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Recommendations Summary

ONC: Head and Neck Cancer: Radiation and Use of Medical Food Supplement 2007

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  ONC: Head and neck cancer: Medical Food Supplements and Radiation

  Dietitians should consider use of medical food supplements (MFS) to improve protein and calorie intake for patients with head and neck cancer undergoing radiation therapy. Use of MFS may be associated with fewer treatment interruptions, a reduction of mucosal damage, and may minimize weight loss.

  Rating: Fair
  Imperative

  • Risks/Harms of Implementing This Recommendation

    No potential risks or harms are associated with the application of this recommendation.

     

  • Conditions of Application

    No conditions limit the application of this recommendation.

  • Potential Costs Associated with Application

    • Consuming additional protein and calories through the use of MFS may increase food costs.
    • Social services may be needed to assist patients with financial arrangements if economic issues are a concern.

  • Recommendation Narrative

    • Two (2) RCTs found that oral nutritional supplementation during radiation therapy for head and neck cancer may be helpful in preventing treatment interruptions,  in reducing number of mucosal interruptions and in minimizing weight loss. 
      • A positive quality RCT (Nayel et al, 1992) found all patients in the intervention group increased body weight, MAC and TSF. Malnourished patients in the intervention group demonstrated the largest increase in body weight. In five (5) out of 12 control patients treatment had to be suspended due to Grade III treatment toxicities, whereas no intervention patient experienced Grade III toxicities, and none required suspension of treatment.
      • A neutral quality RCT (Arnold and Richter, 1989) found that both the supplemented (MFS) and unsupplemented groups lost weight during treatment, but the supplemented group lost less weight through week 7 of treatment. Supplemental calories did not displace food calories in supplemented patients, but added to total nutrient intake. There were no differences in radiation side effects, treatment interruptions, tumor response, or survival status between the two groups.
    • Further research is needed to determine the appropriate use of MFS during radiation therapy for head and neck cancer.

  • Recommendation Strength Rationale

    • Based on one positive and one neutral quality RCT, conclusion statement is a Grade II.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  Is there a relationship between the use of medical food supplements to improve nutritional intake (protein, kcals) and the reduction of symptoms associated with radiation therapy for patients with head and neck cancer?

  • References

    Arnold C, Richter MP. The effect of oral nutritional supplements on head and neck cancer. Int J Radiat Oncol Biol Phys. 1989;16(6):1595-99.
    
    Nayel H, El-Ghoneimy E, El-Haddad S.  Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation.  Nutrition 1992;8:13-18.