scholarly journals Effects of early nutritional intervention on oral mucositis in patients with radiotherapy for head and neck cancer

QJM ◽  
2019 ◽  
Vol 113 (1) ◽  
pp. 37-42
Author(s):  
J Wei ◽  
J Wu ◽  
L Meng ◽  
B Zhu ◽  
H Wang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Oral Mucositis ◽  
Lymphocyte Count ◽  
Nutritional Intervention ◽  
Total Lymphocyte Count ◽  
High Grade ◽  
Early Group ◽  
Late Group

Summary Background To observe the effect of early nutritional intervention on radiation-induced oral mucositis and nutritional status in patients with head and neck cancer (HNC). Methods A total of 54 HNC patients were divided into early (28 cases) and late (26 cases) nutritional intervention groups. The early group received enteral nutrition at the beginning of radiotherapy (RT), while the late group received enteral nutrition after restricted feeding. Operators reported and assessed the timing and extent of oral mucositis and nutritional status during treatment. The nutritional status assessment indicators included body weight; body mass index (BMI); Patient-Generated–Subjective Global Assessment (PG-SGA) score; levels of albumin, hemoglobin and pre-albumin and total lymphocyte count. Results The incidence of high-grade oral mucositis was significantly lower in the early group than that in the late group (P < 0.05). Nutritional status assessments showed more significant weight and BMI losses in the late group than in the early group at weeks 4 and 7 after RT (P < 0.01). The albumin decreased in the late group at week 7 after RT was more significant than that in the early group (P < 0.05). Albumin, hemoglobin and pre-albumin levels and total lymphocyte count decreased significantly in both groups (P > 0.05). During therapy, more patients in the early group were well-nourished and fewer were malnourished according to PG-SGA scores (P < 0.05). Conclusion Early nutritional intervention can reduce the incidence of high-grade oral mucositis during RT in patients with HNC and improve the nutritional status during treatment, which has important clinical significance.

Effect of early nutrition intervention on advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17504-e17504
Author(s):  
Lingbin Meng ◽  
Xiaochun Xu ◽  
Xin Jiang ◽  
Tarek Mekhail
Keyword(s):  
Weight Loss ◽  
Nasopharyngeal Carcinoma ◽  
Nutritional Status ◽  
Nutritional Intervention ◽  
Nutrition Intervention ◽  
Lower Percentage ◽  
Early Group ◽  
Early Nutrition ◽  
Treatment Tolerance ◽  
Late Group

e17504 Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n = 46) and late (n = 32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or > 10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p< 0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p< 0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusions: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients’ life quality.

scholarly journals The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy

2021 ◽  
Vol 10 ◽  
Author(s):  
Zhuangzhuang Zheng ◽  
Xin Zhao ◽  
Qin Zhao ◽  
Yuyu Zhang ◽  
Shiyu Liu ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Nutritional Status ◽  
Head And Neck ◽  
Neck Cancer ◽  
Oral Mucositis ◽  
Intervention Strategy ◽  
Nutritional Intervention ◽  
Assessment Tools ◽  
Common Side Effect ◽  
Clinical Factor

Radiation-induced oral mucositis (RIOM) is a common side effect after radiotherapy (RT) in head and neck cancer (HNC) patients. RIOM patients with severe pain have difficulty in eating, which increases the incidence of malnutrition and affects patients’ quality of life and the process of RT. The mechanism of RIOM is not fully understood, and inflammatory response and oxidative stress appear to be important for RIOM occurrence and development. The nutritional status of patients is very important for their RT tolerance and recovery. Malnutrition, which can lead to anemia, low protein, decreased immunity and other problems, is an important clinical factor affecting tumor progression and treatment. Recent studies have shown that early nutritional intervention can ameliorate oral mucositis and nutritional status of patients with HNC. However, in clinical practice, early nutritional intervention for patients with HNC is not a conventional intervention strategy. Therefore, this review summarized the possible pathogenesis of RIOM, commonly used assessment tools for malnutrition in patients, and recent studies on the effects of early nutritional interventions on RIOM and nutritional status of patients with HNC. We hope to provide the basis and reference for the clinical application of early nutritional intervention models.

Enteral Nutrition in the Chronic Obstructive Pulmonary Disease (COPD) Patient

2012 ◽  
Vol 25 (6) ◽  
pp. 583-585 ◽  
Author(s):  
Heather F. DeBellis ◽  
James W. Fetterman
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Enteral Nutrition ◽  
Nutritional Status ◽  
Pulmonary Disease ◽  
Dietary Habits ◽  
Physiological Stress ◽  
Nutritional Intervention ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient’s nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient’s dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

Does early oral feeding increase the likelihood of salivary fistula after total laryngectomy?

