Nutritional support in head and neck cancer: how and why?

To devise a meaningful nutritional therapy in cancer, a greater understanding of nutritional dimensions as well as of expectations of patients and disease impact is essential. We have shown that nutritional deterioration in patients with gastrointestinal and head and neck cancer was multifactorial and mainly determined by tumour burden and location. In a larger cohort, stage and location were yet again the major determinants of patients' quality of life (QoL), despite the fact that nutritional deterioration combined with intake deficits was functionally more relevant than the cancer stage. On the basis of this framework, the potential role of integrated oral nutritional support on outcomes was investigated. In a pilot study using individualized nutritional counselling on a heterogeneous patient population, the achieved improvement in nutritional intake was proportional to a better QoL. The role of early nutritional support was further analysed in a prospective randomized controlled trial in patients with head and neck cancer stratified by stage, undergoing radiotherapy. Predefined outcomes were as follows: nutritional status and intake, as well as morbidity and QoL, at the end and 3 months after radiotherapy. Nutritional interventions only given during radiotherapy consisted of three randomization arms: (i) individualized nutritional counselling; (ii) ad-libitum diet plus high-protein supplements; and (iii) ad-libitum diet. Nutritional interventions 1 and 2 positively influenced outcomes during radiotherapy; however, 3 months after its completion, individualized nutritional counselling was the single method capable of sustaining a significant impact on patients' outcomes. The early provision of the appropriate mixture of foods and textures using regular foods may modulate outcomes in patients with cancer.