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.


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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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