The impact of dietetic input in post radiotherapy head and neck cancer patients


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Robynne Cranston1,Nola Lynch1,Isobel Bowe1,Charles Kelly2,Shahid Iqbal2,Rachel A Pearson3
1Nutrition and Dietetics Department, Freeman Hospital, NHS Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK,2Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK,3 Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK, Newcastle University, Newcastle upon Tyne, UK

Abstract

Background

The impact of regular dietetic input 8 weeks after radiotherapy treatment for head and neck cancer (H&N) is poorly understood.  Nutritional status is an important clinical issue in this phase.

Method

This study evaluated the impact of dietetic input into an already established once-weekly post radiotherapy (PRT) clinic. Data was collected from two patient cohorts over an 18 month period: Group 1: pre dietetic input (n= 171); Group 2 dietetic input weekly for 8 weeks (n= 191). Percentage weight loss, duration of oral and enteral nutritional support, hospital admission rates and duration of stay, and duration of community dietetic follow-up were recorded. QOL H&N cancer questionnaires were completed week 1 and 6 of PRT.

Results

Dietetic follow-up time PRT was reduced from 49 to ≤7 days PRT (p=0.00).  Percentage weight loss (beginning of radiotherapy to week 8 PRT) in Group 2 was 5.7% compared with 8.3% Group 1(p=0.00). Patients requiring oral nutritional support (ONS) reduced high calorie supplement drinks from 3 bottles to 1, compared to 3 bottles to 2 in Group 1 (p=0.00). 41.7% of patients in Group 2 discontinued ONS during the PRT period compared to 7.4% in Group 1 (p=0.00). Patients reported areas of their QOL improved; enjoyed life more; and able to enjoy food with managing more solid textures. There was no statistically significant difference in the number of NG tubes placed or duration of feeding after PRTC. Total hospital admission days over 18 months was reduced by 24 days compared to group 1.

Conclusion

Intensive weekly dietetic support in head and neck cancer radiotherapy patients for 8-weeks after treatment can provide important gains in nutritional status with reduced need for ONS and improved QOL. Furthermore, this approach may have cost benefits for NHS trusts.