Clinical nutrition

Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit



Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention.

Subjects and methods

Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT.


135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044).


The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

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Fig. 1: Flow chart of the two different approaches.


  1. 1.

    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  Google Scholar 

  2. 2.

    Van Bokhorst-de van der Schueren MA, van Leeuwen PA, Sauerwein HP, Kuik DJ, Snow GB, Quak JJ. Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck. 1997;19:419–25.

    Article  Google Scholar 

  3. 3.

    Van den Berg MG, Rasmussen-Conrad EL, Wei KH, Lintz-Luidens H, Kaanders JH, Merkx MAW. Comparison of the effect of individual dietary counselling and of standard nutritional care on weight loss in patients with head and neck cancer undergoing radiotherapy. Br J Nutr. 2010;104:872–7.

    Article  Google Scholar 

  4. 4.

    Arribas L, Hurtós L, Taberna M, Peiró I, Vilajosana E, Lozano A, et al. Nutritional changes in patients with locally advanced head and neck cancer during treatment. Oral Oncol. 2017;71:67–74.

    CAS  Article  Google Scholar 

  5. 5.

    Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004;91:447–52.

    CAS  Article  Google Scholar 

  6. 6.

    Citak E, Tulek Z, Uzel O. Nutritional status in patients with head and neck cancer undergoing radiotherapy: a longitudinal study. Support Care Cancer. 2019;27:239–47.

    Article  Google Scholar 

  7. 7.

    Lees J. Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care. 1999;8:133–6.

    CAS  Article  Google Scholar 

  8. 8.

    Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27:659–68.

    Article  Google Scholar 

  9. 9.

    Ocón Bretón MJ, Luengo Pérez LM, Virizuela JA, Álvarez Hernández J, Jiménez, Fonseca P, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Endocrinol Diabetes Nutr. 2018;65:17–23.

    Article  Google Scholar 

  10. 10.

    Talwar BP. Head and neck cancer. In: Shaw C, editor. Nutrition and Cancer. Oxford: Wiley Blackwell Science Ltd, 2010; 188–220.

  11. 11.

    Valentini V, Marazzi F, Bossola M, Miccichè F, Nardone L, Balducci M, et al. Nutritional counselling and oral nutritional supplements in head and neck cancer patients undergoing chemoradiotherapy. J Hum Nutr Diet. 2012;25:201–8.

    CAS  Article  Google Scholar 

  12. 12.

    Jeffery E, Sherriff J, Langdon C. A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy. Australas Med J. 2012;5:8–13.

    CAS  Article  Google Scholar 

  13. 13.

    Alhambra Expósito MR, Herrera-Martínez AD, Manzano García G, Espinosa Calvo M, Bueno Serrano CM, Gálvez Moreno MA. Early nutrition support therapy in patients with head-neck cancer. Nutr Hosp. 2018;35:505–10.

    PubMed  Google Scholar 

  14. 14.

    Licitra L, Keilholz U, Tahara M, Lin JC, Chomette P, Ceruse P, et al. Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer. Oral Oncol. 2016;59:73–79.

    Article  Google Scholar 

  15. 15.

    Gorenc M, Kozjek NR, Strojan P. Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy. Rep Pr Oncol Radiother. 2015;20:249–58.

    Article  Google Scholar 

  16. 16.

    Langius JA, Bakker S, Rietveld DH, Kruizenga HM, Langendijk JA, Weijs PJM, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013;109:1093–9.

    CAS  Article  Google Scholar 

  17. 17.

    Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130:S32–S40.

    CAS  Article  Google Scholar 

  18. 18.

    Findlay M, Bauer J, Brown T, Committee HaNGS. Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer. Sydney: Cancer Council Australia, 2014.

  19. 19.

    Álvarez J, Del Río J, Planas M, García Peris P, García de Lorenzo A, Calvo V, et al. SENPE-SEDOM documento on coding of hospital hyponutrition. Nutr Hosp. 2008;23:536–40.

    PubMed  Google Scholar 

  20. 20.

    Van den Berg MG, Rasmussen-Conrad EL, Gwasara GM, Krabbe PF, Naber AH, Merkx MA. A prospective study on weight loss and energy intake in patients with head and neck cancer, during diagnosis, treatment and revalidation. Clin Nutr. 2006;25:765–72.

