Presented on during my dietetic internship at Mount Sinai Hospital

1. Incorporating Psychology
into Dietetics Practice in
the Head & Neck Cancer
Population
Claudia Gonzalez, MS
New York University Diete;c Intern

2. Head and Neck Cancer
Depression

3. Depression & Weight Loss
Depressive
symptoms
Weight Loss
(Van Liew et al.,2016)

4. Depression
Weight
loss
Malnutri2on
Poor nutrient
intake

5. Head and Neck Cancer
Malnutrition
Malnutri2on
Treatment interrup2ons
Reduced effec2veness
Reduced survival Increased morbidity
(Van Liew et al.,2016)

6. Addressing Depression:
Bringing psychology into the mix
1. Can psychological strategies
impact nutri&on status?

7. Heads Up
70 control
59 interven;on
Control
• RD
Interven2on
• RD
• Psychologist
Using psychological interven&on by psychologists to improve nutri2on
status in HNC pa2ents
Nutri;on
Depression
Mortality
Assessing for:
(BriUen et al. 2017)

8. PRIMARY ANALYSIS
RESULTS
Nutri;on Depression Mortality
No significant differences
between control and
interven;on group

9. Addressing Depression:
Bringing psychology into the mix…
2. Can psychological strategies
be implemented into diete&cs
prac2ce?

10. Eating As Treatment (EAT)
Using psychological interven&on by trained RDs to improve nutri2onal
behaviors in HNC pa2ents
151 control
156 interven;on
Control
• Care as usual
Interven2on
• Eat to LIVE
Assessing for:
Nutri;on Status
Weight loss
Depression
Treatment interrup;ons
Unplanned admissions
Length of stay
(BriUen et al. 2018)

11. EAT Intervention
Aer week 5 5 weeks later
Change talk
Nutri2on Plan
Monitor
Ini.ally (rela.onship building)
Nutri2on Assessment
Depression Screening
Eat to LIVE convo
(BriUen et al. 2018)

12. Promising Results
Nutri2onal
status
Weight
Depression
Treatment
interrup2ons
(BriUen et al. 2018)

13. ReGlections
• New research
• Heads Up vs. EAT to LIVE– Psychological interven;on conducted by
psychologists vs. Registered Die;;ans.
• Promising impact of CBT/MI on nutri;on related outcomes.
• Future Implica2ons:
• Training RDs to screen for depression.
• Training RDs in MI/CBT.
• Enforcing collabora;ve rela;onships between RDs and pa;ents in an
inpa;ent care se_ng.

14. References
1. BriUon, B., Baker, AL., Clover, K., Mcelduff, P., WraUen, C., Carter, G. (2017). Heads Up: a pilot
trial of a psychological interven;on to improve nutri;on in head and neck cancer
pa;ents undergoing radiotherapy. European Journal of Cancer Care, 26: 1-10. Doi: 10.1111/ecc.
12502
2. BriUon, B., Baker, AL., Wolfenden, L., WraUen, C., Bauer, J., Beck, AK., McCarter, K.,
Harrowfield ,J., Isenring, E., Tang, C., Oldmeadow, C., Carter, G. (2018). Ea;ng As Treatment (EAT):
A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Interven;on
Provided by Die;;ans to Improve Nutri;on in Pa;ents With Head and Neck Cancer Undergoing
Radia;on Therapy (TROG 12.03). Interna.onal Journal of Radia.on Oncology, 103(2): 353-362.
hUps://doi.org/10.1016/j.ijrobp.2018.09.027
3. Van Liew, JR., Brock, RL., Christensen, AJ., Karnell, LH., Pagedar, NA., Funk, GF. Weight. (2016).
Loss aer head and neck cancer: A dynamic rela;onship with depressive symptoms. Head &
Neck , 370-370. Doi: 10.1002/hed.24601