2014 ◽  
Vol 128 (4) ◽  
pp. 372-378 ◽  
Author(s):  
A A Sousa ◽  
J M Porcaro-Salles ◽  
J M A Soares ◽  
G M de Moraes ◽  
G S Silva ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Neck Dissection ◽  
Total Laryngectomy ◽  
Randomised Trial ◽  
Oral Feeding ◽  
Early Group ◽  
Salivary Fistula ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
Late Group

AbstractObjective:This study compared the incidence of salivary fistula between groups with an early or late reintroduction of oral feeding, and identified the predictive factors for salivary fistula.Methods:A randomised trial was performed using 89 patients with larynx or hypopharynx cancer, assigned to 2 groups (early or late). In the early group, oral feeding was started 24 hours after total laryngectomy or total pharyngolaryngectomy, and in the late group, it was started from post-operative day 7 onwards. The occurrence of salivary fistula was evaluated in relation to the following variables: early or late oral feeding, nutritional status, cancer stage, surgery performed, and type of neck dissection.Results:The incidence of salivary fistula was 27.3 per cent (n = 12) in the early group and 13.3 per cent (n = 6) in the late group (p = 0.10). The following variables were not statistically significant: nutritional status (p = 0.45); tumour location (p = 0.37); type of surgery (p = 0.91) and type of neck dissection (p = 0.62). A significant difference (p = 0.02) between the free margins and invasive carcinoma was observed.Conclusion:The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.

scholarly journals Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

2016 ◽  
Vol 130 (S2) ◽  
pp. S32-S40 ◽  
Author(s):  
B Talwar ◽  
R Donnelly ◽  
R Skelly ◽  
M Donaldson
Keyword(s):  
Head And Neck Cancer ◽  
Nutritional Status ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Tube Feeding ◽  
Nutritional Intervention ◽  
Nutrition Support ◽  
Subjective Global Assessment ◽  
Chyle Leak

AbstractNutritional support and intervention is an integral component of head and neck cancer management. Patients can be malnourished at presentation, and the majority of patients undergoing treatment for head and neck cancer will need nutritional support. This paper summarises aspects of nutritional considerations for this patient group and provides recommendations for the practising clinician.Recommendations• A specialist dietitian should be part of the multidisciplinary team for treating head and neck cancer patients throughout the continuum of care as frequent dietetic contact has been shown to have enhanced outcomes. (R)• Patients with head and neck cancer should be nutritionally screened using a validated screening tool at diagnosis and then repeated at intervals through each stage of treatment. (R)• Patients at high risk should be referred to the dietitian for early intervention. (R)• Offer treatment for malnutrition and appropriate nutrition support without delay given the adverse impact on clinical, patient reported and financial outcomes. (R)• Use a validated nutrition assessment tool (e.g. scored Patient Generated–Subjective Global Assessment or Subjective Global Assessment) to assess nutritional status. (R)• Offer pre-treatment assessment prior to any treatment as intervention aims to improve, maintain or reduce decline in nutritional status of head and neck cancer patients who have malnutrition or are at risk of malnutrition. (G)• Patients identified as well-nourished at baseline but whose treatment may impact on their future nutritional status should receive dietetic assessment and intervention at any stage of the pathway. (G)• Aim for energy intakes of at least 30 kcal/kg/day. As energy requirements may be elevated post-operatively, monitor weight and adjust intake as required. (R)• Aim for energy and protein intakes of at least 30 kcal/kg/day and 1.2 g protein/kg/day in patients receiving radiotherapy or chemoradiotherapy. Patients should have their weight and nutritional intake monitored regularly to determine whether their energy requirements are being met. (R)• Perform nutritional assessment of cancer patients frequently. (G)• Initiate nutritional intervention early when deficits are detected. (G)• Integrate measures to modulate cancer cachexia changes into the nutritional management. (G)• Start nutritional therapy if undernutrition already exists or if it is anticipated that the patient will be unable to eat for more than 7 days. Enteral nutrition should also be started if an inadequate food intake (60 per cent of estimated energy expenditure) is anticipated for more than 10 days. (R)• Use standard polymeric feed. (G)• Consider gastrostomy insertion if long-term tube feeding is necessary (greater than four weeks). (R)• Monitor nutritional parameters regularly throughout the patient's cancer journey. (G)• Pre-operative:○ Patients with severe nutritional risk should receive nutrition support for 10–14 days prior to major surgery even if surgery has to be delayed. (R)○ Consider carbohydrate loading in patients undergoing head and neck surgery. (R)• Post-operative:○ Initiate tube feeding within 24 hours of surgery. (R)○ Consider early oral feeding after primary laryngectomy. (R)• Chyle Leak:○ Confirm chyle leak by analysis of drainage fluid for triglycerides and chylomicrons. (R)○ Commence nutritional intervention with fat free or medium chain triglyceride nutritional supplements either orally or via a feeding tube. (R)○ Consider parenteral nutrition in severe cases when drainage volume is consistently high. (G)• Weekly dietetic intervention is offered for all patients undergoing radiotherapy treatment to prevent weight loss, increase intake and reduce treatments interruptions. (R)• Offer prophylactic tube feeding as part of locally agreed guidelines, where oral nutrition is inadequate. (R)• Offer nutritional intervention (dietary counselling and/or supplements) for up to three months after treatment. (R)• Patients who have completed their rehabilitation and are disease free should be offered healthy eating advice as part of a health and wellbeing clinic. (G)• Quality of life parameters including nutritional and swallowing, should be measured at diagnosis and at regular intervals post-treatment. (G)

