Nutritional Status Druring Treatment for Head and Neck Cancer
Dear OncoLink "Ask The Experts,"
My father was recently diagnosed with epiglottis cancer, and he just had his first chemo treatment and the first week of radiation. Are there any suggestions that you have in regards to what he would be able to eat? Should we have a nutritionist? Your article was very informational, thank you. You told me things that his doctor has not. I look forward to your response.
Harry Quon, MD, MS (CRM), Assistant Professor of Radiation Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:
Definitely see a nutritionist. The reason is that the normal diet an individual will be able to take orally will be affected. We know now that maintaining as much of an oral diet as possible is beneficial during a course of radiation, likely due to the maintenance of muscle tone. Keeping up your muscle tone increases the likelihood of maintaining future swallow function, and should be encouraged as much as possible. This should of course be balanced against too much swallowing, which could place the patient at risk for developing serious aspiration pneumonia. The ability to maintain some oral diet is different for different sites of cancer involvement. It is easier for nasopharynx cancers than oropharynx cancers, and is most challenging for cancers of the larynx and hypophyarnx. For the epiglottis, it is likely that with the use of concurrent chemotherapy, the patient will still need the use of a PEG tube to support nutrition. The nutritionist's role is to ensure that when the oral diet is supplemented or replaced by PEG feeds, the patient must receive the necessary amounts of fluid and nutritional intake. The change in the way one maintains his/her nutrition during a course of radiation can also affect other medical conditions such as hypertension, diabetes and congestive heart failure, and thus need to be coordinated with a nutritionist who has an intimate understanding of the makeup of various supplements.