Q8. Does nutrition intervention improve outcomes? - Post treatment

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Q8. Does nutrition intervention improve outcomes? - Post treatment

Summary

The three level II positive quality studies [1][2][3] looked at the impact of dietetic counselling for up to three months post radiotherapy treatment, and found the nutrition intervention group had a smaller decline and faster recovery in quality of life [1], maintained or improved their nutritional status and quality of life [2] and had improved nutritional intake [3]. One level III-1 neutral quality study, which followed up patients for 10 weeks post radiotherapy, continued to demonstrate benefits of regular dietetic counselling on patient outcomes such as nutritional status and weight [4]. Longer-term studies have not been completed in this area, however, as many patients have still been shown to have symptoms and require enteral nutrition support for 6 months or more (see Q23 for further information), the benefits of dietetic intervention beyond 3 months could be expected to continue.

To determine whether nutritional status affects long-term outcomes - one level III-2 neutral quality study [5] shows that underweight patients (low body mass index (BMI)) have an increased risk of osteoradionecrosis (ORN). One level IV neutral quality study [6] found that patients who were considered malnourished at six months post treatment (>10% weight loss) had a reduced quality of life. One level IV neutral quality study also reported malnourished patients post treatment had reduced physical functioning and increased fatigue [7].

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Recommendation Grade
Nutrition intervention (dietary counselling and/or supplements) for 3 months post treatment improves/maintains nutritional status.
A
Nutrition intervention (dietary counselling and/or supplements) for 3 months post treatment improves/maintains quality of life.
A

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References

  1. 1.0 1.1 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. 2.0 2.1 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. 3.0 3.1 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. Goldwaser BR, Chuang SK, Kaban LB, August M. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 2007 Nov;65(11):2311-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17954330.
  6. van den Berg MG, Rasmussen-Conrad EL, van Nispen L, van Binsbergen JJ, Merkx MA. A prospective study on malnutrition and quality of life in patients with head and neck cancer. Oral Oncol 2008 Sep;44(9):830-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18243771.
  7. Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BF, van Oort RP, Roodenburg JL. Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 2011 Apr;33(4):490-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20824806.

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