Correlation of Preoperative Nutritional Status and Postoperative Wound Infection in Children

2020 ◽  
Vol 23 (2) ◽  
pp. 48-53
Author(s):  
Partha Sarathy Majumder ◽  
Anuradha Karmaker ◽  
Md Nooruzzaman ◽  
Zahidur Rahman ◽  
Syed Abdul Adil ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Serum Albumin ◽  
Wound Infection ◽  
Lymphocyte Count ◽  
Total Lymphocyte Count ◽  
Postoperative Wound Infection ◽  
Postoperative Wound ◽  
Malnourished Children ◽  
Total Lymphocyte ◽  
Low Bmi

Background: Despite improvements in antimicrobial therapy, surgical technique and postoperative care, wound infection is still a major concern in pediatric surgical practice particularly in developing countries like Bangladesh. Objective: This study was conducted to ascertain the relationship between the preoperative nutritional status and postoperative wound infection in children as malnutrition is very prevalent among them. It was also decided to estimate the rate of wound infection in children and to identify the indicator of malnutrition that best predicts wound infection. Methods: This prospective study was carried out in the Department of Pediatric Surgery, BSMMU, Dhaka during the period of January 2009 to September 2010 and included consecutive 100 children undergoing routine surgery. Nutritional status was assessed by measuring BMI, serum albumin, haemoglobin and total lymphocyte count and thus children were categorized preoperatively. The children were assessed during the first 30 postoperative days for the evidence of wound infection that were confirmed by culture and sensitivity. Results: We found most of the wound infections among the malnourished children with low BMI and low serum albumin. Conclusion: Preoperative good nutritional status is associated with less postoperative wound infection and BMI and serum albumin are good indicators but total lymphocyte count and haemoglobin are not good indicators of protein calorie malnutrition and serum albumin is the best predictor of wound infection. Journal of Surgical Sciences (2019) Vol. 23(2): 48-53

scholarly journals TOTAL LYMPHOCYTE COUNT AND SERUM ALBUMIN AS PREDICTORS OF NUTRITIONAL RISK IN SURGICAL PATIENTS

2015 ◽  
Vol 28 (3) ◽  
pp. 193-196 ◽  
Author(s):  
Naruna Pereira ROCHA ◽  
Renata Costa FORTES
Keyword(s):  
Postoperative Complications ◽  
Nutritional Status ◽  
Lymphocyte Count ◽  
Global Assessment ◽  
Total Lymphocyte Count ◽  
Nutritional Risk ◽  
Surgical Patients ◽  
Subjective Global Assessment ◽  
Total Lymphocyte ◽  
High Prevalence

Background: Early detection of changes in nutritional status is important for a better approach to the surgical patient. There are several nutritional measures in clinical practice, but there is not a complete method for determining the nutritional status, so, health professionals should only choose the best method to use. Aim: To evaluate the total lymphocyte count and albumin as predictors of identification of nutritional risk in surgical patients. Methods: Prospective longitudinal study was conducted with 69 patients undergoing surgery of the gastrointestinal tract. The assessment of nutritional status was evaluated by objective methods (anthropometry and biochemical tests) and subjective methods (subjective global assessment). Results: All parameters used in the nutritional assessment detected a high prevalence of malnutrition, with the exception of BMI which detected only 7.2% (n=5). The albumin (p=0.01), the total lymphocytes count (p=0.02), the percentage of adequacy of skinfolds (p<0.002) and the subjective global assessment (p<0.001) proved to be useful as predictors of risk of postoperative complications, since the smaller the values of albumin and lymphocyte count and higher the score the subjective global assessment were higher risks of surgical complications. Conclusions: A high prevalence of malnutrition was found, except for BMI. The use of albumin and total lymphocyte count were good predictor for the risk of postoperative complications and when used with other methods of assessing the nutritional status, such as the subjective global assessment and the percentage of adequacy of skinfolds, can be useful for identification of nutritional risk and postoperative complications.

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