Enteral Nutrition Support of Head and Neck Cancer

Head and Neck Cancer • In US: – Annual Incidence: 40, 500 – Death

Treatment and Treatment-Related Side Effects • Treatment: – Surgery – Radiotherapy (RT) – Combination

Surgery • Side effects – Oropharyngeal dysfunction – Dysphagia • Postoperative complications – Infection

Chemoradiation (CR) • Side effects – – – – Chewing / swallowing difficulties Nausea

Nutrition Therapy • Enteral feeding – Why? • Functional stomach and lower GI tract

Nutrition Support During Treatment of Head and Neck Cancer • Advantages of early enteral

Enteral Access • Nasogastric tubes: > 3 weeks • PEG placement – Long-term enteral

Feeding Formulas • Polymeric formulas – – Calorie: 1 -2 kcal/m. L Protein: 12

Nutrition Requirements • In general: – Calorie: 25 -35 kcal/kg – Protein: 1 -1.

Long-Term Home Enteral Nutrition • Who? – Patients with chronic dysphagia • Enteral feeding

Complications of Home Enteral Nutrition • • • Diarrhea Constipation Leakage from the fistula

Role of Nutrition Support Team • Nutrition support service – Provides education about the

Summary • Patients are at high risk for malnutrition • Advantages of early enteral

Slides: 14

Download presentation

Enteral Nutrition Support of Head and Neck Cancer Patients Nutrition in Clincal Practice 22: 68 -73, February 2007 American Society of Parenteral and Enteral Nutrition

Head and Neck Cancer • In US: – Annual Incidence: 40, 500 – Death rate: 11, 170 – Impaired nutrition status: 25 -57%

Treatment and Treatment-Related Side Effects • Treatment: – Surgery – Radiotherapy (RT) – Combination of RT and chemotherapy • Result: – Poor food intake

Surgery • Side effects – Oropharyngeal dysfunction – Dysphagia • Postoperative complications – Infection – Orocutaneous fistulas – Wound dehiscence

Chemoradiation (CR) • Side effects – – – – Chewing / swallowing difficulties Nausea Altered taste sensation Xerostomia Changes in saliva viscosity Stomatitis Mucositis Anorexia

Nutrition Therapy • Enteral feeding – Why? • Functional stomach and lower GI tract • Safe and effective • Easily administered

Nutrition Support During Treatment of Head and Neck Cancer • Advantages of early enteral feeding: – – – Weight loss Dehydration Malnutrition Treatment interruption Improvements in nutrition parameters

Enteral Access • Nasogastric tubes: > 3 weeks • PEG placement – Long-term enteral nutrition

Feeding Formulas • Polymeric formulas – – Calorie: 1 -2 kcal/m. L Protein: 12 -20% CHO: 40 -60% Fats: 30 -40%

Nutrition Requirements • In general: – Calorie: 25 -35 kcal/kg – Protein: 1 -1. 5 g/kg – Fluid: 30 -40 m. L/kg

Long-Term Home Enteral Nutrition • Who? – Patients with chronic dysphagia • Enteral feeding for at least 1 year • Advantages: – Increased energy levels – Promote quality of life

Complications of Home Enteral Nutrition • • • Diarrhea Constipation Leakage from the fistula tract Tube-site infection Tube dislogement Tube clogging

Role of Nutrition Support Team • Nutrition support service – Provides education about the feedings – Care of the PEG tube – Regular monitoring of the patient

Summary • Patients are at high risk for malnutrition • Advantages of early enteral nutrition support: – – – Weight loss Nutrition deficiencies Dehydration Hospitalizations Quality of life