The Efficacy of Medical Nutrition Therapy on Patients with Nasopharyngeal Carcinoma

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Authors (including presenting author) :
Mak WY(1), Kwok M(1), Chang KYS(1)
Affiliation :
(1)Department of Dietetics, Queen Elizabeth Hospital
Introduction :
Nasopharyngeal carcinoma (NPC) was the 6th most common cancer for male in Hong Kong by 2016 according to the Hong Kong Cancer Registry. It accounted for 805 cancer incidences locally and caused 327 deaths. Radical concurrent chemoradiotherapy is the mainstay of treatment for most non-metastatic NPC. However, the treatment induced toxicities including oral mucositis hinder adequate nutrient intake. Hence, these nutrition impact symptoms can lead to unintentional weight loss which was found to adversely affect patient’s response to treatment, tolerance to toxicities and survival. In order to prevent malnutrition, a dietetic program was launched since Aug 15 to provide medical nutrition therapy (MNT) to NPC patients. It included a class of nutrition management followed by a series of intensive individual consultations during treatment period until their body weight and oral intake were optimal enough to be discharged.
Objectives :
To evaluate the efficacy of MNT in bodyweight and muscle strength maintenance on NPC patients.
Methodology :
Newly diagnosed NPC patients were referred by oncologists at QEH. Their demographic and clinical information were collected at the first visit and updated subsequently. Bodyweight (BW,kg) and handgrip strength (HGS,kgf) were measured at every visit. Data collected in between Aug 16 – Nov 18 was then extracted for the preliminary analysis.
Result & Outcome :
216 patients were recruited so far while results of 94 completed cases (55 ± 12 years old) were analyzed. The average duration of follow-up (FU) and number of visits was 4.95 ± 3.40 months and 5.69 ± 1.72 times respectively. Majority of patients required oral nutrition supplementation during the treatment while 6.4% (n=6) of them required nasogastric tube feeding mainly due to odynophagia. BW and BMI between baseline and last visit were significantly different. [63.05 (54.5– 73.00) vs 57.00 (50.2 – 64.3) and 24.1 ± 3.62 vs 21.6 ± 2.93, both p< 0.0001]The mean % of BW loss was 9.70 ± 8.51 which fell within the 10% clinical weight loss cutoff. The trend of BW loss was found attenuating but persisting at post-treatment period. In post-hoc analysis, patients were further categorized by weight loss : < 10% (n=45) and >=10% (n=49). No significant difference was found in age of diagnosis and stage of disease between groups. However, the baseline BMI was significantly lower in < 10% group [23.15 (21.56, 25.04) vs >=10% (25.22 (22.04, 27.39), p< 0.001]. In addition, multi-variate analysis revealed that baseline BMI was an independent predictor for weight loss during treatment period. For HGS, no significance difference was observed between baseline and last visit. Conclusion: Nutritional intervention is important as an integral part of NPC patients care in order to minimize the inevitable weight loss during treatment. The ongoing BW loss after treatment highlighted the necessity of regular dietetics review among these patients .In order to further ascertain the efficacy of the MNT, a larger sample size and involvement of control group could be considered in future study.

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