Nutritional evaluation and dietetic care in cancer patients treated with radiotherapy: prospective study. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. More Than 10% Weight Loss in Head and Neck Cancer Patients During Radiotherapy Is Independently Associated with Deterioration in Quality of Life A Randomized Preventive Rehabilitation Trial in Advanced Head and Neck Cancer Patients Treated with Chemoradiotherapy: Feasibility, Compliance, and Short-term Effects Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area The effect of oral nutritional supplements on head and neck cancer. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy Predictors of severe acute and late toxicities in patients with localized head-and-neck cancer treated with radiation therapy. Percutaneous endoscopically guided gastrostomy in patients with head and neck cancer. Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Nutritional rehabilitation in patients with advanced head and neck cancer receiving radiation therapy. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Enteral nutrition support in head and neck cancer: tube vs. oral feeding during radiation therapy. The impact of enteral feeding route on patient-reported long term swallowing outcome after chemoradiation for head and neck cancer. Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. Evaluation of Nutritional Status in Cancer Patients Receiving Radiotherapy: A Prospective Study Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer: a randomized study.
Ninety-three cancer patients about to undergo radiotherapy were studied . These patients were affected by cancer of the head and neck , breast cancer , and abdominopelvic cancer . They were r and omly distributed into control and experimental groups . The patients from the control group were allowed to eat ad libitum , whereas those from the experimental group followed a strict nutritional protocol that covered their needs while satisfying their particular tastes and habits . Data were collected the day before radiotherapy commenced and the day treatment ended . Anthropometric , analytical , and clinical parameters were determined . The results showed the benefit of dietetic treatment in experimental patients with head and neck or abdominopelvic cancer BACKGROUND A r and omized controlled trial previously conducted in radiation oncology patients demonstrated that nutrition intervention had a beneficial impact on body weight , nutritional status , and quality of life compared with st and ard practice , but it did not report on dietary intake data . OBJECTIVE To determine the impact of nutrition intervention compared with st and ard practice on dietary intake in out patients receiving radiotherapy . DESIGN Prospect i ve , r and omized , controlled trial . SUBJECTS Sixty consecutive radiation oncology out patients ( 51 men and nine women ; age 61.9+/-14 years [ mean+/-st and ard deviation ] ) . SETTING Australian private radiotherapy facility . INTERVENTION Patients were r and omly assigned to receive either nutrition intervention ( n=29 ) ( nutrition counseling following the American Dietetic Association [ ADA ] medical nutrition therapy [ MNT ] protocol for radiation oncology ) or st and ard practice ( n=31 ) ( general nutrition talk and booklet ) . MAIN OUTCOME MEASURE Dietary intake ( protein , energy , fiber ) assessed at baseline and at 4 , 8 , and 12 weeks after starting radiotherapy . STATISTICAL ANALYSES Repeated- measures analysis of variance done on an intention to treat basis . RESULTS The nutrition intervention group had a higher mean total energy ( P=0.029 ) and protein intake ( P<0.001 ) compared with the st and ard practice group . Mean intake per kilogram of body weight for the nutrition intervention group ranged from 28 to 31 kcal/kg/day compared with 25 to 29 kcal/kg/day for the st and ard practice group ( P=0.022 ) . The nutrition intervention group had a higher mean protein intake ( 1.1 to 1.3 g/kg/day ) compared with the st and ard practice group ( 1.0 to 1.1 g/kg/day ) ( P=0.001 ) . Although the change in fiber intake between the groups was not significant , there was a trend in the anticipated direction ( P=0.083 ) . CONCLUSIONS Intensive nutrition intervention following the ADA MNT protocol results in improved dietary intake compared with st and ard practice and seems to beneficially impact nutrition-related outcomes previously observed in oncology out patients receiving radiotherapy . The ADA MNT protocol for radiation oncology is a useful guide to the level of nutrition support required The authors prospect ively assessed the independent association between weight loss and deterioration in quality of life ( QOL ) in patients treated by radiotherapy for head and neck cancer . In 533 head and neck cancer patients treated by curative radiotherapy  , changes in weight and QOL were assessed between baseline ( before radiotherapy ) and follow-up ( 12 wk after the start of radiotherapy ) . Patients were categorized into 4 weight loss categories : 0 % , 0.1%–5.0 % , 5.1%–10.0 % , and > 10 % weight loss . The association between weight loss and change in QOL was analyzed by linear regression analysis , adjusted for sociodemographic and tumor-related characteristics , and additionally for disease specific symptoms and tube feeding . Thirty percent of patients lost 0.1%–5.0 % weight , 26 % lost 5.1%–10.0 % weight , and 24 % lost > 10 % weight . Adjusted regression analyses showed a significant association between weight loss and deterioration of global QOL , physical functioning , social functioning , social eating , and social contact . After additional adjustment for disease-specific symptoms and tube feeding , weight loss ( > 10 % ) remained significantly associated with global QOL , social eating , and social contact ( P < 0.05 ) . More than 10 % weight loss during and directly after radiotherapy has a significant impact on social eating , social contact , and QOL in head and neck cancer patients The aim of this study was to assess the effect of ( preventive ) rehabilitation on swallowing and mouth opening  after concomitant chemoradiotherapy ( CCRT ) . Forty-nine patients with advanced oral cavity , oropharynx , hypopharynx and larynx , or nasopharynx cancer treated with CCRT  were r and omized into a st and ard ( S ) or an experimental ( E ) preventive rehabilitation arm . Structured multidimensional assessment ( i.e. ,  videofluoroscopy , mouth-opening measurement , structured question naires ) was performed before and 10 weeks after CCRT . In both S and E arms , feasibility was good ( all patients could execute the exercises within a week ) and compliance was satisfactory ( mean days practice d per week was 4 ) . Nevertheless , mouth opening , oral intake , and weight decreased significantly . Compared to similar CCRT studies at our institute , however , fewer patients were still tube-dependent after CCRT . Furthermore , some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises . Patients in the E arm practice d significantly fewer days in total and per week , but they obtained results comparable to the S arm patients . Preventive rehabilitation ( regardless of the approach , i.e. , experimental or st and ard ) in head and neck cancer patients , despite advanced stage and burdensome treatment , is feasible , and compared with historical controls , it seems helpful in reducing the extent and /or severity of various functional short-term effects of CCRT Clinical research shows that nutritional intervention is necessary to prevent malnutrition in head and neck cancer patients undergoing radiotherapy . The objective of the present study was to assess the value of individually adjusted counselling by a dietitian compared to st and ard nutritional care ( SC ) . A prospect i ve study , conducted between 2005 and 2007 , compared individual dietary counselling ( IDC , optimal energy and protein requirement ) to SC by an oncology nurse ( st and ard nutritional counselling ) . Endpoints were weight loss , BMI and malnutrition ( 5 % weight loss/month ) before , during and after the treatment . Thirty-eight patients were included evenly distributed over two groups . A significant decrease in weight loss was found 2 months after the treatment ( P = 0.03 ) for IDC compared with SC . Malnutrition in patients with IDC decreased over time , while malnutrition increased in patients with SC ( P = 0.02 ) . Therefore , early and intensive individualised dietary counselling by a dietitian produces clinical ly relevant effects in terms of decreasing weight loss and malnutrition compared with SC in patients with head and neck cancer undergoing radiotherapy BACKGROUND We aim ed to determine the effect of dietary counseling or oral supplements on outcome for patients with cancer , specifically , nutritional outcome , morbidity , and quality of life ( QOL )  , during and 3 months after radiotherapy . METHODS Seventy-five patients with head and neck cancer who were referred for radiotherapy ( RT ) were r and omized to the following groups : group 1 ( n = 25 ) , patients who received dietary counseling with regular foods ; group 2 ( n = 25 ) , patients who maintained usual diet plus supplements ; and group 3 ( n = 25 ) , patients who maintained intake ad lib .  