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New Insights into the Nutritional Management of Patients with Head and Neck Cancer

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (15 October 2020) | Viewed by 23403

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Dr. Judy Bauer

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Guest Editor

School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
Interests: oncology; head and neck cancer; malnutrition; sarcopenia; nutrition intervention; body composition; medical nutrition therapy; implementation

Special Issue Information

Dear Colleagues,

The role of nutritional management of patients with head and neck cancer has gained increased recognition, with studies demonstrating impact on a range of clinical, cost, and patient-related outcomes. At diagnosis, this complex patient group has a high prevalence of malnutrition and/or sarcopenia as well as nutrition impact symptoms, which may be exacerbated through the treatment trajectory. Further research is warranted examining key aspects of nutritional management of these patients to minimize these detrimental sequelae and improve outcomes. This includes exploring body composition analysis techniques, nutrition intervention strategies, new models of nutrition care delivery, the role of the multidisciplinary team, as well as implementation of current evidence into practice. The aim of this Special Issue is to showcase recent research on these topics. Submissions of original research, narrative and systematic reviews, and meta-analyses will be included. Studies that explore aspects of nutrition assessment including body composition analysis, nutrition intervention strategies such as prescription of nutrients, intensity and method of nutrition support, and nutrition counseling will be considered. Manuscripts that investigate implementation of evidence-based nutrition care into practice, including exploration of barriers and facilitators to delivery of best-practice nutrition care as well as new models of nutrition care, are encouraged.

Dr. Judy Bauer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Head and neck cancer
Nutrition intervention
Body composition
Malnutrition
Sarcopenia
Implementation

Published Papers (6 papers)

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Research

13 pages, 821 KiB

Open AccessArticle

The Impact of Human Papillomavirus (HPV) Associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) on Nutritional Outcomes

by Jane Harrowfield, Elizabeth Isenring, Nicole Kiss, Erin Laing, Ruby Lipson-Smith and Ben Britton

Nutrients 2021, 13(2), 514; https://doi.org/10.3390/nu13020514 - 4 Feb 2021

Cited by 9 | Viewed by 2445

Abstract

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients’ (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing >10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p ≤ 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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17 pages, 369 KiB

Open AccessArticle

Translating Evidence-Based Guidelines into Practice—Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM)

by Merran Findlay, Judith D. Bauer, Rupinder Dhaliwal, Marian de van der Schueren, Alessandro Laviano, Adrianne Widaman, Lisa Martin, Andrew G. Day and Leah M. Gramlich

Nutrients 2020, 12(12), 3808; https://doi.org/10.3390/nu12123808 - 11 Dec 2020

Cited by 11 | Viewed by 3127

Abstract

Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer care settings in North America, Europe and Australia between 2016 and 2018. Adherence criteria were derived from relevant EBG recommendations with pooled results for participating centres reported according to the Nutrition Care Model at either system or patient levels. Adherence to EBG recommendations was: good (≥80%) for performing baseline nutrition screening and assessment, perioperative nutrition assessment and nutrition prescription for energy and protein targets; moderate (≥60 to 80%) for utilizing validated screening and assessment tools and pre-radiotherapy dietitian consultation; and poor (60%) for initiating post-operative nutrition support within 24 h and also dietetic consultation weekly during radiotherapy and fortnightly for 6 weeks post-radiotherapy. In conclusion, gaps in evidence-based cancer nutrition care remain; however, this may be improved by filling known evidence gaps through high-quality research with a concurrent evolution of EBGs to also encompass practical implementation guidance. These should aim to support multidisciplinary cancer clinicians to close evidence–practice gaps throughout the patient care trajectory with clearly defined roles and responsibilities that also address patient-reported concerns. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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13 pages, 437 KiB

Open AccessArticle

Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment

by Belinda Steer, Jenelle Loeliger, Lara Edbrooke, Irene Deftereos, Erin Laing and Nicole Kiss

