Effect of oral nutritional supplements on nutritional status in head and neck cancer patients with radiation therapy

• Main Authors: Shu-Chen Ko, 柯淑貞
• Other Authors: 陳曉鈴
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/83669136864726186026

碩士 === 中山醫學大學 === 營養學研究所 === 102 === Objective This study was to determine the impact of early and intensive nutrition intervention on a range of outcomes including body weight, body composition, nutritional status, radiotherapy side effect, treatment interruption of radiotherapy, global quality of life (QoL), and physical function compared to usual practice in oncology outpatients receiving radiotherapy in the head and neck cancer patients. Methods The patients with head and neck cancer receiving radiotherapy at Changhua Christian Hospital since September 2012 to October 2013. The inclusion criteria were oncology outpatients, age >20 years and<80 years. Patients who were age <20 years, >80 years, pregnant, breastfeeding or severe liver or kidney failure were excluded. 53 out of 73 newly diagnosed patients have signed the informed consent to participate in the study. Completed testing data was collected on 40 patients. All of the patients were randomized into either the intervention or the control groups. For the intervention group, every patient was provided with 500 kcal nutrient supplements per day during a 2-month period of radiotherapy. In contrast, there were no nutrient intervention for the control group. Results The immediate effects of nutrition intervention, such as calorie and protein intakes were obviously close to the suggested value (p<0.05). The intervention group was better than control on diet. Control group was significantly reduced on red blood count (×106/mm3), hemoglobin (g/dl), Hct (%), lymphocyte (%), total lymphocyte count (×103/mm3) before and after the testing period (p<0.05). In contrast, there were only white blood cells, lymphocyte (%) and total lymphocyte count (×103/mm3) had been reduced significantly for intervention. The reducing effects were not significantly different between the intervention and the control group. Serum albumin was reduced in both groups, but there is still no significant difference in intergroup comparisons. Significant difference in weight loss was observed at the 4th week of study (p<0.05). The most obviously effect was appeared on final week. There were 4.6±2.4 kg and 2.6±2.4 kg (p<0.05) of weight loss in the control and the intervention group, respectively. This implied that the nutrition intervention could slow down the weight loss of intervention group. The analysis of weight loss percentage also exhibited the same trend and showed a significant difference, which was 2.9% vs. 1.3% for intervention and control groups on week 4 (p<0.05), respectively. The most distinct effect was occurred on final week. There were 6.9±3.2 % and 4.1±4.0 % of weight loss (p<0.05) for control and intervention group, respectively. The results patient generated subjective global assessment (PGSGA) showed that higher score was observed in longer time period of therapy. The intervention group was stable after 3-4 weeks; while the control group was followed an increasing trend. The score comparison on week 6 and final week had a significant difference (p<0.05). In addition to weight loss of cancer patient, body composition is a more concerned issue. All the fat, water content and fat free mass showed a reducing trend. Although, the reducing amounts were not significant between two groups, they were reduced more in control. These results indicated that intervention group could keep the body composition more stable than control. It had been shown some benefits described below. The treatment interruption rate, defined as a 5-day interruption had been improved, which was 15 % vs. 45 % for intervention and control groups, respectively; Interruption group had superior finishing rate of 100%, In contrast, there was only 86% for control. Conclusions It is suggested that adequate nutrition support during radiotherapy can decrease impact of side effects, minimize weight loss, and improve quality of life (QoL), decrease radiotherapy interruption rate and increase finishing rate and help patients to recover from the radiotherapy more quickly.