Nutritional intake ( determined by diet history ) and status ( determined by Ottery 's Subjective Global Assessment ) , and QOL ( determined by the European Organization for the Research and Treatment of Cancer Quality of Life Question naire version 3.0 [ EORTC QLQ-C30 ] ) were evaluated at baseline , at the end of RT , and at 3 months . RESULTS Energy intake after RT increased in both groups 1 and 2 ( p < or = .05 ) . Protein intake also increased in both groups 1 and 2 ( p < or = .006 ) . Both energy and protein intake decreased significantly in group 3 ( p < .01 ) . At 3 months , group 1 maintained intakes , whereas groups 2 and 3 returned to or below baseline levels . After RT , > 90 % of patients experienced RT toxicity ; this was not significantly different between groups , with a trend for reduced symptomatology in group 1 versus group 2/group 3 ( p < .07 ) . At 3 months , the reduction of incidence/severity of grade 1 + 2 anorexia , nausea/vomiting , xerostomia , and dysgeusia was different : 90 % of the patients improved in group 1 versus 67 % in group 2 versus 51 % in group 3 ( p < .0001 ) . After RT , QOL function scores improved ( p < .003 ) proportionally with improved nutritional intake and status in group 1/group 2 ( p < .05 ) and worsened in group 3 ( p < .05 ) ; at 3 months , patients in group 1 maintained or improved overall QOL , whereas patients in groups 2 and 3 maintained or worsened overall QOL . CONCLUSIONS During RT , nutritional interventions positively influenced outcomes , and counseling was of similar/higher benefit ; in the medium term , only counseling exerted a significant impact on patient outcomes BACKGROUND AND PURPOSE Concomitant radio-chemotherapy is the gold st and ard treatment for unresectable head and neck carcinomas . Placement of prophylactic gastrostomy has been proposed to provide adequate nutrition during the therapeutic sequence . The objectives of this study were to assess the impact of prophylactic gastrostomy on the 6-month quality of life , and to determine the factors related to this quality of life . MATERIAL S AND METHODS Design . r and omized , controlled , open study ( " systematic percutaneous gastrostomy " versus " no systematic gastrostomy " ) . Patients . squamous cell head and neck carcinoma ( stages III and IV , UICC 1997 ) . Setting . oncological departments of French university teaching hospitals . Treatment . optimal concomitant radio-chemotherapy . Evaluations . T0 baseline evaluation , T1 during the treatment , T2 end of the treatment , and T3 6-month post- inclusion . Primary endpoint . 6-month quality of life ( Qol ) assessed using SF36 , EORTC QLQ-C30 , EORTC QLQ H&N35 question naires . RESULTS The Qol changes from baseline included a decline ( T1 and T2 ) followed by an improvement ( T3 ) . Qol at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy ( p=10(-3 ) ) . Higher initial BMI and lower initial Karnofsky index were significant factors related to a higher 6-month Qol . CONCLUSIONS The study results suggest that prophylactic gastrostomy improves post-treatment quality of life for unresectable head and neck cancer patients , after adjusting for other potential predictive quality of life factors Malnutrition occurs frequently in patients with cancer of the gastrointestinal ( GI ) or head and neck area and can lead to negative outcomes . The aim of this study is to determine the impact of early and intensive nutrition intervention ( NI ) on body weight , body composition , nutritional status , global quality of life ( QoL ) and physical function compared to usual practice in oncology out patients receiving radiotherapy to the GI or head and neck area . Out patients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were  r  and omised to receive intensive , individualised nutrition counselling by a dietitian using a st and ard protocol and oral supplements if required , or the usual practice of the centre ( general advice and nutrition booklet ) . Outcome parameters were measured at baseline and 4 , 8 and 12 weeks after commencing radiotherapy using valid and reliable tools . A total of 60 patients ( 51 M : 9F ; mean age 61.9±14.0 years ) were r and omised to receive either NI ( n=29 ) or usual care ( UC ) ( n=31 ) . The NI group had statistically smaller deteriorations in weight ( P<0.001 ) , nutritional status ( P=0.020 ) and global QoL ( P=0.009 ) compared with those receiving UC . Clinical ly , but not statistically significant differences in fat-free mass were observed between the groups ( P=0.195 ) . Early and intensive NI appears beneficial in terms of minimising weight loss , deterioration in nutritional status , global QoL and physical function in oncology out patients receiving radiotherapy to the GI or head and neck area . Weight maintenance in this population leads to beneficial outcomes and suggests that this , rather than weight gain , may be a more appropriate aim of NI Fifty ambulatory patients with head and neck cancer treated by definitive radiation therapy at the Fox Chase Cancer Center were prospect ively studied to determine the effect of oral nutritional supplements on both nutritional status and treatment response . Nutritional supplements maintained serum albumin during and post treatment . Nutritional supplements were shown to increase total protein and total calorie intake rather than displace these nutrients