Skip to main content

Advertisement

SpringerLink
Log in

A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Malnutrition is prevalent in head and neck cancer patients and is associated with poorer outcomes and increased health care costs. This study aimed to evaluate the acceptability, organisational efficiency and clinical outcomes of a dietitian-led head and neck cancer clinic.

Methods

Two consecutive, independent, patient cohorts were studied with a pre–post-test design of 98 patients prior to the introduction of a dietitian-led clinic (DLC) and the subsequent 100 patients who attended the newly formulated DLC. The two groups were compared for frequency of dietitian intervention, weight loss, enteral feeding, hospital admissions and post-treatment medical follow-up requirements.

Results

Nutritional management in a DLC was associated with reduced nutrition-related admissions from 12% to 4.5% (p = 0.0029), unplanned nasogastric tube insertions from 75% to 39% (p = 0.02), improved transition to oral diet post-radiotherapy from 68.3% to 76.7% (p = 0.10) and reduced radiation oncologist review at 2 weeks post-radiotherapy from 32% to 15% patients (p = 0.009) compared to the cohort prior to the DLC.

Conclusions

A dietitian-led head and neck cancer clinic is associated with improved efficiency and nutritional management of head and neck cancer patients and offers a feasible model of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. AIHW (2006) Cancer in Australia: an overview, 2006. Australian Institute of Health and Welfare (AIHW)

  2. Davidson W, Isenring E, Brown T, Riddle B (2006) Nutritional management of patients with head and neck cancer: integrating research into practice. Cancer Forum 30:183–186

    Google Scholar 

  3. Schweinfurth J, Boger G, Feustel P (2001) Preoperative assessment for gastrostomy tube placement in head and neck cancer patients. Head Neck 23:376–382

    Article  PubMed  CAS  Google Scholar 

  4. Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M (2010) Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 18(4):433–437

    Article  PubMed  Google Scholar 

  5. Mekhail T, Adelstein D, Rybicki L, Larto M, Saxton J, Lavertu P (2001) Enteral nutrition during the treatment of head and neck carcinoma. Cancer 91(9):1785–1790

    Article  PubMed  CAS  Google Scholar 

  6. Arends J, Bodoky G, Bozzetti F et al (2006) ESPEN guidelines on enteral nutrition: non surgical oncology. Clin Nutr 25:245–259

    Article  PubMed  CAS  Google Scholar 

  7. Riddle B, Davidson W, Elliot R, Balsillie F, Porceddu S (2005) Collaborative management of acute side effects for head and neck cancer patients receiving radiotherapy. Asia Pac J Clin Oncol 1(Suppl):A1–A32

    Google Scholar 

  8. Dellagiacoma T (2007) Eight essential factors for successful nurse-led services. Aust Nurs J 14(10):28–31

    PubMed  Google Scholar 

  9. Kimball B, Joynt J, Cherner D, O’Neil E (2007) The Quest for new innovative care delivery models. J Nurs Adm 37(9):392–398

    Article  PubMed  Google Scholar 

  10. Dietitians Association of Australia (2008) Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy. Aust J Nutr Diet 65:S1–S20

    Google Scholar 

  11. Ottery F (1996) Definition of a standardised nutritional assessment and interventional pathways in oncology. Nutrition 12:s15–s19

    PubMed  CAS  Google Scholar 

  12. Hill J (1997) Patient satisfaction in a nurse-led rheumatology clinic. J Adv Nurs 25:347–354

    Article  PubMed  CAS  Google Scholar 

  13. Isenring E, Capra S, Bauer J (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452

    Article  PubMed  CAS  Google Scholar 

  14. Isenring E, Bauer J, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107:404–412

    Article  PubMed  CAS  Google Scholar 

  15. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Ermilinda Camilo M (2005) Impact of nutrition on outcome: a prospective randomised controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668

    Article  PubMed  Google Scholar 

  16. Beaver M, Matheny K, Roberts D, Myers J (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125:645–648

    Article  PubMed  CAS  Google Scholar 

  17. Trotti A, Bellm L, Epstein J et al (2003) Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 66:253–262

    Article  PubMed  Google Scholar 

  18. Rademaker A, Vonesh E, Logemann J et al (2003) Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12 month follow up study accounting for drop out. Head Neck 25:1034–1041

    Article  PubMed  Google Scholar 

  19. Corry J, Poon W, McPhee N et al (2009) Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation. Head Neck 31(7):867–876

    Article  PubMed  Google Scholar 

  20. Magne N, Marcy P, Foa C et al (2001) Comparison between nasogastric tube feeding and percutaneous fluroscopic gastrostomy in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol 258:89–92

    Article  PubMed  CAS  Google Scholar 

  21. Lees J (1997) Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit: a two year study. Eur J Cancer Care 6:45–49

    Article  CAS  Google Scholar 

  22. Munshi A, Bhushan Pandey M, Durga T, Chander Pandey K, Bahadur S, Mohanti B (2003) Weight loss during radiotherapy for head and neck malignancies: what factors impact it? Nutr Cancer 47(2):136–140

    Article  PubMed  Google Scholar 

  23. Lawson J, Gaultney J, Saba N, Grist W, Davis L, Johnstone P (2009) Percutaneous feeding tubes in patients with head and neck cancer: rethinking prophylactic placement for patients undergoing chemoradation. Am J Otolaryngol 30:244–249

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge Ms Anna Boltong, Ms Sally Muir, Ms Wendy Poon, Dr Andrew Coleman, Dr Ieta D’Costa, Dr Chen Liu, Dr Tsien Fua and Dr Mark Lee, PMCC Nutrition Department and Head and Neck Service for their support of the project. This study was undertaken with a supportive care infrastructure grant from the Victorian Cancer Agency. The authors have no conflict of interest to declare, have full control of all primary data and agree to allow the journal to review the data if requested.

Author information

Authors and Affiliations

  1. Nutrition Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia

    Nicole K. Kiss, Jenelle Loeliger & Alba Granados

  2. Division of Nursing, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia

    Meinir Krishnasamy

  3. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia

    Gaelle Dutu

  4. Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia

    June Corry

Authors
  1. Nicole K. Kiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meinir Krishnasamy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jenelle Loeliger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alba Granados
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gaelle Dutu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. June Corry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicole K. Kiss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kiss, N.K., Krishnasamy, M., Loeliger, J. et al. A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer. Support Care Cancer 20, 2111–2120 (2012). https://doi.org/10.1007/s00520-011-1321-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1321-7

Keywords

Search

Navigation