Journal
RADIOTHERAPY AND ONCOLOGY
Volume 126, Issue 1, Pages 81-88Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2017.10.015
Keywords
Radiotherapy; Head and neck cancer; Malnutrition; Nutritional support; Nutritional counseling; Oral nutritional supplements; Quality of life; Treatment tolerance
Funding
- Fondazione IRCCS Policlinico San Matteo
- Italian Ministry of Health [RF-2011-02351315]
- ESPEN
- Nestle Health Science (provision of ONS)
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Background: To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT). Methods: In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02055833; February 2014-August 2016), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with ONS (N = 78) or without ONS (N = 81) from the start of RT and continuing for up to 3 months after its end. Methods: Primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life and anticancer treatment tolerance. Results: In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus ONS (N = 67) resulted in smaller loss of body weight than nutritional counseling alone (N = 69; mean difference, 1.6 kg [95%Cl, 0.5-2.7]; P = 0.006). Imputation of missing outcomes provided consistent findings. In the ONS-supplemented group, higher protein-calorie intake and improvement in quality of life over time were also observed (P < 0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR=0.40 [95%Cl, 0.18-0.91], P = 0.029). Conclusion: In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance. (C) 2017 Elsevier B.V. All rights reserved.
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