Malnutrition, hospitalisation and enteral nutrition use in head and neck cancer patients: A retrospective study

Abstract

Purpose: The primary aim of this thesis was to analyse body mass index (BMI) and enteral nutrition (EN) use as predictors of weight change and hospital admissions during radiotherapy in patients with head and neck cancer (HNC). A secondary aim was to develop guidelines for the selection of appropriate nutritional interventions. Methods: A narrative literature review of nutritional interventions used during treatment of HNC was completed. A retrospective chart review of patients treated with radiotherapy for HNC between October 2012 and April 2014 was conducted. Data on each subject’s diagnosis, age, sex, treatment modality, EN use and BMI were examined for their association with weight changes and hospital admissions during treatment. Results: Eighty-three patients were included, mean age ±standard deviation was 61 ±11 years. Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was -5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age and definitive radiotherapy ± chemotherapy predicted greater weight loss (p<0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n=10) (p=0.011) compared to those without critical weight loss (n=2). EN use was associated with a higher number of nutrition related admissions; however, it did not predict length of stay amongst those admitted. Conclusion: Critical weight loss during radiotherapy is a predictor of unplanned nutrition related hospital admissions. Higher BMI and younger age were associated with greater weight loss during radiotherapy, whilst EN assisted in weight preservation. A decision tool guiding patient selection for EN at the point of diagnosis warrants further investigation for its merits in minimising critical weight loss and hospital admissions during radiotherapy.