BYLINE: Kristi Birch
Newswise — Proper nutrition is important for people diagnosed with cancer, both to help them feel better and to assist them in maintaining their strength during treatment and its side effects. But cancer and its treatment can affect both a person’s ability and desire to eat, making it hard to get enough calories and nutrients. This is especially true for people who have been diagnosed with some type of head and neck cancer, malignancies that arise predominantly in the mouth, throat and voice box.
“The tumor itself can lead to symptoms and side effects like difficulty swallowing and difficulty chewing,” said Anna Arthur, Ph.D., MPH, associate professor of dietetics and nutrition at the University of Kansas School of Health Professions and a member of The University of Kansas Cancer Center. “On top of that, surgical resections of the tumor, radiation and chemotherapies can lead to severe symptoms and side effects — including taste changes, dry mouth, nausea, gastrointestinal disturbances and painful ulceration of the membranes in the mouth and throat, all of which severely compromise the ability of these patients to get the nutrition they need.”
Last month, Arthur, along with a multidisciplinary team of researchers and clinicians at KU Medical Center and the Moffitt Cancer Center & Research Institute in Florida, published an article in Lancet Oncology issuing a call for nutrition-related head and neck cancer research and presenting a roadmap that identifies gaps and strategies to improve care.
Research on nutrition therapy for head and neck cancers, which account for 4% of all cancers in the United States, lags behind that of other types of cancer. (Research overall for head and neck cancer receives the second lowest amount of funding from the National Institutes of Health.) Yet the prevalence of malnutrition in people with head and neck cancer is among the highest of all the cancer types, ranging from roughly one-quarter to three-quarters of these patients, depending on the type and severity of the malignancy and the treatment. Insufficient nutrition has been associated with increased mortality and decreased tolerance to cancer therapy in head and neck cancer patients.
“Even though we know that these patients experience really severe nutritional deficits before, during and even long-term after their treatment, we don’t have a huge evidence base to define exactly what types of nutrition interventions are needed, and how those interventions should be timed, to prevent and manage the nutritional issues that they face,” said Arthur. “And we know from working with these patients clinically that they really need nutrition counseling because of where the tumor is located and the symptoms and side effects that they experience due to the treatment.”
Dietitians can help these patients deal with the side effects of the disease and its treatment by, for example, advising them on modifying their food choices if they have trouble swallowing, providing recipes for liquid diets and even helping them select foods high in protein and calories so they don’t have to eat as much.
But access to registered dietitians is drastically inadequate for these patients, Arthur noted. She cited a report from the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics that showed the ratio of dietitian to cancer patient in U.S. cancer centers is far below what is needed to provide care: one for every 2,308 patients. Medical nutrition therapy services are typically not covered by insurance, so many patients do not get the care they need from a registered dietitian.
“We think the combination of more research with better policies and better insurance coverage would ultimately lead to not only better nutritional outcomes, but better survival and better quality of life,” Arthur said.
In addition to calling for more research funding opportunities, the article proposes eight action items to increase research and improve head and neck cancer outcomes. These include:
- Improving access to medical nutrition therapy provided by registered dietitians
- Establishing medical nutrition therapy reimbursement policies
- Addressing nutrition care needs for long-term survivors
- Establishing a consensus on criteria for feeding tubes and when they should be placed
- Providing nutrition literacy to people who have been diagnosed with head and neck cancer
- Increasing access to psychological screenings and services
- Addressing gaps in speech-language pathology care, which can help patients with difficulties swallowing and speaking
- Promoting active participation in exercise programming