Chapter 21: MNT for Head and Neck Cancer

Question 1

Malignant tumors in which locations are considered “Head and Neck” cancer (HNC)?

Answer 1

oral cavity, nasal cavity, sinuses, lips, salivary glands, throat and larynx

Question 2

90% of head and neck cancers are ____ cell carcinoma?

Answer 2

Squamous

Question 3

What are the other 10% of head and neck cancers comprised of?

Answer 3

adenocarcinoma, melanoma, adenoic cystic carcinoma and thyroid cancers found in the head/neck region.

Question 4

What are the biggest risk factors for HNC?

Answer 4

alcohol and tobacco use

Question 5

Possible NIS of HNC surgery?

Answer 5

swelling, pain, structural deformities such as loss of teeth, heliglossectomy (removal of part of the tongue), soft palate fistula or tracheostomy making it difficult to chew/swallow and potentially limiting nutrient intake.

Question 6

Possible NIS of HNC radiation?

Answer 6

Mucositis, odynophagia, thick saliva, xerostomia, trismus, pharyngeal fibrosis and decreased appetite and a result of dysguesia, tooth decay.

Question 7

What is IMRT?

Answer 7

Intensity-modulated radiation therapy. An advanced form or radiation therapy allowing more precise cancer targeting while reducing dose to normal tissue.

Question 8

What is the standard chemotherapy treatment for HNC?

Answer 8

Cisplatin and radiation treatment

Question 9

What are the 4 Oral Toxicity Scale Phases for individuals receiving CRT?

Answer 9

Grade 0: No change over baseline
Grade 1: soreness +/- erythema
Grade 2: Erythema, ulcers, and pt can’t swallow food
Grade 3: Ulcers with extensive erythema, pt can’t swallow food
Grade 4: Mucositis so severe that oral alimentation is not possible. pt needs alternative method of feeding

Question 10

What are the 4 Nutritional Phases of CRT for HNC?

Answer 10

Phase 0: Pre-treatment: G-tube not in use
Phase 1: week 1-3 - G-tube not in use- high kcal
Phase 2: week 3-5 - G-tube may or may not be in use
Phase 3: week 5-7 - G-tube may or may not be in use
Phase 4: Post-CRT treatment

Question 11

T/F: HNC patients experience one of the highest rates of malnutrition among all cancer diagnoses.

Answer 11

True (25-50% are at risk for malnutrition prior to starting treatment).

Question 12

Why are HNC patients at such a high risk for malnutrition?

Answer 12

They have a diminished oral intake d/t diagnosis or during treatment. They may also present with pre-existing nutritional deficiencies d/t excessive alcohol and/or tobacco use, decreased appetite and cachexia resulting from the malignancy. Plus, side effects of treatment.

Question 13

What are the nutritional goals of HNC?

Answer 13

• Weight maintenance during and after treatment.
• Weight maintenance post-treatment until the patient is able to consume solid food.
• successful, break-free completion of treatment
• minimal, if any weight loss in overweight or obese patients until pt is fully recovered from treatment and is able to eat without difficulty
• weight maintenance during transitional feedings from enteral nutrition support.

Question 14

______ is the strongest independent predictor or shortened survival in a series of HNC patients treated with multiple modalities.

Answer 14

Weight loss

Question 15

Undernutrition in HNC patients is associated with…

Answer 15

Poor treatment outcomes, including morbidity, infections, cancer recurrence, mortality and poor quality of life.

Question 16

What are the benefits of prophylactic G-tube feeding?

Answer 16

Fewer hospital admissions for dehydration or malnutrition, less treatment interruptions and or delays and better quality of life during treatment.

Question 17

Phase 0 of CRT for HNC

Answer 17

Pre-Treatment: Includes a comprehensive nutrition assessment. RD creates a nutrition care plan to manage NIS and minimize treatment side effects. Educates pt, maybe prophylactic G-tube.

Question 18

Phase 1 of CRT for HNC

Answer 18

Weeks 1-3 of CRT: Most can tolerate oral diet at this phase. High cal/pro, may need nutritional beverage.

Question 19

Phase 2 of CRT HNC

Answer 19

Week 3-5 of CRT: Pt starts to get dysphagia, odynophagia, xerostomia, dysgeusia, thick oral secretions and mucositis start to impede oral intake. RD to discuss TF formula options with pt/family.

Question 20

What are strategies to control mucus secretions?

Answer 20

salt and baking soda rinses, Caphosol, elevate the head of the bed, cool mist vaporizer, portable suction machine, increased fluids

Question 21

When is G-Tube indicated?

Answer 21

When a person is unable to consume >50% of estimated energy and nutrient needs.

Question 22

Phase 3 of CRT of HNC.

Answer 22

Week 5-7: Pts usually depended on feeding tube during this phase. RD to monitor formula tolerance and may need to adjust the feeding method (gravity vs. pump), etc.

Question 23

Phase 4 of CRT of HNC.

Answer 23

Post-Treatment: NIS continue for weeks after therapy is over. Pt’s likely need EN for 4-6 weeks after treatment. 6-8 weeks post-treatment, oral diet is usually tolerated.

Question 24

At what rate should EN be tapered off if pt is weight stable?

Answer 24

250 mL per week (1 carton/week), while increasing oral intake.