COSA:Head and neck cancer nutrition guidelines/Nutrition implementation - Palliative care/What is the role for the dietitian in the management of palliative care H&N cancer patients

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Q22. What is the role for the dietitian in the management of patients with head and neck cancer requiring palliative care?

Summary

One level III-2 neutral quality study [1] which compares home based versus hospital based palliative care programs, where the incidence of tube feeding, severe weight loss of >10% and symptoms were similar in each setting found hospital patients were more likely to have very severe weight loss of >15%.

There were four other level IV neutral quality studies which all reported on the high frequency of dysphagia, weight loss and tube feeding in this group [2][3][4][5]. One level IV neutral quality study [4] reported on 10 patients with end stage disease who had a gastrostomy inserted - all died of their disease within 2-95 days. For more guidance see Dietitians Association of Australia Position Paper on Palliative Care [6]. Patients may also experience cancer cachexia and nutrition management for this can be found in the Evidence Based Practice Guidelines for the Nutritional Management of Cancer Cachexia [7].

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Recommendation Grade
The goals and outcomes of nutrition intervention will be dependent on the prognosis of the patient. For patients with end stage disease the desired outcome is to maximise patient comfort and quality of life, and the dietitian should liaise with patient, family or carers and the palliative care team for the appropriate level of intervention required.
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The dietitian is an important member of the palliative care team due to the high incidence of weight loss, dysphagia and tube feeding in this patient population. Liaise with the speech pathologist for the expected nature of any dysphagia and likely progression, to determine level of nutrition intervention required.
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References

  1. Talmi YP, Bercovici M, Waller A, Horowitz Z, Adunski A, Kronenberg J. Home and inpatient hospice care of terminal head and neck cancer patients. J Palliat Care 1997;13(1):9-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9105152.
  2. Ethunandan M, Rennie A, Hoffman G, Morey PJ, Brennan PA. Quality of dying in head and neck cancer patients: a retrospective analysis of potential indicators of care. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005 Aug;100(2):147-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16037771.
  3. Forbes K. Palliative care in patients with cancer of the head and neck. Clin Otolaryngol Allied Sci 1997 Apr;22(2):117-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9160922.
  4. 4.0 4.1 Campos AC, Butters M, Meguid MM. Home enteral nutrition via gastrostomy in advanced head and neck cancer patients. Head Neck 1990;12(2):137-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2107154.
  5. Lin YL, Lin IC, Liou JC. Symptom patterns of patients with head and neck cancer in a palliative care unit. J Palliat Med 2011 May;14(5):556-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21413849.
  6. Dietitians Association Australia. Nutrition priorities in palliative care of oncology patients. Aust J Nutr Diet 1994;51:91-92.
  7. Bauer JD, Ash S, Davidson WL, et al. Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutrition & Dietetics 2006;63:3-32. Abstract available at http://onlinelibrary.wiley.com/doi/10.1111/j.1747-0080.2006.00099.x/abstract.

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