in usual food intake . Equal weight loss occurred in both the supplemented and non-supplemented groups during the observation period of 6 months , with the same or greater amount of weight loss registered 10 weeks after the start of treatment . Food supplements did not affect treatment response or complications , nor did they offer any survival advantage The aim of this study was to examine whether weight loss  at presentation , in patients who were to receive chemotherapy for gastrointestinal carcinomas , influences outcome and whether nutritional intervention would be worthwhile . This study was a retrospective review of prospect ively gathered data . The outcomes of patients with or without weight loss and treated for locally advanced or metastatic tumours of the oesophagus , stomach , pancreas , colon or rectum were compared . In 1555 such consecutive patients treated over a 6-year period ,  weight loss at presentation  was reported more commonly by men than women ( 51 versus 44 % , P = 0.01 ) . Although patients with weight loss received lower chemotherapy doses initially , they developed more frequent and more severe dose limiting toxicity -- specifically plantar-palmar syndrome ( P < 0.0001 ) and stomatitis ( P < 0.0001)--than patients without weight loss . Consequently , patients with weight loss on average received 1 month ( 18 % ) less treatment ( P < 0.0001 ) . Weight loss correlated with shorter failure-free ( P < 0.0001 , hazard ratio = 1.25 ) and overall survival ( P < 0.0001 , hazard ratio = 1.63 ) , decreased response ( P = 0.006 ) , quality of life ( P < 0.0001 ) and performance status ( P < 0.0001 ) . Patients who stopped losing weight had better overall survival ( P = 0.0004 ) . Weight loss at presentation was an independent prognostic variable ( hazard ratio = 1.43 ) . The poorer outcome from treatment in patients with weight loss appears to occur because they receive significantly less chemotherapy and develop more toxicity rather than any specifically reduced tumour responsiveness to treatment . These findings provide a rationale for attempting r and omised nutritional intervention studies in these patients Nutritional interventions are not routine in patients undergoing oropharyngeal radiotherapy . The aim of the present study was to assess the effects of early nutritional intervention . Forty-five out patients undergoing radiotherapy for oropharyngeal cancer were prospect ively managed by nutritionists  ( intervention group ) . In this group , a percutaneous endoscopic gastrostomy ( PEG ) was inserted before radiotherapy in any patient in whom at least one of the following applied : weight loss > 10 % ; BMI < 20 kg/m2 ; age > 70 years . Data were compared with those recorded in an historical control group of 45 paired patients . A PEG was inserted in 33 ( 74 % ) of the 45 patients in the intervention group , as against 5 ( 11 % ) of the 45 in the control group ( P<0.001 ) . The mean weight loss and the frequency of hospital admission for dehydration were lower in the intervention group than in the control group ( P<0.01 ) . In conclusion , early nutritional intervention , including PEG insertion , is feasible and efficient in preventing dehydration in oropharyngeal cancer patients undergoing radiotherapy .  It may improve quality of life by decreasing the frequency of hospital admissions PURPOSE Radiation therapy ( RT ) causes acute and late toxicities that affect various organs and functions . In a large cohort of patients treated with RT for localized head and neck cancer ( HNC ) , we prospect ively assessed the occurrence of RT-induced acute and late toxicities and identified characteristics that predicted these toxicities . METHODS AND MATERIAL S We conducted a r and omized trial among 540 patients treated with RT for localized HNC to assess whether vitamin E supplementation could improve disease outcomes . Adverse effects of RT were assessed using the  Radiation Therapy Oncology Group Acute Radiation Morbidity Criteria during RT and one month after RT , and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme at six and 12 months after RT . The most severe adverse effect among the organs/tissues was selected as an overall measure of either acute or late toxicity . Grade 3 and 4 toxicities were considered as severe . Stepwise multivariate logistic regression models were used to identify all independent predictors ( p < 0.05 ) of acute or late toxicity and to estimate odds ratios ( OR ) for severe toxicity with their 95 % confidence intervals ( CI ) . RESULTS Grade 3 or 4 toxicity was observed in 23 % and 4 % of patients , respectively , for acute and late toxicity . Four independent predictors of severe acute toxicity were identified : sex ( female vs. male : OR = 1.72 , 95 % confidence interval [ CI ] : 1.06 - 2.80 ) , Karnofsky Performance Status ( OR = 0.67 for a 10-point increment , 95 % CI : 0.52 - 0.88 ) , body mass index ( above 25 vs. below : OR = 1.88 , 95 % CI : 1.22 - 2.90 ) , TNM stage ( Stage II vs. I : OR = 1.91 , 95 % CI : 1.25 - 2.92 ) . Two independent predictors were found for severe late toxicity : female sex ( OR = 3.96 , 95 % CI : 1.41 - 11.08 ) and weight loss during RT ( OR = 1.26 for a 1 kg increment , 95 % CI : 1.12 - 1.41 ) . CONCLUSIONS Knowledge of these predictors easily collected in a clinical setting could help tailoring therapies to reduce toxicities among patients treated with RT for HNC In 212 patients with tumors in the head and neck region the nutritional status prior to , during , and following radiotherapy , was determined by body measurements and biochemical and immunological parameters . In 165 orally fed patients the nutritional parameters deteriorated rapidly under radiation and afterwards recovered only slowly and incompletely , 31 patients requiring PEG during radiotherapy . By contrast , 47 patients with a poor initial status who had a prospect ively performed percutaneous endoscopically guided gastrostomy ( PEG ) experienced an amelioration of their nutritional status even before radiotherapy ended . The subjective status of the patients was assessed using the Padilla quality of life index . Here , too , the PEG patients had significantly worse initial values than the orally fed patients . As with the objective indicators of nutritional status a significant deterioration was seen in the orally fed patients during radiotherapy , while the scores of the PEG patients remained constant . We consider early institution of a carefully monitored enteral feeding by PEG useful for stabilizing the nutritional status of patients with tumors in the head and neck region , and therefore recommend , when aggressive multimodal therapy is planned- and particularly if primary malnutrition is already obvious-prophylactic performance of PEG prior to the start of therapy Ninety-seven patients with cancer , undergoing radiation treatment , were studied . Forty-two were given special dietary counseling and supplements of Sustagen or Isocal ;  42 controls  received no special advice or supplements .  Thirteen patients were excluded because of poor prognoses and the ethical need for food supplements . Nutrient intake of all groups was assessed by 3-d diet records in household measures in the first and the last week of treatment . Intake was significantly higher in the adjunctive than the control group . The excluded group , despite supplementation , had intakes similar to the control group . No difference was observed between the control and adjunctive groups in clinical status at the end of treatment or in long-term outcome Previous studies of nutritional support in cancer patients have applied parenteral techniques for relatively short periods . The purpose of this prospect i ve , r and omized trial was to evaluate the efficacy of long-term enteral alimentation in patients at high risk for malnutrition during oncologic treatment . Forty patients with inoperable squamous carcinoma of the nasopharynx and oropharynx were r and omized to either optimal oral nutrition or to intensive nasogastric tube feedings during radiation therapy for an average of 8 weeks . Dietetic counselling and oral supplements were provided to both groups . Body weight , dietary intake , and toxicity to therapy were assessed weekly ; and serum protein concentrations and anthropometric measurements were made at the time of entry , during the fourth week , at the conclusion of radiation therapy , and 1 month after radiation therapy . Tumor status was assessed at the conclusion of radiation therapy and during routine follow-up , which ranged from 9 to 39 months . The 35 evaluable patients ( 18 tube fed and 17 orally fed ) were comparable with regard to age , disease site , and total radiation dosage , but the tube group had more stage IV patients and a greater median radiation field size . The tube fed group showed no difference in the partial tumor response rate compared with the complete tumor response rate ( 16 of 18 patients versus 14 of 17 patients ) , a slightly longer duration of response in those who had recurrence compared with those without recurrence ( 4.5 months versus 3.4 months ) and a similar overall survival pattern to that of the orally fed group . Compared with the orally fed group , the tube fed group had a higher mean caloric intake ( 39 kcal/kg per day versus 30 kcal/kg per day , p less than 0.001 ) , mean protein intake ( 1.4 versus 1.1 g/kg per day , p less than 0.01 ) , and in the oropharynx cancer patients , less mean body weight loss ( 0.6 percent versus 6.1 percent , p less than 0.04 ) during treatment . The tube fed patients maintained mean mid-arm circumference and recovered mean serum albumin levels after radiation therapy in contrast with the orally fed group . Intensive outpatient tube-feeding nutritional support during radiation therapy in patients with advanced inoperable squamous cancer of the oropharynx significantly improved mean weight maintenance , mean caloric and protein intake , and mean serum albumin levels compared with patients who received optimal oral nutrition . Tumor response to radiation therapy , however , was unchanged Twenty-three patients with head and neck cancer were r and omly allocated , regardless of pretreatment nutrition status , to receive either radiotherapy alone ( 12 patients ) or radiotherapy plus nutritional oral supplementation ( 11 patients ) with high-protein nutritional powder of balanced nutrient content ( Ensure ) .  