Multimodal cancer treatment and its association with nutrition care practices in patients with head and neck and esophageal cancer: an international prospective cohort study

Background: Both cancer and its’ treatment contribute to the development of malnutrition, particularly in cancers that impact nutrition intake such as head and neck (HNC) and esophageal (EC) cancers. This study was undertaken to explore the relationship between cancer treatment and nutrition care in patients with HNC and EC.

Methods: Adult patients (≥18 years) with newly diagnosed head and neck (HN) or esophageal (ESO) cancers scheduled to receive cancer treatment were enrolled between 2016 and 2018 in the INFORM study, a longitudinal multi-centre prospective cohort study. Baseline clinical characteristics of patients, cancer characteristics, treatment type (chemotherapy/radiotherap y /surgery) and frequency, nutrition risk (Patient Generated Subjective Global Assessment Short Form (PG-SGA SF) and nutrition care were recorded.

Results: 100 HNC and 51 EC patients were included. Data were collected across 4 time periods from baseline to 6 months at 11 sites in Canada, Australia Italy, The Netherlands and the United States. Seventy-nine percent of the patients were male with a mean (SD) age of 63 (10) years. At admission, the mean (SD) BMI was 27 (5) kg/m2 and 30% were current smokers. Baseline PGA-SGA SF was ≥ 4 indicating nutrition risk for 59% of the HNC and 77% of the EC patients. The number of cancer treatments was positively associated with increases in enteral (EN) and parenteral nutrition (PN). In HNC patients receiving a single cancer treatment, 39% required EN and with 3 cancer treatment types, 78% required EN. In EC requiring a single cancer treatment, 50% required EN and in patients with 3 cancer treatments 94% required EN.

Conclusion: The number of cancer treatment modalities is associated with the intensity of nutrition therapy required to sustain the patients through their cancer journey.