As many as 50% of patients with head and neck cancer experience pretreatment weight loss. In addition, treatment frequently involves chemotherapy and radiation, which can also result in weight loss, as well as mucositis and dysphagia, which can affect patients’ ability to eat. This could lead to treatment delays that may impact treatment efficacy.
Many patients with head and neck cancer receiving outpatient treatment do not have access to nutritional counseling from a dietician, yet maintaining oral intake and nutritional status can reduce the impact of adverse events. Advanced practice nurses (APNs) may be in a position to fill the void.
The results of a new study showed that implementing an APN-led nutritional intervention in patients with head and neck cancer was feasible and effective. Laura Weldishofer, RN, DNP, OCN®, NP-C, presented her findings in “Nutritional Assessment and Management for Head and Neck Cancer Patients Receiving Definitive Radiation Therapy in the Community Setting” as part of the e-poster sessions on November 2 and 3 during the 2018 JADPRO Live conference in Hollywood, FL.
Weldishofer reviewed medical records of 40 randomly selected patients who received definitive radiation or chemoradiation in the past 2.5 years to establish benchmarks for implementation. The intervention occurred at a private, community-based practice recently affiliated with a nationwide oncology group. Six radiation oncologists and two nurse practitioners were involved in the project. The intervention was conducted at three hospital-affiliated offices with one nurse navigator at each site.
Twelve patients were included and evaluated for nutritional risk with the Patient-Generated Subjective Global Assessment at consult or first week of treatment, and nutritional recommendations were made based on guidelines from the Academy of Nutrition and Dietetics, National Comprehensive Cancer Network, and European Society for Clinical Nutrition and Metabolism. Patients underwent additional assessment mid-treatment and during the final week of treatment. Counseling continued until patients were nutritionally stable post-treatment.
The small sample size precluded any statistical significance of outcomes; however, some results were clinically significant, according to Weldishofer. For patients who received radiation only, the percentage of weight loss in the benchmark group was 10.1% (n = 14) whereas the percentage of weight loss in the intervention group was 5.6% (n = 6). For patients receiving chemoradiation, the percentage of weight loss in the benchmark group was 12.6% (n = 26) whereas the percentage of weight loss for the intervention group was 11.2% (n = 5).
Patients who received nutritional counseling completed 100% of their intended radiation therapy treatments whereas the benchmark group completed 92.5%. The radiation therapy group receiving the intervention also had decreased weight loss percentages, decreased reliance on IV hydration, and no use of enteral feedings.
During the program, 93% of nutritional visits were completed as intended. One of the identified barriers was scheduling conflicts, which occasionally required an extra provider visit to complete the intervention.
“APNs frequently address symptom management with patients,” Weldishofer concluded. “With targeted education or partnership with a dietician, APNs are in an ideal role to provide nutritional assessment and counseling.”