Nutrition status was assessed subjectively and objective ly for all patients before and at weekly intervals during the course of irradiation . All patients who received nutritional supplementation experienced an increase in body weight and in triceps skin-fold thickness , whereas 58 % of the other group had weight loss ( p = 0.001 ) . Irradiation had to be suspended in 5 of the 12 patients who received no nutritional support because of severe mucosal reaction and /or poor performance status . All patients who received nutritional supplementation during radiotherapy had their course of irradiation without interruption This comparison of tube feeding with oral nutrition was made in patients with advanced head and neck cancer during intensive outpatient radiation therapy . Twenty-six patients with Stage III and IV head and neck cancers were stratified by site ( nasopharynx vs. all other tumors , including recurrent nasopharynx ) and r and omized to receive oral or tube feeding during radiation therapy . All patients were counseled to have an intake of 40 kcal/kg and 1 gm protein per kilogram body weight . Body weights and dietary recalls were obtained weekly , along with evaluation of toxicities to therapy . Serum albumins were obtained at baseline , week 4 , end of radiation therapy , and 1 month after radiation therapy . Patients with nasopharyngeal carcinoma presented with significantly less body weight loss ( means = -2.6 % ) than patients with all other carcinomas ( means = -9.8 % ; p = .008 ) . No differences in toxic responses were observed despite larger radiation field size in the tube-fed group ( p = .02 ) . Serum albumins in both groups dropped during radiation therapy , with no difference between groups . The tube-fed group maintained higher caloric and protein intakes ( 35 to 42 kcal/kg , 1.2 to 1.6 gm protein per kilogram ) than the oral-fed group ( 15 to 34 kcal/kg , 0.3 to 1.3 gm protein per kilogram ) . No differences in body weights were observed between the tube-fed ( means = 3.8 % ) and the oral-fed ( means = 3.3 % ) patients with nasopharyngeal carcinoma . Patients with oropharyngeal and recurrent nasopharyngeal carcinoma had significantly less weight loss with tube feeding ( means = 0.2 % ) than with oral feeding ( means = -7.3 % ; p = .005 ) ; thus , tube feeding is recommended during radiation therapy in such patients Prospect i ve evidence suggests that the selection of feeding tube during  chemoradiation ( CRT ) indirectly affects swallowing outcome . This study explores the patients ' perspective on long-term swallowing ability comparing these two feeding routes . Two groups , receiving nutritional supplementation via a prophylactic gastrostomy tube ( group G ) and by the oral route or via a nasogastric tube ( group NG ) during CRT , disease-free at ≥24 months following treatment were matched for age , site and stage of tumour .  Patient-reported swallowing outcomes for both groups were assessed using the MD And erson Dysphagia Inventory ( MDADI ) . Group G consisted of 16 patients and group NG of 15 patients . There was statistically significant difference in MDADI scores between the two groups in all domains of the question naire ( p<0.001 ) , with superior outcomes in group NG . Use of gastrostomy tubes during CRT conferred a worse swallowing outcome in the long term in this tightly matched cohort of patients BACKGROUND Satisfaction with services has been considered vital for the provision of quality health care , however , there are few published papers utilizing patient satisfaction with nutrition services as a measurable outcome . METHOD A r and omized , controlled trial investigating the impact of nutrition intervention ( NI ) vs. usual care ( UC ) in 54 ambulatory oncology patients receiving radiotherapy to the gastrointestinal or head and neck area demonstrated beneficial impacts in terms of body weight , nutritional status , quality of life and bowel health . This study reports the changes in patient satisfaction that were associated with these improved outcomes for patients receiving NI compared with UC . The patient satisfaction with clinical nutrition services question naire was used to measure overall satisfaction and