Abstract B19: Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

Purpose: 1. To understand practice patterns among head and neck surgeons and radiation oncologists in the assessment and management of malnutrition in head and neck cancer patients. 2. To identify barriers that prevent the identification of and intervention upon malnutrition.

Background: Among patients who undergo surgery for head and neck cancer, there is a strong association between severe malnutrition and increased postoperative complications, length of stay, and cost of care. We aim to evaluate the association between the type of head and neck cancer provider and their comfort with the diagnosis and management of malnutrition in this patient population.

Methods: A 17-question survey was distributed to 1,392 members of the American Head and Neck Society (AHNS) between 04/01/2018 and 04/18/2018. Chi squared testing was used to perform subgroup analysis by hospital type, fellowship training, clinical experience, and specialty.

Results: The response rate among AHNS members was 9%, with 124 total respondents, including both otolaryngologists and radiation oncologists. There was strong agreement among respondents that malnutrition is important to identify and negatively impacts the quality of life, cost of care, length of hospital stay, mortality, and postoperative complications. The majority of respondents stated that although they were comfortable with screening for malnutrition, they were not familiar with the National Comprehensive Cancer Network (NCCN) guidelines on nutrition screening and intervention. Respondents reported use of various screening tools including serum markers, body mass index (BMI), and weight loss. Subgroup analysis demonstrated that otolaryngologists and academic hospitals were significantly more likely to screen by lab markers compared to radiation oncologists and community hospitals (p<0.05). Furthermore, although familiarity with NCCN guidelines was poor, fellowship-trained head and neck surgeons felt significantly more comfortable in their knowledge of NCCN guidelines than those without additional training (p<0.05). Barriers to screening for malnutrition included lack of training or familiarity with screening tools and guidelines, as well as lack of access to ancillary staff, such as nutritionists and speech therapists.

Conclusion: There was a strong consensus among respondents that identification and management of malnutrition among head and neck cancer patients is important. However, familiarity with guidelines on screening and treating malnutrition was lacking, occasionally leading to practice patterns that deviated from the best available evidence.

Citation Format: Amarbir S. Gill, Michael Kinzinger, Michael G. Moore. Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B19.

Malnutrition evaluation in head and neck cancer patients: Practice patterns among otolaryngologists and radiation oncologists

BACKGROUND

Physician practice patterns regarding diagnosis and management of malnutrition in the head and neck cancer patient population are not well studied.

METHODS

A 17-question survey was distributed to 1392 members of the American Head and Neck Society (AHNS). The impact of hospital type, fellowship training, experience, and specialty was assessed.

RESULTS

Among AHNS members, there were 124 total respondents (9% response rate), including both otolaryngologists and radiation oncologists. Respondents strongly agreed (90%) that malnutrition negatively impacts patient outcomes. The majority (63%) felt comfortable screening for malnutrition, but 13% reported no routine assessment of malnutrition; 57% were unfamiliar with relevant guidelines. Barriers to screening included lack of familiarity with screening tools/guidelines, lack of time, and lack of access to dietitian.

CONCLUSION

Although there was a strong consensus among respondents that the identification and management of malnutrition among head and neck cancer patients is critical, familiarity with relevant guidelines was poor.

Degree of Frontal Bone Exposure via Upper Blepharoplasty Incision: Considerations for Frontal Sinus Fracture

OBJECTIVE

The upper eyelid blepharoplasty incision affords direct access to the frontal bone for skull base surgery and trauma reconstruction with a well-hidden scar. The goal of this study is to quantify frontal bone exposure that can be achieved with an upper eyelid blepharoplasty incision.

DESIGN

Anatomic study with human cadaver heads.

SETTING

UC Davis Medical Center.

SUBJECTS/METHODS

Fourteen human cadaver heads were used to perform 26 upper blepharoplasty approaches. Exposure was measured with virtual planning software to create virtual reference points at the midline of the superior orbital rim. Surgical navigation was used with a 3-dimensionally printed drill model to measure the maximum exposure achievable relative to the virtual reference point at 5 standardized angles.

RESULTS

Mean ± SD exposures at medial 60°, medial 30°, 0°, lateral 30°, and lateral 60° were 16.1 ± 1.3 mm, 17.8 ± 1.3, 18.3 ± 1.4, 19.3 ± 1.9, and 20.9 ± 1.9, respectively. Significant differences were detected between exposures at 60° laterally and 60° medially and between exposures 60° laterally and 30° medially ( P < .05).

CONCLUSIONS

The upper eyelid blepharoplasty incision provides direct surgical access to the inferior frontal bone. Access was greatest with far lateral extension (mean, 20.9 mm) and most limited with far medial extension (mean, 16.1 mm). Treatment of injuries above this level could be achieved with additional percutaneous incisions for screw placement.

Mechanical analysis of cartilage graft reinforced with PDS plate

OBJECTIVES/HYPOTHESIS

This study attempts to characterize the biomechanical properties of a PDS-cartilage composite graft for use in septorhinoplasty.

STUDY DESIGN

Experimental Study.

METHODS

This study used a PDS analog, porcine cartilage cut to 1 × 5 × 20 mm, and a mechanical testing platform to measure flexure of a composite graft. Samples were assessed in four groups based on variations in suture pattern and orientation. The platform measured the force required to deflect the sample 2 mm in single cantilever beam geometry before and after the polymer was affixed to the specimen. Elastic Moduli were calculated before and after application of the polydioxanone polymer.

RESULTS

The average modulus of the cartilage alone was 17 ± 0.9 MPa. The modulus of the composite cartilage-polymer graft with 2 suture fixation was 21.2 ± 1.5 MPa. The 3-suture configuration produced an increase to 25.8 ± 2.23 MPa. The four-suture configuration produced 23.1 ± 3.19 MPa. The five-suture configuration produced 25.7 ± 2.6 MPa. The modulus of the analog alone was 170 ± 30 MPa. The modulus of the 0.5 mm PDS was 692 ± 37.4 MPa. The modulus of the 0.15 mm perforated PDS was 447 ± 34.8 MPa.

CONCLUSIONS

The study found that suturing a polymer plate to cartilage resulted in enhanced stiffness of the composite. Under the conditions of the study, there was no significant difference in elastic moduli between suture configurations, making the two-suture linear configuration optimal in the one-plane cantilever deflection model.