Chapter 21: MNT for Head and Neck Cancer Flashcards

1
Q

Malignant tumors in which locations are considered “Head and Neck” cancer (HNC)?

A

oral cavity, nasal cavity, sinuses, lips, salivary glands, throat and larynx

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2
Q

90% of head and neck cancers are ____ cell carcinoma?

A

Squamous

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3
Q

What are the other 10% of head and neck cancers comprised of?

A

adenocarcinoma, melanoma, adenoic cystic carcinoma and thyroid cancers found in the head/neck region.

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4
Q

What are the biggest risk factors for HNC?

A

alcohol and tobacco use

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5
Q

Possible NIS of HNC surgery?

A

swelling, pain, structural deformities such as loss of teeth, heliglossectomy (removal of part of the tongue), soft palate fistula or tracheostomy making it difficult to chew/swallow and potentially limiting nutrient intake.

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6
Q

Possible NIS of HNC radiation?

A

Mucositis, odynophagia, thick saliva, xerostomia, trismus, pharyngeal fibrosis and decreased appetite and a result of dysguesia, tooth decay.

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7
Q

What is IMRT?

A

Intensity-modulated radiation therapy. An advanced form or radiation therapy allowing more precise cancer targeting while reducing dose to normal tissue.

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8
Q

What is the standard chemotherapy treatment for HNC?

A

Cisplatin and radiation treatment

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9
Q

What are the 4 Oral Toxicity Scale Phases for individuals receiving CRT?

A

Grade 0: No change over baseline
Grade 1: soreness +/- erythema
Grade 2: Erythema, ulcers, and pt can’t swallow food
Grade 3: Ulcers with extensive erythema, pt can’t swallow food
Grade 4: Mucositis so severe that oral alimentation is not possible. pt needs alternative method of feeding

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10
Q

What are the 4 Nutritional Phases of CRT for HNC?

A

Phase 0: Pre-treatment: G-tube not in use
Phase 1: week 1-3 - G-tube not in use- high kcal
Phase 2: week 3-5 - G-tube may or may not be in use
Phase 3: week 5-7 - G-tube may or may not be in use
Phase 4: Post-CRT treatment

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11
Q

T/F: HNC patients experience one of the highest rates of malnutrition among all cancer diagnoses.

A

True (25-50% are at risk for malnutrition prior to starting treatment).

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12
Q

Why are HNC patients at such a high risk for malnutrition?

A

They have a diminished oral intake d/t diagnosis or during treatment. They may also present with pre-existing nutritional deficiencies d/t excessive alcohol and/or tobacco use, decreased appetite and cachexia resulting from the malignancy. Plus, side effects of treatment.

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13
Q

What are the nutritional goals of HNC?

A
  • Weight maintenance during and after treatment.
  • Weight maintenance post-treatment until the patient is able to consume solid food.
  • successful, break-free completion of treatment
  • minimal, if any weight loss in overweight or obese patients until pt is fully recovered from treatment and is able to eat without difficulty
  • weight maintenance during transitional feedings from enteral nutrition support.
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14
Q

______ is the strongest independent predictor or shortened survival in a series of HNC patients treated with multiple modalities.

A

Weight loss

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15
Q

Undernutrition in HNC patients is associated with…

A

Poor treatment outcomes, including morbidity, infections, cancer recurrence, mortality and poor quality of life.

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16
Q

What are the benefits of prophylactic G-tube feeding?

A

Fewer hospital admissions for dehydration or malnutrition, less treatment interruptions and or delays and better quality of life during treatment.

17
Q

Phase 0 of CRT for HNC

A

Pre-Treatment: Includes a comprehensive nutrition assessment. RD creates a nutrition care plan to manage NIS and minimize treatment side effects. Educates pt, maybe prophylactic G-tube.

18
Q

Phase 1 of CRT for HNC

A

Weeks 1-3 of CRT: Most can tolerate oral diet at this phase. High cal/pro, may need nutritional beverage.

19
Q

Phase 2 of CRT HNC

A

Week 3-5 of CRT: Pt starts to get dysphagia, odynophagia, xerostomia, dysgeusia, thick oral secretions and mucositis start to impede oral intake. RD to discuss TF formula options with pt/family.

20
Q

What are strategies to control mucus secretions?

A

salt and baking soda rinses, Caphosol, elevate the head of the bed, cool mist vaporizer, portable suction machine, increased fluids

21
Q

When is G-Tube indicated?

A

When a person is unable to consume >50% of estimated energy and nutrient needs.

22
Q

Phase 3 of CRT of HNC.

A

Week 5-7: Pts usually depended on feeding tube during this phase. RD to monitor formula tolerance and may need to adjust the feeding method (gravity vs. pump), etc.

23
Q

Phase 4 of CRT of HNC.

A

Post-Treatment: NIS continue for weeks after therapy is over. Pt’s likely need EN for 4-6 weeks after treatment. 6-8 weeks post-treatment, oral diet is usually tolerated.

24
Q

At what rate should EN be tapered off if pt is weight stable?

A

250 mL per week (1 carton/week), while increasing oral intake.