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July 2023The nutritional impact of head and neck cancer (HNC) doesn’t begin with diagnosis. Approximately 30% of affected patients are malnourished prior to diagnosis and treatment due to odynophagia, early satiety, and fatigue. (Cancers. 2023;15:822). Therefore, the key to nutritional support for patients with HNC is a multidisciplinary care plan that begins before treatment, continues during therapy, and extends well after the end of treatment.
“Eating and drinking are one of life’s pleasures,” said Allen L. Feng, MD, assistant professor of otolaryngology–head and neck surgery at Harvard Medical School and surgeon at Massachusetts Eye and Ear Institute, in Boston. “Most of what we do as surgeons is about function: making sure that patients aren’t nutritionally depleted and have adequate reserves to withstand surgery, radiation, or chemotherapy, or sometimes all three.”
Most of what we do as surgeons is about function: making sure that patients aren’t nutritionally depleted and have adequate reserves to withstand surgery, radiation, or chemotherapy, or sometimes all three. — Allen L. Feng, MD
Surgeons, medical oncologists, and radiation oncologists are critical to the care of these patients; however, registered dietitian nutritionists (RDNs), speech pathologists, and social workers also play an important role, experts noted.
“Evaluation by a qualified dietician and speech pathologist prior to starting treatment is the key to successful completion of therapy,” said Kalika P. Sarma, MD, a clinical assistant professor at Carle Illinois College of Medicine and a radiation oncologist at Carle Cancer Institute, Urbana, Ill.
“As a head and neck cancer surgeon, I have come to appreciate just how important a multidisciplinary team is to the quality of life of patients,” agreed Dr. Feng.
Best Practices for HNC Patients
Because of tumor locations and associated treatments, “HNC patients experience exceptionally high rates of nutritional impact symptoms [NIS] that affect their ability and desire to eat,” said Anna Arthur, PhD, MPH, RDN, an assistant professor in the department of dietetics and nutrition at Kansas University Medical Center in Kansas City, Kan. A recent study reported that 90% of HNC survivors who undergo chemotherapy/radiation therapy experience one or more NIS (Cancers. 2023;15:822). In addition, nearly 40% of HNC patients are unaware that NIS could become chronic and could persist well beyond the completion of their therapy.
Patients with head and neck cancers are at higher risk of unintentional weight loss, reduced muscle mass, malnutrition, and cachexia than many other patients with cancer.— Anna Arthur, PhD, MPH, RDN
