Q13. What is the nutrition prescription to meet these goals? - Radiotherapy and chemotherapy

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Q13. What is the nutrition prescription to meet these goals? - Radiotherapy and chemotherapy

Summary

The Evidence Based Practice Guidelines for Nutritional Management of Patients Receiving Radiation Therapy [1], which includes the level III-2 neutral quality study [2], recommends aiming for 125kJ/kg/day (30kcal/kg/day) and 1.2g protein/kg/day. The level III-1 neutral quality study [3] followed similar guidelines in their study, using a minimum of 125kJ/kg/day (30kcal/kg/day) and 1-1.5g protein/kg/day. A level IV positive quality study found that patients with sufficient intake of >145kJ/kg/day (35kcal/kg/day) and >1.5g protein/kg/day lost less body weight/lean mass than those with insufficient intakes [4]. Another level IV neutral quality study [5] reports that energy intakes drop significantly during chemoradiotherapy to 80kJ/kg/day (19kcal/kg/day), resulting in weight loss during treatment.

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Recommendation Grade
Aim for energy and protein intakes of at least 125kJ/kg/day (30kcal/kg/day) and 1.2g protein/kg/day in patients receiving radiotherapy or chemoradiotherapy. Patients should have their weight and nutritional intake monitored regularly to determine whether their energy requirements are being met.
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References

  1. 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&.
  2. García-Peris P, Lozano MA, Velasco C, de La Cuerda C, Iriondo T, Bretón I, et al. Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry. Nutrition 2005;21(11-12):1107-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16308133.
  3. 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.
  4. 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. 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.

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