Q24. What nutritional parameters need to be monitored?

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Q24. What nutritional parameters need to be monitored?

Summary

The three level II positive quality studies in which dietetic counselling was provided weekly during treatment and then fortnightly post treatment monitored the following parameters of weight, fat free mass, nutritional status, global quality of life, and nutritional intake via diet history [1][2][3]. These were sufficient parameters to show improvements in patient outcomes. Fat free mass and global quality of life were parameters for research purposes and may not be required in everyday practice. Monitoring of weight change during and post treatment, either alone or in addition to nutritional status, was further supported by one level III-1 neutral quality study [4] and two level III-3 neutral quality studies [5][6].

One level IV neutral quality study reported on the changes in nutritional status, body weight, intake, albumin and micronutrient status (zinc, copper) during radiotherapy, with all measures significantly decreasing during treatment [7]. Another level IV study (negative quality) compared selenium levels pre and post radiotherapy and found that these are reduced during radiotherapy. Selenium status is also lower at baseline compared to healthy controls, and remains lower in those patients that have residual disease [8]. One final level IV neutral quality study [9] reported on hyperglycaemia during concurrent chemoradiotherapy and suggested that BGL’s should also be monitored.

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Recommendation Grade
Monitor weight, intake and nutritional status during and post (chemo) radiotherapy.
A

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References

  1. Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 2004 Aug 2;91(3):447-52 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15226773.
  2. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 2005 Aug;27(8):659-68 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15920748.
  3. Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 2007 Mar;107(3):404-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17324657.
  4. van den Berg MG, Rasmussen-Conrad EL, Wei KH, Lintz-Luidens H, Kaanders JH, Merkx MA. Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. Br J Nutr 2010 Sep;104(6):872-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20441684.
  5. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 2010 Jul;18(7):837-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19727846.
  6. Kiss NK, Krishnasamy M, Loeliger J, Granados A, Dutu G, Corry J. A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer. Support Care Cancer 2012 Sep;20(9):2111-20 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22086406.
  7. Mahdavi R, Faramarzi E, Mohammad-Zadeh M, Ghaeammaghami J, Jabbari MV. Consequences of radiotherapy on nutritional status, dietary intake, serum zinc and copper levels in patients with gastrointestinal tract and head and neck cancer. Saudi Med J 2007 Mar;28(3):435-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17334475.
  8. Yadav SP, Gera A, Singh I, Chanda R. Serum selenium levels in patients with head and neck cancer. J Otolaryngol 2002 Aug;31(4):216-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12240756.
  9. Nguyen NP, Vos P, Vinh-Hung V, Borok TL, Dutta S, Karlsson U, et al. Altered glucose metabolism during chemoradiation for head and neck cancer. Anticancer Res 2009 Nov;29(11):4683-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20032420.

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