Trending: Proactive Approach to Nutrition for Head and Neck Cancer

Megan Brooks

May 09, 2014

Oncologists treating patients with head and neck cancer are taking a proactive approach when it comes to home enteral nutrition support, a new study suggests.

The study of 172 patients with gastrostomy tubes found that half had the feeding tubes placed prior to beginning treatment for head or neck cancer. Most of these patients were put on home enteral nutrition support to help them maintain their current weight during treatment, as opposed to being put on it after treatment to try to regain lost weight, researchers found.

The study was presented at the Oncology Nursing Society 39th Annual Congress in Anaheim, California.

An estimated 55,000 people in the United States develop head and neck cancers each year.

"These patients have many nutritional concerns because of the location of the cancer, which often causes trouble swallowing," said investigator Noreen Luszcz, RD, MBA, CNSC, nutrition program director for Walgreens Infusion Services. "They can't eat, won't eat, or can't eat enough," she told Medscape Medical News.

Many of these patients have impaired nutrition status at the time of diagnosis, she noted. In addition to losing weight prior to the diagnosis, they can lose 10% of their pretherapy body weight during treatment.

Enteral nutrition can help head and neck cancer patients minimize weight loss, maintain quality of life, manage symptoms, and improve tolerance to treatment, Luszcz said. Home enteral nutrition coordinated by a multidisciplinary nutrition support team has been shown to be safe and beneficial in these patients, she added.

Early Screening, Assessment Key

To gather more information on home enteral nutrition in the head and neck cancer population, Luszcz and a colleague took a look back at 121 men and 51 women (mean age, 63 years) with head and neck cancer who received enteral nutrition support from their service from July 2012 to June 2013.

They found that 50% of the patients had their feeding tubes placed before radiation and chemotherapy, which suggests that "clinicians are thinking about nutrition ahead of time. Studies have shown positive results when there is early use of enteral feeding," Luszcz explained.

Only 8% of patients were considered severely malnourished at the start of their cancer treatment; malnutrition was mild in 55%, moderate in 17%, and not known in 20%. "This finding also speaks to the fact that physicians are thinking about nutrition early on," Luszcz said.

The initial goals of therapy were gaining weight for 27% of patients and maintaining weight for 64%. Goals were not known for the other 9%.

For the 62 patients who completed enteral therapy, the average length of therapy was 131 days; 46% of these patients met their initial goal. Of patients remaining on enteral nutrition, 70% were progressing toward their goal.

The head and neck cancer population has "red flags" for nutrition, Luszcz said, and "early screening and assessment of nutrition risk and early nutrition intervention is key."

"It's been well documented that having a multidisciplinary team approach — the nurse, pharmacist, dietitian, and physician working together — results in positive outcomes," she added.

"There are multiple home infusion service companies — like PromptCare, Coram, Home Solutions — in the market that we use for home enteral patients," said Harpinder Sandhu, FNP-BC, a nurse practitioner in the GI/Clinical Nutrition Services Department at the Memorial Sloan-Kettering Cancer Center in New York City.

"The servicing company depends on patients' insurance and where they live. Case management takes cares of that. Patients call us if they have issues with delivery of enteral formula or supplies," he told Medscape Medical News. "We work closely with representatives from these companies to make sure that our patients are provided with formula and supplies that they need."

"The only concerns are that, recently, Medicare patients have needed to switch companies, owing to some companies losing the bid and therefore not being able to provide services for those patients," Sandhu said.

Ms. Luszcz and Mr. Sandhu have disclosed no relevant financial relationships.

Oncology Nursing Society (ONS) 39th Annual Congress. Poster 69. Presented May 1, 2014.

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