Malnutrition risk, nutrition impact symptoms, and dietary intake in community-living head and neck cancer survivors six months to three years post-treatment : a case series : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
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Date
2024
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Massey University
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Abstract
Background: Head and neck cancer (HNC), characterised by malignant neoplasms originating in the oral cavity, upper aerodigestive tract, the sinuses, salivary glands, bone, and soft tissues of the head and neck, is diagnosed in approximately 600 people annually in New Zealand. Although HNC is a less common cancer, it has a profound effect on almost all aspects of the lives of those affected, particularly the nutritional and social domains. This is due to the common treatment modality being surgery and/or radiotherapy, which can result in major structural and physiological changes in the affected areas, which in turn affects chewing, swallowing, and speaking (Nilsen et al., 2020). Specific nutrition impact symptoms (NIS) of HNC have been identified and are significant predictors of reduced dietary intake and malnutrition risk (Kubrak et al., 2010). Aim: We aimed to identify and describe the malnutrition risk, prevalence of NIS, and energy, macronutrient, and micronutrient intakes of community-living adult HNC survivors six months to three years post-treatment in New Zealand. Methods: Participants were recruited through virtual HNC support groups in New Zealand. A descriptive observational case series design was used. Malnutrition risk was determined using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). NIS were obtained via a validated symptom checklist, and dietary data was collected using a four-day food record. Results: Participants are referred to as PTP1-PTP7. PTP1 was well-nourished. PTP3 through PTP7 were categorised as mildly/suspected to moderately malnourished (PG-SGA SF scores of 2-7), and PTP2 was severely malnourished (score of 16). NIS were experienced by all seven participants, with “difficulty chewing,” “difficulty swallowing,” and “dry mouth” the most common. PTP2 scored loss of appetite, difficulty chewing, and difficulty swallowing as interfering “a lot.” Despite being well-nourished, PTP1 had inadequate energy intake (EI) (86% of their estimated energy requirement [EER]). PTP2, 3, 6, and 7 also had inadequate EI (79%, 79%, 73%, and 99%, respectively, of their EER). PTP1–PTP6 had adequate protein intake based on a range of 1.2-1.5 g/kg body weight per day, with PTP7 meeting 97% of their protein requirements. Deficiencies in dietary calcium and potassium were identified. PTP1, 2, 4, and 6 exhibited inadequate calcium intakes, corresponding to 74%, 73%, 72%, and 55% of their recommended dietary intake, respectively. PTP2, 3, and 6 demonstrated insufficient potassium intakes, reflecting 88%, 91%, and 91% of their adequate intake, respectively. Conclusion: The prevalence of malnutrition, NIS, and micronutrient deficiencies in this case series indicates an urgent need for greater long-term support for HNC survivors post-treatment and research to identify the true extent of malnutrition in this vulnerable cohort.
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head and neck cancer, survivorship, malnutrition, nutrition impact symptoms