Nutrients 2020, 12(11), 3493; https://doi.org/10.3390/nu12113493 - 13 Nov 2020

Cited by 34 | Viewed by 3341

Abstract

Malnutrition is highly prevalent in people with head and neck cancer (HCN) and is associated with poorer outcomes. However, variation in malnutrition diagnostic criteria has made translation of the most effective interventions into practice challenging. This study aimed to determine the prevalence of malnutrition in a HNC population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and assess inter-rater reliability and predictive validity. A secondary analysis of data available for 188 patients with HNC extracted from two cancer malnutrition point prevalence studies was conducted. A GLIM diagnosis of malnutrition was assigned when one phenotypic and one etiologic criterion were present. Phenotypic criteria were ≥5% unintentional loss of body weight, body mass index (BMI), and subjective evidence of muscle loss. Etiologic criteria were reduced food intake, and presence of metastatic disease as a proxy for inflammation. The prevalence of malnutrition was 22.6% (8.0% moderately malnourished; 13.3% severely malnourished). Inter-rater reliability was classified as excellent for the GLIM criteria overall, as well as for each individual criterion. A GLIM diagnosis of malnutrition was found to be significantly associated with BMI but was not predictive of 30 day hospital readmission. Further large, prospective cohort studies are required in this patient population to further validate the GLIM criteria. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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18 pages, 731 KiB

Open AccessArticle

Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention

by Alison Kate Beck, Amanda L. Baker, Gregory Carter, Chris Wratten, Judith Bauer, Luke Wolfenden, Kristen McCarter and Ben Britton

Nutrients 2020, 12(8), 2332; https://doi.org/10.3390/nu12082332 - 4 Aug 2020

Cited by 3 | Viewed by 3572

Abstract

Background: A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). Purpose: To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of “EAT: Eating As Treatment”, a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Methods: Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. Results: Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. Conclusions: Although what level of fidelity is “good enough” remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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27 pages, 650 KiB

Open AccessArticle

Effects of a Multidisciplinary Residential Nutritional Rehabilitation Program in Head and Neck Cancer Survivors—Results from the NUTRI-HAB Randomized Controlled Trial

by Marianne Boll Kristensen, Irene Wessel, Anne Marie Beck, Karin B. Dieperink, Tina Broby Mikkelsen, Jens-Jakob Kjer Møller and Ann-Dorthe Zwisler

Nutrients 2020, 12(7), 2117; https://doi.org/10.3390/nu12072117 - 17 Jul 2020

Cited by 8 | Viewed by 3403

Abstract

Head and neck cancer survivors frequently experience nutritional challenges, and proper rehabilitation should be offered. The trial objective was to test the effect of a multidisciplinary residential nutritional rehabilitation programme addressing physical, psychological, and social aspects of eating problems after treatment. In a randomized controlled trial, 71 head and neck cancer survivors recruited through a nationwide survey were randomized to the program or a wait-list control group. Inclusion was based on self-reported interest in participation. The primary outcome was change in body weight. Secondary outcomes included physical function, quality of life, and symptoms of anxiety and depression. Differences between groups at the 3-month follow-up were tested. No significant differences were seen in body weight change, but there were overall trends towards greater improvements in physical function (hand grip strength: p = 0.042; maximal mouth opening: p = 0.072) and quality of life (“Role functioning”: p = 0.041; “Speech problems”: p = 0.040; “Pain”: p = 0.048) in the intervention group. To conclude, a multidisciplinary residential nutritional rehabilitation program had no effect on body weight in head and neck cancer survivors with self-reported interest in participation, but it may have effect on physical function and quality of life. Further research on relevant outcomes, inclusion criteria, and the program’s effect in different subgroups is needed. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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20 pages, 263 KiB

Open AccessArticle

Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes

by Merran Findlay, Nicole M. Rankin, Tim Shaw, Kathryn White, Michael Boyer, Christopher Milross, Richard De Abreu Lourenço, Chris Brown, Gemma Collett, Philip Beale and Judith D. Bauer

Nutrients 2020, 12(5), 1465; https://doi.org/10.3390/nu12051465 - 19 May 2020

Cited by 23 | Viewed by 6957

Abstract

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings. Full article

(This article belongs to the Special Issue New Insights into the Nutritional Management of Patients with Head and Neck Cancer)

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