    Article  Google Scholar 

  21. 21.

    Kang WX, Li W, Huang SG, Dang Y, Gao H. Effects of nutritional intervention in head and neck cancer patients undergoing radiotherapy: a prospective randomized clinical trial. Mol Clin Oncol. 2016;5:279–82.

    Article  Google Scholar 

  22. 22.

    Silander E, Jacobsson I, Bertéus-Forslund H, Hammerlid E. Energy intake and sources of nutritional support in patients with head and neck cancer-a randomised longitudinal study. Eur J Clin Nutr. 2013;67:47–52.

    CAS  Article  Google Scholar 

  23. 23.

    Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, et al. Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck. 2010;32:290–300.

    PubMed  Google Scholar 

  24. 24.

    Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer. 2010;18:837–45.

    Article  Google Scholar 

  25. 25.

    Beaver ME, Matheny KE, Roberts DB, Myers JN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg. 2001;125:645–8.

    CAS  Article  Google Scholar 

  26. 26.

    Leistra E, Eerenstein SE, van Aken LH, Jansen F, de van der Schueren MA, Twisk JW, et al. Effect of early individualized dietary counseling on weight loss, complications, and length of hospital stay in patients with head and neck cancer: a comparative study. Nutr Cancer. 2015;67:1093–103.

    CAS  Article  Google Scholar 

  27. 27.

    Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, et al. Influence of weight loss on outcomes in patients with head and neck cancer undergoingconcomitant chemoradiotherapy. Head Neck. 2008;30:503–8.

    Article  Google Scholar 

  28. 28.

    Eskander A, Krzyzanowska MK, Fischer HD, Liu N, Austin PC, Irish JC, et al. Emergency department visits and unplanned hospitalizations in the treatment period for head and neck cancer patients treated with curative intent: a population-based analysis. Oral Oncol. 2018;83:107–14.

    CAS  Article  Google Scholar 

  29. 29.

    Ling DC, Kabolizadeh P, Heron DE, Ohr JP, Wang H, Johnson J, et al. Incidence of hospitalization in patients with head and neck cancer treated with intensity-modulated radiation therapy. Head Neck. 2015;37:1750–5.

    Article  Google Scholar 

  30. 30.

    Gupta S, Kong W, Booth CM, Mackillop WJ. Impact of concomitant chemotherapy on outcomes of radiation therapy for head-and-neck cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2014;88:115–21.

    Article  Google Scholar 

  31. 31.

    Moore ZR, Pham NL, Shah JL, Nedzi L, Sumer BD, Andrew T. et al. Risk of unplanned hospital encounters in patients treated with radiotherapy for head and neck squamous cell carcinoma. J Pain Symptom Manag. 2019;57:738–45.

    Article  Google Scholar 

  32. 32.

    Ehrsson YT, Langius-Eklöf A, Laurell G. Nutritional surveillance and weight loss in head and neck cancer patients. Support Care Cancer. 2012;20:757–65.

    Article  Google Scholar 

  33. 33.

    Datema FR, Ferrier MB, Baatenburg, de Jong RJ. Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer. Oral Oncol. 2011;47:910–4.

    Article  Google Scholar 

  34. 34.

    Van Bokhorst-de van der Schuer, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, et al. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519–27.

    Article  Google Scholar 

  35. 35.

    Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G. ESPEN (European Society for Parenteral and Enteral Nutrition) et al. ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr. 2006;25:245–59.

    CAS  Article  Google Scholar 

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The authors’ contributions were as follows: MGR and RVT were responsible for designing the research; MGR, RVT, MASD and SFF were responsible for conducting the research; MGR, RVT, AFP and MPC were responsible for extracting and analyzing the data and performing the statistical analysis; MGR, RVT and AFP were responsible for interpreting the results. MGR, RVT and AFP were responsible for writing the manuscript; ACB and MAMO provided feedback on the research. All authors read and approved the final manuscript.

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Correspondence to R. Villar-Taibo.

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González-Rodríguez, M., Villar-Taibo, R., Fernández-Pombo, A. et al. Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit. Eur J Clin Nutr (2020).

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