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… Pre-treatment weight loss 5% past 1 month 10% past 6 months Airway obstruction Dysphagia Factors suggesting strong consideration of prophylactic PEG Severe weight loss prior to treatment 5% past 1 month 10% past 6 months Symptoms include… Ongoing dehydration Severe dysphagia Anorexia 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