ONC: Head and Neck Cancer: Chemoradiation and Determination of Resting Energy Expenditure (REE) 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.
ONC: Head and neck cancer: Chemoradiation and Determination of REE
Use of indirect calorimetry to measure Resting Energy Expenditure (REE) is more accurate than estimation in patients with advanced head and neck cancer undergoing chemoradiation therapy. If measurement of REE is not possible or not thought to be imperative, use the Harris Benedict Equation (HBE) to estimate calorie needs. However, limited evidence indicates that HBE underestimates REE in this population.
Risks/Harms of Implementing This Recommendation
- Some patients may experience anxiety associated with the indirect calorimetry measurement process.
- Under- or over-feeding may result when energy needs are estimated rather than measured.
Conditions of Application
- The studies reviewed for this recommendation only reviewed HBE as an energy estimating equation. See energy expenditure and energy assessment recommendations in the Critical Illness Guideline for information on other conditions. For more information on measuring vs. estimating RMR, see Determining Resting Metabolic Rate.
- The AARC Clinical Practice Guidelines (1994) recommend that measurements may be indicated in patients with several conditions including:
- Cancer with residual tumor
- Extreme obesity
- The AARC Clinical Practice Guidelines (1994) also provide recommendations for hazards and complications, limitations of the procedures and infection control.
- Measures should be conducted by specialty-trained personnel who have documented and demonstrated proficiency to calibrate, operate and maintain the calorimeter and to recognize calorimeter values within the normal physiologic range.
Potential Costs Associated with Application
Cost of equipment, supplies and staff needs to be addressed in all indirect calorimetry measurements.
One small, neutral quality time-series study (Garcia-Peris et al, 2005) compared measured REE with estimated REE using the HBE during a course of radiation therapy in head and neck cancer patients. Measured REE formed a U-shaped curve, with higher measures before, at end, and after treatment, while REE estimated by HBE decreased throughout the study.
Further research is needed to determine the energy needs of head and neck cancer patients.
Recommendation Strength Rationale
- Based on one small, neutral quality time-series study, conclusion statement is a grade III.
- Risks/Harms of Implementing This Recommendation
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).
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994; 39 (12): 1, 170-1, 175.