Q11. What are the goals of nutrition intervention? - Radiotherapy and chemotherapy

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Q11. What are the goals of nutrition intervention? - Radiotherapy and chemotherapy

Summary

The Evidence Based Practice Guidelines for Nutritional Management of Malnutrition in Adult Patients Across the Continuum of Care [1] state the goal is to prevent a decline/improve nutritional status. In the Evidence Based Practice Guidelines for Nutritional Management of Patients Receiving Radiation Therapy [2] and Updated evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy the goal is to aim to minimise weight loss and maintain quality of life and symptom management. There is one level II positive quality study [3] which demonstrated an outcome of weight maintenance, and another [4] which demonstrated an outcome of maintained or improved quality of life.

One level III-2 neutral quality study found that weight loss of >5% during radiotherapy was associated with reduced disease specific survival[5]. A level III-1 neutral quality study [6] showed that despite intensive intervention during radiotherapy, patients still lost 3% body weight although this improved during rehabilitation, whereas those with standard care continued to lose weight post treatment. Similar findings were also seen in a level III-3 neutral quality study [7], in which weight loss during treatment was seen in patients who received early intensive nutritional care as well as standard care, but again the differences were noted to be in long term follow up.

There was one level IV positive quality study [8], and three level IV neutral quality studies [9][10][11]. Jagner-Wittenaar et al. demonstrated that despite sufficient energy and protein intakes according to recommended prescriptions, patients still lost weight and lean body mass during treatment [8]. Similarly, Silander et al. found that weight loss occurred even with intensive early nutrition intervention through tube feeding [11]. Clavel et al. also reported mean weight loss of 10.4% despite use of nasogastric feeding [9], while Ehrsson et al. reported weight loss of 13% with enteral nutrition [10].


Recommendation Grade
Aim to minimise a decline in nutritional status/weight and to maintain quality of life and symptom management in patients receiving radiotherapy/chemotherapy.
A

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References

  1. Watterson C, Fraser A, Banks M, Isenring E, Miller M, Silvester C, et al. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutrition & Dietetics 2009 Dec;66(Suppl 3):1-34. Abstract available at http://www.clinicalguidelines.gov.au/search.php?pageType=2&fldglrID=1617&.
  2. Isenring E. Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy. Nutrition & Dietetics 2008;65:1-20. Abstract available at http://www.clinicalguidelines.gov.au/search.php?pageType=2&fldglrID=1256&.
  3. 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.
  4. 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.
  5. Langius JA, Bakker S, Rietveld DH, Kruizenga HM, Langendijk JA, Weijs PJ, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer 2013 Sep 3;109(5):1093-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23928661.
  6. 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.
  7. 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.
  8. 8.0 8.1 Jager-Wittenaar H, Dijkstra PU, Vissink A, Langendijk JA, van der Laan BF, Pruim J, et al. Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck 2011 Jun;33(6):863-70 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20737491.
  9. 9.0 9.1 Clavel S, Fortin B, Després P, Donath D, Soulières D, Khaouam N, et al. Enteral feeding during chemoradiotherapy for advanced head-and-neck cancer: a single-institution experience using a reactive approach. Int J Radiat Oncol Biol Phys 2011 Mar 1;79(3):763-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20510546.
  10. 10.0 10.1 Ehrsson YT, Langius-Eklöf A, Laurell G. Nutritional surveillance and weight loss in head and neck cancer patients. Support Care Cancer 2011 Apr 19 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21503674.
  11. 11.0 11.1 Silander E, Nymanb J, Bovec M, Johanssond L, Larssone S, Hammerlida E.. The use of prophylactic percutaneous endoscopic gastrostomy and early enteral feeding in pateitns with advanced head and neck cancer - a prospective longitudinal study. The european e-journal of clinical nutrition and metabolism 2010 Aug;5(4):e166-e172 Abstract available at http://www.e-spenjournal.org/article/S1751-4991(10)00024-7/abstract.

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