Head and neck cancer constitutes approximately 5.1% of all cancers worldwide. In these patients, nutritional problems present an immense and complex range of challenges. If the patient cannot swallow and the gastrointestinal tract is functioning normally, nutritional support is mainly given with enteral nutrition. The most common way to administer enteral feeding is via a polyurethane nasogastric feeding tube (NGT) or via a percutaneous endoscopic gastrostomy (PEG) tube.
Objectives: Different cohorts of patients with Head & Neck cancer have been studied with the aim to identify patients requiring nutritional support and to improve the nutritional surveillance.
Methods: In study I, the predictive value of systematic inflammatory and metabolic markers was prospectively studied in 21 patients undergoing RT. In Study II, a retrospective study of 151 patients with a PEG tube is presented. Study III Consecutive patients (n=147) with HEAD AND NECK cancer who were seen for nutritional control were evaluated for factors contributing to body weight loss. Study IV Using a prospective design, interviews about what in life is influenced by disease and feeding (oral feeding, NGT or PEG) were conducted.
Results: In Study I, all patients lost body weight with the greatest loss at the end of RT. Highly sensitive C-reactive protein (hsCRP) increased during RT. In study II, complications were seen in 40% of the patients. In study III, lowest body weight was observed at 6 months after RT. In total, 82 patients with no evidence of residual tumour after treatment received enteral nutrition. Body weight loss was not found to be associated with post-operative infections or mortality. In Study IV, more than 45% of the patients manifested eating-related problems.
Conclusion: Body weight and CRP are valuable variables to follow-up. NGT should be regarded as the first choice of enteral nutrition in patients with an expected limited time of tube feeding, whereas in patients in which prolonged treatment is needed PEG can be the choice. The extended body weight loss after treatment indicates that a pre-treatment nutritional surveillance programme is important.