Patients undergoing treatment for HNC often require tube feeding, however weight loss remains prevalent. The aim of this study was to investigate the impact of patient adherence to nutrition recommendations on weight loss and understand patient barriers to meeting goal enteral feeding.
Observational study in patients with HNC deemed at high nutritional risk with prophylactic gastrostomy placed prior to treatment following local protocol. Weight was recorded at placement of gastrostomy and three months post treatment. Time of recommended commencement of gastrostomy feeding by the dietitian was recorded. Patients were asked to maintain a daily record of gastrostomy intake during treatment, main nutrition impact symptom necessitating gastrostomy use, and the reasons for not meeting nutrition prescription if applicable. Adherence was defined as actual intake >75% of prescribed intake.
Patients were predominantly male (88%), median age 60, with oropharyngeal tumours (77%), stage IV disease (87%) treated with chemoradiotherapy (87%). Gastrostomy was placed a median 5 days prior to start of treatment and commenced use by week 4 in 83% of patients. The primary reason for gastrostomy use in weeks 2-3 was poor appetite/dysgeusia and in week 4-7 it was odynophagia/mucositis. Patients only met 100% of goal nutrition on 36% (range, 0-100%) of prescribed enteral feeding days. Key barriers to intake were; nausea/vomiting (23%), feeling full, bloated or no appetite (17%), lack of time, support or motivation (11%) and substituting with nutritionally inadequate oral intake (11%). Adherent patients (n=49) had less weight loss than non-adherent patients (n=55) (-10.3% vs -12.6% respectively, p=0.038).
Despite prophylactic gastrostomy placement, patients still have clinically significant weight loss >10% and only achieve goal nutritional intake for a third of the duration tube feeding is prescribed. Key areas to target have been identified to help future patients, including optimising symptom management and developing psychosocial support.