous side effects of anticancer treatment like mous carcinoma of the head and neck. 2020. https:// changes in taste, mucositis, nausea or diarrhea en- www.who.int/selection_medicines/committees/expert/ hance malnutrition and have a significant negative 20/applications/HeadNeck.pdf. Accessed29Jan2020. 3. Alshadwi A, Nadershah M, Carlson E, et al. Nutritional impact on mortality, morbidity and quality of life. It consideration for head and neck cancer patients: a review is important to maintain body weight and nutritional of the literature. J Oral Maxillofac Surg. 2013;71:1853–60. status throughout oncologic treatment. Most com- https://doi.org/10.1016/j.joms.2013.04.028. mon methods for this are the evaluation of weight his- 4. Arends J, Bertz H, Bischoff SC, et al. Klinische Ernährung tory, physical examination and measurement of BMI. in der Onkologie. Aktuel Ernahrungsmed. 2015;40:e1–e74. Nutritional needs of each patient are often very https://doi.org/10.1055/s-0035-1552741. 5. Sandmael JA, Sand K, Bye A, et al. Nutritional experiences complex and have to be adapted during the course of in head and neck cancer patients. Eur J Cancer Care. cancer therapy. Oral nutrition should be encouraged 2019;28(6):e13168. https://doi.org/10.1111/ecc.13168. at all times. However, administration of oral nutri- 6. BAPEN. Introducing ’MUST’. 2016. https://www.bapen. tional supplements may be required if oral feeding is org.uk/screening-and-must/must/introducing-must.Ac- inadequate to maintain body weight. cessed5Feb2020. Enteral and parenteral nutrition via tube feeding 7. DeutscheGesellschaftfürErnährungsmedizine. V.. Screen- should be considered for further weight loss. ing. 2020. http://dgem.de/screening. Accessed5Feb2020. 8. ElmadfaI.Ernährungslehre. Stuttgart: EugenUlmer;2004. K Nutritional management during treatment for head and neck cancer 407 short review 9. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines Publisher’s Note Springer Nature remains neutral with regard on nutrition in cancer patients. Clin Nutr. 2017;36:11–48. to jurisdictional claims in published maps and institutional https://doi.org/10.1016/j.clnu.2016.07.015. affiliations. 10. Orell H, Schwab U, Saarilahti K, et al. Nutritional counseling for head and neck cancer patients undergo- ing(chemo)radiotherapy—Aprospectiverandomizedtrial. FrontNutr. 2019;https://doi.org/10.3389/fnut2019.00022. For latest news from interna- 11. Talwar B, Donnelly R, Skelly R, et al. Nutritional management in head and neck cancer: United King- tional oncology congresses see: dom National Multidisciplinary Guidelines. J Laryngol http://www.springermedizin.at/ Otol. 2016;130(S2):S32–S40. https://doi.org/10.1017/ memo-inoncology s0022215116000402. 12. Kristensen MB, Isenring E, Brown B. Nutrition and swal- lowing therapy strategies for patients with head and neck cancer. Nutrition. 2020;69:110548. https://doi.org/10. 1016/j.nut.2019.06.028. 408 Nutritional management during treatment for head and neck cancer K

Journal

memo - Magazine of European Medical Oncology – Springer Journals

Published: Dec 1, 2020

Keywords: oncology; medicine/public health, general

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