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Senesse P, Briant J, Boisselier P, Bensadoun RJ, Vinches M, Faravel K. Head and neck cancer patients treated with concomitant chemoradiotherapy involving the oral cavity and oropharynx: is another choice possible than prophylactic gastrostomy? Curr Opin Oncol 2024; 36:128-135. [PMID: 38573201 DOI: 10.1097/cco.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Recent recommendations on cachexia highlight, in head and neck cancers, the heterogeneity of studies, focusing on weight loss and sequelae including swallowing disorders. The current national guidelines emphasize that, in cases of concurrent chemoradiotherapy (cCRT) involving the oral cavity and oropharynx, prophylactic gastrostomy placement should be carried out systematically. We review why this technique is particularly relevant in this specific location for the feasibility of cCRT. RECENT FINDINGS A randomized trial is underway on swallowing disorders and the quality of life of patients after prophylactic vs. reactive gastrostomy in advanced oropharyngeal cancer patients treated with CRT. Concurrently, recent literature reviews emphasize the importance of the cumulative dose of chemotherapy for local control and survival. In cases of cCRT involving the oral cavity or the oropharynx, nutritional support could have a beneficial or detrimental impact on chemotherapy. SUMMARY Specifically for patients treated with cCRT involving the oral cavity and oropharynx, prophylactic gastrostomy would be able to fulfill the three objectives of local control, survival, and quality of life, minimizing complications related to nutritional support. Studies need to be more homogeneous. In clinical practice, nutrition should primarily assist in carrying out cancer treatment when survival is the main goal.
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Affiliation(s)
- Pierre Senesse
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Jeanne Briant
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
| | - Pierre Boisselier
- Institut du Cancer Montpellier (ICM), Radiotherapy Department, University of Montpellier, France
| | | | - Marie Vinches
- Institut du Cancer Montpellier (ICM), Medical Oncology Department, University of Montpellier, France
| | - Kerstin Faravel
- Institut du Cancer Montpellier, (ICM), Supportive Care Department, University of Montpellier, France
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Ding C, Chen Q, Zhang F, Xu B, Zhang H. Effect of a Personalized Enteral Nutrition Protocol on the Postoperative Nutritional Status in Patients Who Underwent Oral Cancer Surgery. Nutr Cancer 2023; 75:815-824. [PMID: 36533888 DOI: 10.1080/01635581.2022.2157449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Differences in the implementation of the perioperative nutrition guidelines and pathways by caregivers lead to differences in enteral nutrition provided to the patients. This study investigated the effect of a personalized enteral nutrition protocol on the postoperative nutritional status of patients who underwent oral cancer surgery at Zhejiang Ningbo NO. 2 Hospital. Those who underwent surgery between July 2017 and October 2018 received routine enteral nutrition based on the Nutritional Risk Screening 2002 (routine group), while those between November 2018 and August 2021 received personalized enteral nutrition based on the Patient-Generated Subjective Global Assessment tool (personalized group). Seventy patients completed the study (routine group, n = 34; personalized group, n = 36). After surgery, the personalized group exhibited significantly greater improvements in serum albumin levels (P < 0.01) (on the 7th and 10th day) and hand grip strength (P < 0.01), higher self-care ability (P < 0.01), lower incidence of gastrointestinal reactions during enteral feeding (P < 0.05), and shorter hospital stay (P < 0.05) than the routine group. Therefore, a personalized enteral nutrition program might improve the postoperative nutritional status, shorten the hospital stay, and accelerate postoperative recovery in patients who underwent oral cancer surgery.
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Affiliation(s)
- Chunbo Ding
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Qing Chen
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Feng Zhang
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Bin Xu
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Huiqin Zhang
- Department of Nutrition, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
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Kang J, Li H, Shi X, Ma E, Chen W. Validation of the efficacy of the NUTRISCORE for the nutritional screening of cancer patients in China. BMC Cancer 2022; 22:43. [PMID: 34991505 PMCID: PMC8740059 DOI: 10.1186/s12885-021-09135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is common in cancer patients. The NUTRISCORE is a newly developed cancer-specific nutritional screening tool and was validated by comparison with the Patient-Generated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST) in Spain. We aimed to evaluate the performance of the NUTRISCORE, MST, and PG-SGA in estimating the risk of malnutrition in Chinese cancer patients. Methods Data from an open parallel and multicenter cross-sectional study in 29 clinical teaching hospitals in 14 Chinese cities were used. Cancer patients were assessed for malnutrition using the PG-SGA, NUTRISCORE, and MST. The sensitivity, specificity, and areas under the receiver operating characteristic curve were estimated for the NUTRISCORE and MST using the PG-SGA as a reference. Results A total of 1000 cancer patients were included. The mean age was 55.9 (19 to 92 years), and 47.5% were male. Of these patients, 450 (45.0%) had PG-SGA B and C, 29 (2.9%) had a NUTRISCORE ≥5, and 367 (36.7%) had an MST ≥ 2. Using the PG-SGA as a reference, the sensitivity, specificity, and area under the curve values of the NUTRISCORE were found to be 6.2, 99.8%, and 0.53, respectively. The sensitivity, specificity, and area under the curve values of the MST were 50.9, 74.9%, and 0.63, respectively. The kappa index between the NUTRISCORE and PG-SGA was 0.066, and that between the MST and PG-SGA was 0.262 (P < 0.05). Conclusions The NUTRISCORE had an extremely low sensitivity in cancer patients in China compared with the MST when the PG-SGA was used as a reference.
