Q22. What is the role for the dietitian in the management of patients with head and neck cancer requiring palliative care?
One level III-2 neutral quality study  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 . One level IV neutral quality study  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 . 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 .
|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.||C|
|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.||C|
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