Enteral Nutrition Support of Head and Neck Cancer Patients Nutrition in Clincal Practice 22:68-73, February 2007 American Society of Parenteral and Enteral Nutrition

Head and Neck Cancer In US: –Annual Incidence: 40,500 –Death rate: 11,170 –Impaired nutrition status: 25-57%

Treatment and Treatment-Related Side Effects Treatment: –Surgery –Radiotherapy (RT) –Combination of RT and chemotherapy Result: –Poor food intake

Surgery Side effects –Oropharyngeal dysfunction –Dysphagia Postoperative complications –Infection –Orocutaneous fistulas –Wound dehiscence

Chemoradiation (CR) Side effects –Chewing / swallowing difficulties –Nausea –Altered taste sensation –Xerostomia –Changes in saliva viscosity –Stomatitis –Mucositis –Anorexia

Nutrition Therapy Enteral feeding –Why? Functional stomach and lower GI tract Safe and effective Easily administered

Nutrition Support During Treatment of Head and Neck Cancer Advantages of early enteral feeding: –  Weight loss –  Dehydration –  Malnutrition –  Treatment interruption –Improvements in nutrition parameters

Enteral Access Nasogastric tubes: > 3 weeks PEG placement –Long-term enteral nutrition

Feeding Formulas Polymeric formulas –Calorie: 1-2 kcal/mL –Protein: 12-20% –CHO: 40-60% –Fats: 30-40%

Nutrition Requirements In general: –Calorie: kcal/kg –Protein: g/kg –Fluid: mL/kg

Long-Term Home Enteral Nutrition Who? –Patients with chronic dysphagia Enteral feeding for at least 1 year Advantages: –Increased energy levels –Promote quality of life

Complications of Home Enteral Nutrition Diarrhea Constipation Leakage from the fistula tract Tube-site infection Tube dislogement Tube clogging

Role of Nutrition Support Team Nutrition support service –Provides education about the feedings –Care of the PEG tube –Regular monitoring of the patient

Summary Patients are at high risk for malnutrition Advantages of early enteral nutrition support: –  Weight loss –  Nutrition deficiencies –  Dehydration –  Hospitalizations –  Quality of life