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Affiliation(s)
- Junren Kang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai Fu Yuan, Beijing, 100730, Dongcheng District, China
| | - Hailong Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai Fu Yuan, Beijing, 100730, Dongcheng District, China
| | - Xiaodong Shi
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai Fu Yuan, Beijing, 100730, Dongcheng District, China
| | - Enling Ma
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai Fu Yuan, Beijing, 100730, Dongcheng District, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai Fu Yuan, Beijing, 100730, Dongcheng District, China.
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Hazzard E, Walton K, McMahon AT, Milosavljevic M, Tapsell LC. Healthcare professionals' perspectives on the role of dietitians within multidisciplinary head and neck cancer teams: A qualitative multi-site study. Nutr Diet 2021; 78:506-515. [PMID: 33908185 DOI: 10.1111/1747-0080.12664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/09/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
AIM Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes. Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals. METHODS This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. RESULTS Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines." CONCLUSIONS While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.
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Affiliation(s)
- Emily Hazzard
- Department of Nutrition and Dietetics, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.,School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Walton
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anne-Therese McMahon
- School of Health and Society Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marianna Milosavljevic
- Research Central, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Linda C Tapsell
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Hazzard E, Walton K, McMahon AT, Milosavljevic M, Tapsell L. Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study. J Interprof Care 2021; 35:813-820. [PMID: 33587011 DOI: 10.1080/13561820.2020.1865290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.
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Affiliation(s)
- Emily Hazzard
- Department of Nutrition and Dietetics, The Wollongong Hospital Illawarra Shoalhaven Local Health District, NSW, Australia.b School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW,
| | - Karen Walton
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia, .
| | - Anne-Therese McMahon
- Clinical Associate Professor, The Wollongong Hospital, School of Health and Society, University of Wollongong, Northfields Ave, Wollongong NSW, Australia
| | - Marianna Milosavljevic
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Linda Tapsell
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia,g School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, NSW,
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Allmark G, Calder PC, Marino LV. Research identified variation in nutrition practice by community prescribing dietitians with regards to the identification and management of malnutrition amongst community dwelling adults. Nutr Res 2019; 76:94-105. [PMID: 31837829 DOI: 10.1016/j.nutres.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 01/29/2023]
Abstract
To improve nutritional outcomes of community dwelling adults with malnutrition we identified three related hypotheses to be tested: i) Southampton Community Prescribing Support Service dietitians achieve 100% compliance with selected standards of the National Institute for Health and Clinical Excellence Clinical Guideline (CG) 32, ii) patient service satisfaction amongst community dwelling adults accessing the prescribing support service is high (90%), and iii) nationally, dietitians use weight gain goal >10% and BMI >18.5 kg/m2 as outcome measures from the service phases of prescribing support. A retrospective audit of records of 100 community-dwelling adults accessing local services considered CG32 "Indications for nutrition support in hospital and community standard 1.3.1" and CG32 "Monitoring of nutrition support in hospital and community standard 1.5.6". A questionnaire was distributed to community-dwelling adults (n = 52) accessing the service, in addition to a national survey of dietetic practice. Compliance with standard 1.3.1 was 46% and with standard 1.5.6 it was 82%. The majority of patients (86%; n = 13) reported satisfaction with the support service. Nationally, 89% (n = 51) of dietitians use weight and 87% (n = 50) use BMI as an outcome measure for success of nutritional intervention. All research hypotheses were rejected. These results suggest there is considerable variation in the identification and management of malnutrition amongst community dwelling adults, which may impact on clinical and nutritional outcomes. Future work should consider quality improvement projects to address potential barriers to achieving best practice by community prescribing dietitians through the use of nutrition pathways to support older adults with malnutrition.
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Affiliation(s)
- Grace Allmark
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Luise V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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