1. 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

2. 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

3. 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

4. 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

5. Nutrition-Related Side-Effects and Nutrition Interventions - Radiation
Stomatitis/Mucositis/Odynophagia
Xerostomia/Thick Saliva
Dysgeusia
Dysphagia
Fatigue
Decreased appetite

6. 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

7. 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

8. 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

9. 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

10. 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