Introduction Pre 2009 head and neck cancer (HNC) patients requiring enteral tube feeding during radical (chemo)radiotherapy at our regional cancer centre were admitted reactively in a nutritional “crisis” and fed via a nasogastric(NG) tube.1 Audit resulted in a 1-year service improvement grant for a Specialist Dietitian to proactively support HNC patients “from pre-treatment until rehabilitation is complete”.2 The aim of this 1-year (2009–2010) two-phase prospective project was to reduce nutrition related crisis admissions, malnutrition and refeeding syndrome, thereby reducing length of hospital stay (LOS) from an average of 13 days1 while aiming to improve patient experience and outcome.
Methods Phase1 (9 months): All patients with HNC (squamous cell carcinoma) were included. Nutritional status (MUST score), %weight loss and swallow ability was recorded for all patients before, during and after radiotherapy treatment. Patients were admitted reactively with inadequate nutritional intake and/or 5% weight loss. Interim review of phase 1 highlighted that oral cavity, oropharyngeal, nasopharyngeal, hypopharyngeal carcinomas and unknown primary tumours were at nutritional risk from weeks 2 and 3 of radiotherapy, leading to reactive admissions for NG feeding. Phase 2 (3 months) involved patients with these tumours admitted electively for NG feeding in week 3 radiotherapy. All admitted patients were followed up for 6 months.
Results Refeeding risk, number of days until nutritionally fit and LOS were all significantly reduced in phase 2 compared to phase 1.
Conclusion This data demonstrates that when appropriately funded, a specialist dietetic service working as part of a multidisciplinary team in HNC, by electively admitting high nutritional risk patients for NG feeding, can significantly reduce clinical risk and costs. As a result of clinical benefits and cost savings our Trust made the service improvement funding substantive.
Competing interests None declared.
References 1. Sheth CH, Sharp S, Walters E. A two year audit of enteral feeding in head and neck cancer patients receiving radiotherapy or chemoradiotherapy treatment at a UK Cancer Centre. 2011. Article submitted for publication.
2. National Institute for Clinical Excellence. Improving Outcomes for Head & Neck Cancer. London: NICE, 2004.