satisfaction with four components of nutrition services 12 weeks after patients commenced radiotherapy . RESULTS Patients receiving NI rated satisfaction higher for staff interpersonal skills ( P < 0.001 ) , perceived health benefits ( P = 0.008 ) , staff presentation skills ( P = 0.044 ) and for overall patient satisfaction with nutrition services ( P = 0.002 ) . There were no significant differences between those patients receiving NI or UC for the nutrition supplements factor ( P = 0.191 ) . CONCLUSIONS These data suggest that patients receiving NI perceive nutrition as being beneficial and of higher importance to their health than those receiving UC . This may lead to increased compliance with the nutrition prescription and help explain the better outcomes observed in the NI group compared with the UC group . Patient satisfaction with nutrition services should be conducted regularly to act as a quality -control measure and target areas for improvement Percutaneous endoscopic gastrostomy ( PEG ) tubes have largely replaced nasogastric tubes ( NGT ) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis . A r and omized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes , complications , patient satisfaction and cost . The study was closed early because of poor accrual , predominantly due to patients ' reluctance to be r and omized . There were 33 patients eligible for analysis .  Nutritional support with both tubes was good . There were no significant differences in overall complication rates , chest infection rates or in patients ' assessment of their overall quality of life . The cost of a PEG tube was 10 times that of an NGT . The duration of use of PEG tubes was significantly longer , a median 139 days compared with a median 66 days for NGT . We found no evidence to support the routine use of PEG tubes over NGT in this patient group Objectives : The purpose of the present study was to evaluate the nutritional status of cancer patients receiving radiotherapy ( RT )  and to assess the possible contributions of nutritional support to patients with malnutrition . Methods : Prospect ively , 207 patients referred to our outpatient radiotherapy department were included . The patients were classified according to tumor site ( head/neck , breast , lung , stomach , or colorectal ) .  Nutritional status at the onset , at the end of RT , and 3 and 6 months after irradiation was evaluated with the subjective global assessment ( SGA ) . All of the patients were supported with additional portions of meal or st and ard enteral feeding formula during and after the irradiation period as long as they were in the moderately or severely malnourished groups , respectively . Results : At the onset , malnutrition was present in 31 % of all patients , and it increased to 43 % at the end of RT . This difference predominated in head/neck cancer patients .  Malnutrition ratios in head/neck cancer patients at the onset and after RT were 24 % and 88 % , respectively . By a 6-month follow-up , the ratio of patients with malnutrition decreased to 8 % . Nutritional status of all groups was found to improve during the 6-month follow-up period , except for the breast cancer group , which included no patients with severe malnutrition at any time . Conclusion : The results of the present study may be helpful in planning an appropriate nutritional support for cancer patients undergoing radiotherapy according to the irradiation site BACKGROUND The purpose of this r and omized study was to examine if a prophylactic percutaneous endoscopic gastrostomy ( PEG ) for enteral nutrition could prevent malnutrition , reduce hospital stay , and improve health-related quality of life ( HRQOL ) . METHODS One hundred thirty-four patients with advanced head and neck cancer were r and omized to either prophylactic PEG ( study group ) or clinical praxis ( control group ) . Patients ' weight , body mass index ( BMI ) , need for hospitalization , and HRQOL were noted at 7 occasions during 2 years . RESULTS No difference in hospital stay was found . After 6 months , HRQOL was significantly better and the weight loss was significantly less in the study group . The number of malnourished patients were consistently about 10 % lower in the study group during the first study year . The study group started to use enteral feeding significantly earlier and for a significantly longer time period ( p < .0001 ) . CONCLUSION Prophylactic PEG was associated with significantly earlier start and longer use of enteral nutrition , fewer malnourished patients over time , and improved HRQOL at 6 months posttreatment start
BACKGROUND AND AIMS We performed a systematic review to examine the effect of nutritional interventions on nutritional status , quality of life ( QoL ) and mortality in patients with head and neck squamous cell cancer ( HNSCC ) receiving radiotherapy or chemoradiotherapy .