The oral cancer patients diet challenges during treatment

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The oral cancer patients diet challenges during
treatment

• Carole Anne McAtear
• Specialist Dietitian Head and Neck Cancer
• NHS Greater Glasgow and Clyde

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Oral Cancer Patients Journey

• GP/Dentist Diagnosis
• Surgery Radio/Chemotherapy
  
• Curative Palliative

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Estimated incidence of malnutrition in West of
Scotland Cancer patients 2003
Total 1168

• Adapted from Stratton Et Al 2003 and ISD
  Scotland

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Causes of malnutrition in Head and Neck Cancer

• Cancer Cachexia
• Mechanical
• Lifestyle choices
• Pre-existing chronic malnutrition
• Treatment

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Effects of malnutrition on cancer treatment

• Poor response to therapy
• Increased treatment related toxicity
• Reduced survival
• Increased mortality risk
• Reduced quality of life

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Food First.
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Texture Modified Diets
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Oral Nutritional Support

• Food fortification
• Dietary counselling
• Prescribed oral nutritional supplements
• Compliance is critical to the efficacy of oral
  nutritional support

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• Artificial Nutritional Support

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Nasogastric and Stomogastric
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Patient Comfort
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Pump feeding
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Bolus feeding
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PRIMARY GASTROSTOMY PLACEMENT

• PEG
• Endoscopy
• Risk of transfer of bacteria and abnormal cells
• May be difficult to remove

• RIG
• Inflation of stomach
• X ray
• Risk of referred pain
• Easily removed
• PIG ( hybrid)
• Per- oral image guided gastrostomy

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CONSIDERATIONS WITH GASTROSTOMIES

• Consented Procedure
• Early displacement of tube
• Peritonitis
• Bacterial contamination
• Limiting medical conditions eg ascites/crohns
• Poor healing terminally ill
• Risk low mortality

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Gastrostomy mortality

• The National Confidential Enquiry into Patient
  Outcome and Death (NCEPOD) www.ncepod.org.uk
• 6 (n16648) 2004

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SGH Outcomes 2007
2007 30 day mortality 2.4 ( 1 patient)
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Tumour cell seeding

• Cappel.M.
• Risk factors and risk reduction of malignant
  seeding of the percutaneous endoscopic
  gastrostomy track from pharyngeal malignancy A
  review of all 44 known reported cases
• Am J of gastroenterology 20071021307-11

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Gastric Metastasis

• 100 pharyngeal,laryngeal or oesophagus
• 98 SCC
• Staged T3 T4
• 98 endoscopic (pull technique)
• 69 placed pre chemo/XRT
• ? Natural tumor shredding

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Nutritional Care Plans

• Assessment
• Set realistic and achievable goals
• Follow the patient journey
• Monitor individual responses to nutrition and
  cancer treatments
• Provide follow up
• Use other resources eg. mcmillan nurses,MDT
• Patient centred

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Outcome

• Curative may require further nutritional advice
  on lifestyle and eating plan
• MDT Rehabilitation Dental restoration , Speech
  and Language and Physio therapy
• Palliative ethical issues may need to be
  considered around feeding

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Quality of life