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Recommendations Summary

ONC: Head and Neck cancer: Radiation and Medical Nutrition Therapy (MNT) 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: MNT and radiation therapy

    Medical Nutrition Therapy (MNT) that consists of nutrition assessment, intensive intervention, and ongoing monitoring and evaluation by an RD should be provided for patients with head/neck cancer being considered for radiation therapy. MNT has been shown to improve calorie and protein intake, maintain anthropometric measurements and improve quality of life (QOL).

    Rating: Strong
    Imperative

    ONC: Head and neck cancer: MNT and pre-treatment evaluation

    The Dietitian should provide MNT consisting of a pre-treatment evaluation and weekly visits during radiation treatment for head and neck cancer to improve outcomes.

    Rating: Strong
    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

      Costs of MNT sessions and reimbursement vary.

    • Recommendation Narrative

      • Three positive and one neutral quality studies found that nutrition intervention for head and neck cancer patients undergoing radiation therapy can help to prevent nutrition deterioration.
        • One positive quality RCT (Isenring et al, 2003) found that patients who received regular (weekly for six weeks and biweekly for 12 weeks) nutrition counseling from an RD based on the American Dietetic Association MNT protocol for cancer (radiation oncology) lost significantly less weight and fat-free mass than controls. The researchers concluded that early and intensive nutrition support appears to minimize loss of body weight and FFM when compared with control patients in cancer outpatients receiving radiotherapy for head and neck cancers.
        • Another positive quality RCT (Ravasco et al, 2005) found that nutrition intervention (1 baseline visit and weekly visits for six weeks) for head and neck cancer patients during radiation therapy can increase calorie and protein intake, as well as maintain anthropometric and laboratory measures. Researchers concluded that during radiation therapy, nutrition interventions improved outcomes, with counseling having an equal or greater benefit than MFS supplementation; at 3 months post-therapy, only counseling significantly impacted patient outcomes.
        • One positive quality prospective non-randomized trial (Goncalves et al, 2005) found that 64 patients who received an intensive nutrition intervention with instruction to maintain 40 kcals/kg body weight during the treatment period, were able to maintain weight, preserve FFM, and maintain nutrition parameters.
        • One neutral quality two-group comparison study (Dawson et al, 2001), compared two groups of patients with squamous cell carcinoma of the oral cavity and found that increased interaction or visits by an RD can help decrease post-surgery and post-radiation therapy weight loss in oral cancer patients
      • Further research is needed to determine the frequency, duration and optimal length of nutrition intervention for improved treatment-related outcomes and survival.

    • Recommendation Strength Rationale

      • Based on two positive quality RCTs, one postive quality prospective non-randomized trial, and one neutral quality two-group comparison study, conclusion statement is a Grade II.