Q14. What is the nutrition prescription to meet these goals? - Post treatment

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Q14. What is the nutrition prescription to meet these goals? - Post treatment

Summary

One level II positive quality study measured mean intakes of energy and protein for up to 3 months post radiotherapy treatment [1], and found that patients in the intervention group maintained higher intakes of protein and energy post treatment resulting in weight maintenance. One level III-1 neutral quality study [2], provided dietetic counselling to achieve energy intakes of >125kJ/kg/day (30kcal/kg/day) and protein intakes of 1-1.5g/kg/day for up to 10 weeks post treatment, resulting in weight stabilisation/weight gain of 1%.

There is one level III-2 neutral quality study [3], one level IV positive quality study [4] and two level IV neutral quality studies [5][6], however evidence is not consistent and there is lack of longitudinal studies with sufficient sample size. The level III-2 study looked at patients for two weeks post treatment, and found energy intakes of 105kJ/kg/day (25kcal/kg/day) using indirect calorimetry, which were elevated compared to the measurements taken during radiotherapy.

The level IV positive quality study [4] found that patients whose intake was above 145kJ/kg/day and 1.5g protein/kg/day were able to gain weight and lean body mass, compared to patients whose intake was below this, who were not able to gain weight. The first level IV neutral quality study [5] reported aiming for energy intakes of 125-170kJ/kg/day (30-40kcal/kg/day); however energy intake only reached 80kJ/kg/day (19kcal/kg/day) during chemoradiotherapy resulting in weight loss. Despite increases in energy intake post treatment, weight loss continued post treatment, indicating elevated requirements in this phase. The second level IV neutral quality study [6] reported the following energy intakes at one year post treatment to be associated with the following outcomes to achieve optimal Body Mass Index (BMI): 145kJ/kg/day (35kcal/kg/day) for weight maintenance, 185kJ/kg/day (44kcal/kg/day) for weight gain and 115kJ/kg/day (28kcal/kg/day) for weight loss.

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Recommendation Grade
Energy and protein requirements remain elevated post treatment and weight should continue to be monitored and intervention adjusted as appropriate.
C

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References

  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.
  2. 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.
  3. García-Peris P, Parón L, Velasco C, de la Cuerda C, Camblor M, Bretón I, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life. Clin Nutr 2007 Dec;26(6):710-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17954003.
  4. 4.0 4.1 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.
  5. 5.0 5.1 van den Berg MG, Rasmussen-Conrad EL, Gwasara GM, Krabbe PF, Naber AH, Merkx MA. A prospective study on weight loss and energy intake in patients with head and neck cancer, during diagnosis, treatment and revalidation. Clin Nutr 2006 Oct;25(5):765-72 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16698130.
  6. 6.0 6.1 Schattner MA, Willis HJ, Raykher A, Brown P, Quesada O, Scott B, et al. Long-term enteral nutrition facilitates optimization of body weight. JPEN J Parenter Enteral Nutr 2005;29(3):198-203 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15837780.

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