Malnutrition is a common experience of those suffering head and neck cancer. There are many reasons for this which have been researched by Ms Smith a Specialist Head and Neck Dietitian.
She has kindly agreed to share her findings to help clinicians, carers and patients. We trust you find it useful.
Head and neck cancer is the 8th most common cancer in UK (cancer research UK 2014). Over the past decade the incidence of oral cancer has increased by 92% since the 1970’s and the incidence oropharyngeal cancer has risen 73% and continues to increase due to the human papillomavirus (HPV) with more men being diagnosed than women. Most oral cancers (~ 91%) are linked to lifestyle choices include smoking, an increase alcohol consumption, betel quid/ pann comsumption, and a low intake of fruit and vegetables (Cancer Research UK).
At diagnosis patients that have head and neck cancer usually have quite complex nutritional problems with 30-57% of these patients suffering from malnutrition (Capunano et al 2010). Patients usually present with pain in the mouth or throat, inability to chew, weight loss and difficulty swallowing. Head and neck cancer is treated by surgery or chemo radiotherapy which will increase the symptoms the patient is already experiencing and patients will suffer additional symptoms such as poor tongue movement, mouth ulcers and mucositis (thick, sticky secretions)leaving the patient at extreme risk of becoming malnourished. This can often be distressing for the patient and their family.
Patients often do not want to eat or drink due to the changes in their mouth, pain or difficulty swallowing, however it is vital that they do to promote healing, prevent loss of weight and muscle mass and to help minimise the side effects of treatment. Studies have shown that individualised nutritional counselling provided by a dietitian can to prevent malnutrition. To help prevent malnutrition in patients with head and neck cancer they are advised on a high protein, high energy diet and altered textured diets such as soft, mashed, pureed food and liquidised diets. The texture of the diet is usually recommended by the Speech and Language Therapists and the often recommend patients have their fluids and drinks thickened. Altered textured diets often create a larger portion of food which patients feel they cannot eat and tend to have less energy and protein in them. This means that overall patients will consume less energy and protein and therefore altered textured diets are often combined with high energy and protein drinks. Oral nutritional supplements are regularly used to help a patient meet their energy and protein requirements. Oral nutritional supplements are drinks high in energy, protein, and vitamins and mineral.
Enteral feeding tubes are often used for patients having radiotherapy to help patients meet their energy and protein requirements. This might be because they are unable to eat and drink enough due to treatment side effects or because they have been seen by the Speech and Language therapist who have advised us that the patient has an unsafe swallow. This is where when the patients swallow the food goes into their lungs and they need a feeding tube to prevent the development of pneumonia. Feeding tubes are normally used temporarily until patients can manage the required amount of nutrition and supplements.
Treatment for head and neck cancer can often leave patients with debilitating and long term side effects such as swallowing problems and poor mouth opening which can affect a patient’s quality of life and with more patients surviving this type of cancer it can mean that some patients have to live with an adapted diet for longer. For some patients this can be a return to a normal diet avoiding tough food and for some patients this is a liquid or pureed diet and other patients may need a long term feeding tube.
Ms R Smith. Specialist Head and Neck Dietitian. (UK)