There is high level evidence to support the role of the dietitian in the multidisciplinary team for the management of patients with head and neck cancer. Several studies have demonstrated the beneficial effects of dietary counselling during radiotherapy treatments, with improvements in weight, nutritional status and quality of life (Garg 2009). Many patients also require nutrition support through tube feeding, however the evidence remains unclear as to the optimal form of tube feeding (Nugent 2010). Prophylactic gastrostomy has been recommended in some patient groups due to the beneficial effects on maintaining nutritional status or weight (Tyldesley et al 1996, Lee et al 1998), as well as other benefits such as improved quality of life (Senft et al 1993) and reduced hospital admissions (Piquet et al 2002, Lee et al 1998). Many of these studies were undertaken in patients receiving radiotherapy alone, and now as chemoradiotherapy treatments become standard of care, the same results for nutrition outcomes in more recent trials are not seen (Silander et al 2010).
At the Royal Brisbane and Women’s Hospital, we are using validated guidelines to predict which patients may require prophylactic gastrostomy, and despite this proactive intervention, we have found that high risk patients can still lose 6-7% of body weight during treatment and up to 9-10% by three months post treatment. Weight loss and malnutrition can impact on the patients’ quality of life, functional ability and other clinical outcomes. Therefore the aim of this research is to investigate novel approaches of nutrition intervention through prophylactic nutrition support and to determine whether early tube feeding improves nutrition outcomes.