Transcript PowerPoint Template - St. John Providence Health System

Nutrition Support for the Head
and Neck Cancer Patient
Damien H. Buchkowski, RD, CSO
Registered Dietitian/Board Certified Specialist in
Oncology Nutrition
St. John Providence East-Region Oncology Dietitian
April 11, 2015
OBJECTIVES
• Define the nutrition goals of individuals
diagnosed with oropharyngeal cancer
• Discuss nutrition-related side-effects of various
treatments for head and neck cancers as well
as nutrition-related strategies to combat these
side-effects
• Discuss the role of feeding tubes in individuals
diagnosed with oropharyngeal cancer
• Identify nutrition goals of patients following the
completion of treatment
Nutrition Goals of the Oropharyngeal
Cancer Patient
• Correct pre-existing nutrition conditions prior
to treatment when necessary and possible
• Prepare the patient for treatment
(surgery/chemotherapy/radiation)
• Strive to achieve weight maintenance (or
minimize weight loss) during treatment
• Complete the course of treatment "break-free"
to maximize successful outcomes
Nutrition-Related Side-Effects and
Nutrition Interventions - Surgery
• The type and extent of surgery dictates the
impact upon nutrition intake
• Poor nutrition status prior to surgery can
increase complications such as infection,
wound dehiscence, and delayed wound healing
• Optimizing nutrition prior to surgery can be
successful in both the well-nourished and
malnourished populations
• Diets following surgery must often be tailored
to individual limitations
Nutrition-Related Side-Effects and
Nutrition Interventions - Radiation
• Stomatitis/Mucositis/Odynophagia
• Xerostomia/Thick Saliva
• Dysgeusia
• Dysphagia
• Fatigue
• Decreased appetite
Nutrition-Related Side-Effects and Nutrition
Interventions - Chemotherapy
• Varies based upon agent used and individual
tolerance
• Nausea/Vomiting
• Constipation
• Decreased appetite
• Diarrhea
• Dysgeusia/Metallic Taste
• Stomatitis/Mouth Sores
The Role of Feeding Tubes in
Oropharyngeal Cancers
• Reasons for the placement of feeding tubes
• Prophylactic vs. reactive feeding tube
placement
• National Comprehensive Cancer Center
Network (NCCN) guidelines for considering
prophylactic feeding tube placement
• Complications associated with feeding tubes
• Discussing feeding tubes with patients
• Overweight/obese patients and feeding tubes
• Initiating feedings
• Weaning tube feedings
National Comprehensive Cancer Center Network (NCCN)
Guidelines for Nutrition in Head and Neck Cancer Patients
Global Nutrition Recommendations for patients receiving (chemo-)radiotherapy
•
•
Utilize oral intake as much as possible while maintaining safety
Monitor for the lifetime of the patient even well after therapy
Factors predicting limited enteral feeding
requirement
•
Very good performance status as
measured by the Eastern
Cooperative Oncology Group
(ECOG) Score
•
No Significant…
o
Pre-treatment weight loss
 5% past 1 month
 10% past 6 months
o Airway obstruction
o Dysphagia
Factors suggesting strong consideration
of prophylactic PEG
•
Severe weight loss prior to treatment
 5% past 1 month
 10% past 6 months
•
Symptoms include…
o Ongoing dehydration
o Severe dysphagia
o Anorexia
o Odynophagia interfering with oral
intake
•
Significant comorbidities requiring
good oral intake for health
maintenance
•
Severe aspiration in any patient
•
Any aspiration in an elderly patient or
patients with compromised
cardiopulmonary function
•
Patients anticipating high-dose
radiation
Nutrition Goals Following Treatment
• Weight maintenance while advancing diet
• Wean tube feedings
• Alleviate persistent barriers to eating
• Repletion of lost lean body mass
• Use the diagnosis/treatment to motivate
positive change
CONCLUSION
Successful nutrition interventions in
individuals diagnosed with oropharyngeal
cancers limit the loss of lean body mass,
preserve immune function, and prevent
treatment delays while maximizing treatment
outcomes and quality of life