Mrs. Anjali B. Nair Chief Dietician Tata Cancer Hospital NUTRITION IN HEAD AND NECK CANCER
Oral cancer is the sixth most common cancer in the world
Head and neck cancer refers to a group of biologically similar cancers originating from the upper aero digestive tract including lip, oral cavity, nasal cavity, paramucosal sinuses, pharynx, larynx, oropharynx and Hypopharynx
Cancer of lip Cancer of tongue Cancer of hard palate Cancer of bucal mucosa Cancer of mandible
Weight loss and altered nutritional status are evident in 50% of the patient with cancer at time of diagnosis and therefore nutritional support can improve overall patient performance status.
Nutrition therapy recommendation may vary throughout the continuum of care. Maintenance of adequate intake is important, whether the patient on active therapy, recovering from cancer therapy or in remission and striving to avoid cancer re-occurrence.
Prevent respiratory distress due to drying of secretions.
Shown to increases fistula and wound complications
Decreases the risk and severity of stomatitis
Helps in wound healing after surgery
Reduced the side effects of chemo drugs like doxorubicin etc.
Contraindicated: shown to stimulate growth of cancer cells.
Avoid cooking smell and food with strong odors Have dry meals with drinks taken separately Biscuits, dry toast and cold foods Avoid very sweet and fatly foods Nausea Frequent small quantity and variation in meals Nutritious snacks and drinks between meals Supplementation of high calorie and proteins Anorexia Dietary intervention Symptoms
Avoid food that worsen the unpleasant taste mainly because of zinc deficiency Altered taste Small frequent feed with soft and liquid diets with nutritious drinks after food Difficulty in swallowing (Dysphasia) Dietary intervention Symptoms
Eat foods that are easy to chew and swallow with cool temperature and soft fruits like bananas stewed apple and peach, cottage cheese, mashed potatoes, scramble eggs, cooked cereals, and milk shakes Mouth sores Eat moist foods with extra sauces, butter or margarine and avoid liquids and food that contain lots of sugars and dry fruit nectar instead of juice Dry Mouth Dietary intervention Symptoms
Dysphagia due to oral lesions can be lessened with intake of soft and liquefied foods served at moderate and room temperature.
Patients with Xerostomia should be encouraged to have plenty of fluids(25-30ml/kgbdwt) and eat moist foods with extra gravies and butter.
Patients with chemotherapy complain of decreased ability to eat as the day progresses. Thus morning can be the best time for eating.
This is an attribute to sluggish digestion and gastric emptying as a result of GI mucosal atrophy and gastric muscle atrophy
Approach to nutrition support PRETREATMEN T -Nutrition screening, History( weight loss), Physical examination( BMI) , Lab studies(Serum albumin) Malnourished Is therapy intensive Oral supplements NO Moderately or severely malnourished Aggressive nutritional support Is GI tract functional Oral supp or Enteral tube feeding Parenteral nutrition YES NO
MRS RKT 43 YR/F CA UPPER LIP --- T4 N0 M0 STAGE IV COMPLAINED OF SWELLING IN UPPER LIP ADMITTED TO TMH---24/5/10 DIAG: SPINDLE CELL CARCINOMA BIOCHEMICAL NORMAL EXCEPT FOR Na OPERATED ON 31/5/10 PT ON RT FEEDS SINCE 1/6/10
HOSPITAL DIET 134 -- 134 Na INTAKE PROPER COCONUT WATER=SWEETLIME JUICE SO LESS OF BLEND FEEDS TAKEN ½ RT FEEDS AS NAUSEATED REMARKS 171 141 57 CHO 44 38.5 20 FATS 72 68 32.6 PROT 1541 1278 554 ENERGY DAY3(3/6) DAY2(2/6) DAY1(1/6)