Malnutrition is reported to affect 30 to 50% of patients with head and neck cancers. The contributing factors include tumour growth, cancer cachexia, inability to consume adequate nutrients as a result of chewing and swallowing impairments that may arise from the treatments (surgery, radiotherapy and chemotherapy) and/or its complications.

Nutrition plays a vital role in the care of the head and neck cancer patients. It helps to improve the overall outcomes of the treatment. The objectives of nutritional therapy are to provide sufficient nutrients such as protein and calories to minimise body tissue catabolism, prevent malnutrition and reduce adverse effects of treatment. Ideally, the nutritional management of head and neck cancer patient must be done before, during and after cancer treatment.

Tumour resection in the head and neck area has the potential to severely restrict or eliminate oral intake. Post-operative complications such as infection, development of fistula and sepsis will increase nutritional requirements. Radiotherapy affects the normal tissue in and around the oral cavity, altering the patient’s taste sensation, resulting in compromises in the nutritional status. Patients can experience dry mouth, loss of appetite, mucositis and dysphagia. Early nutritional assessment is required to ensure appropriate pre-treatment nutrition support. Nutritional requirements of head and neck cancer patients are determined by type of treatment, the severity of underlying malnutrition, the degree of weight loss, age and level of activity.

Comprehensive care of head and neck cancer patients should include a nutrition care plan tailored to the patient’s condition and nutritional status to reduce post treatment morbidity and mortality.

The dietician devises a nutrition care plan taking into consideration the above factors. If eating is a problem and patient is not meeting his or her nutritional requirements, there are many ‘ready to drink’ nutritional formulas to supplement intake. The standard nutritional formulas, such as Resource, Ensure and Enercal Plus contain a complete range of nutrients, that can even be used as a meal replacement. Majority of these products are soy-based and lactose-free and can be used for individuals with lactose intolerance.

Reference:

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3.	Reilly JJ. Does nutrition management benefit the head and neck cancer patient? Oncology (Huntingt) 1990;4:105–15.
4.	Sako K, Loré JM, Kaufman S, Razack MS, Bakamjian V, Reese P. Parenteral hyperalimentation in surgical patients with head and neck cancer: a randomized study. J Surg Oncol 1981;16:391–402.Van Bokhorst et al, 1999 Cancer;86(3):519.
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Tan Lee Boo, Senior Dietitian,
Department of Dietetics & Nutrition Services
SGH