May is National Cancer Research Month and it’s an important time to recognize new advances in nutrition research to support cancer treatment and recovery. Earlier this year, the American Society for Parenteral and Enteral Nutrition (ASPEN) published its new guidelines for nutrition in adults with head and neck cancer. With incidence rates of head and neck cancers increasing for adults aged 60 years and older, healthcare providers and decision-makers can use these guidelines to improve delivery of nutrition care for this vulnerable population.
What’s New: Three “Moves” Clinicians Can Use
Older adults battling head and neck cancer often have special nutrition-related challenges that include a high risk of malnutrition, poor appetite, difficulty chewing or swallowing, pain, and other symptoms associated with tumor location and treatment.
Older adults battling head and neck cancer often have special nutrition-related challenges that include a high risk of malnutrition.
Therefore, ASPEN recommends implementation of nutrition care models that include:
- Screen and assess malnutrition early and keep doing it: Healthcare providers should screen for malnutrition using validated tools (e.g., Malnutrition Screening Tool or PRONTO) in people with head and neck cancer at their first visit to a healthcare facility and regularly throughout treatment. For those at higher risk, screening can be bypassed when there is a protocol in place for automatic referral to a registered dietitian nutritionist.
- Dose the follow-up, particularly a regular cadence of dietitian visits during and after treatment: ASPEN recommends people with head and neck cancers should undergo a comprehensive nutrition assessment if they are at risk of or have malnutrition or if they are fed by or plan to be fed by enteral (tube) feeding. Dietitian consultation is recommended weekly during treatment and every two weeks for up to six weeks after treatment. Patients undergoing extensive surgical procedures may require additional dietitian support for a longer duration.
- Proactively initiate nutrition support after surgery: To meet nutrition needs, ASPEN recommends early initiation of supplementation (oral or enteral) within 24 hours after surgery. Return to an oral diet should occur gradually and in consultation with the surgical, dietitian, and speech pathology teams. Supplemental enteral feeding should be maintained until an oral diet is sufficient to meet the patient’s nutrition needs.
It’s important to highlight that limited access to dietitians in outpatient cancer centers may increase patient vulnerability and they may not receive adequate nutrition care to support their specific nutrition needs. A 2019 study of outpatient cancer centers reported there is just one dietitian for every 2,308 patients nationwide which underscores the need to engage more dietitians as part of the outpatient oncology care team.
For older adults with head and neck cancer, nutrition can be the difference between completing therapy and falling behind.
Older Adults Have Increased Vulnerability to Accelerated Muscle Loss
Another concern is that older adults may enter cancer treatment with lower lean body mass because with age there is increased risk for frailty, sarcopenia (muscle wasting) and malnutrition. Because malnutrition and muscle wasting are linked with poorer treatment outcomes, use these daily nutrition targets recommended by ASPEN as a practical approach to help protect muscle health and function:
- Total calories (energy): At least 30 calories per kg of body weight each day
- Protein: 1.2–1.5 grams per kg of body weight each day
- Adjust goals to meet individual needs:
- Food alone may meet their nutrition needs but often it is a combination of food, oral nutrition supplements, and/or enteral nutrition that are required to fully meet nutrition needs
- Calorie and protein goals should be tailored to the patient’s symptom burden and nutrition status while factoring in the impact of treatment plans, clinical, psychosocial, and socioeconomic status
- Use actual body weight and monitor what and how much the patient eats, weight, nutrition status, muscle mass/strength and physical performance over time.
- Important: adjust goals as needed for patients with obesity to avoid overestimation of what they eat.
For older adults with head and neck cancer, nutrition can be the difference between completing therapy and falling behind. The new evidence-based guidance from ASPEN offers a ready-made workflow: screen early and repeatedly, escalate nutrition support when intake slips, start postoperative nutrition within 24 hours, and build weekly dietitian touchpoints throughout treatment with short-term follow-up after treatment is completed.
Additional resources
- The Find a Nutrition Expert tool helps healthcare providers and patients search for credentialed dietetics practitioners by location, specialty, language or insurance and payment options.
- What’s New in Oncology? Addressing Muscle Health and Nutrition is a continuing education course that reviews the impact of malnutrition and muscle loss on clinical outcomes in patients with cancer.
- Good Nutrition During Your Cancer Journey provides patients with practical guidance on recognizing signs of nutrition risk and emphasizes how good nutrition can improve treatment tolerance, reduce side effects, and support overall well-being.
Carley Rusch, PhD, RDN, LDN, is a Medical Science Liaison for the Nutrition Division of Abbott, in Columbus, Ohio.
Photo credit: Shutterstock
