Causes of nutrition deficit during immediate postoperative period after free flap surgery for cancer of the head and neck

Adequate calorie and protein administration via enteral nutrition may contribute to improved 30-day survival in patients with solid tumors at nutritional risk

BACKGROUND

Patients with cancer receiving adequate enteral nutrition (EN) have improved clinical outcomes. Unfortunately, discrepancies may exist between the amounts prescribed and received. This study aimed to investigate: (1) the receiving exclusive EN, (2) the relationship between inadequacy and unfavorable outcomes, and (3) the impact of inadequate EN administration on the survival of patients with cancer.

METHODS

This study included hospitalized patients with solid tumors who exclusively received EN and were evaluated using data extracted from electronic medical records. Nutritional risk was evaluated using Nutritional Risk Screening (NRS - 2002). EN adequacy was assessed from days 3-7 of hospitalization. Calorie and protein delivery by EN was classified as adequate (≥80 % of EN administration) or inadequate (<80 % of EN administration). Data were analyzed using dispersion and Bland-Altman plots, Pearson's chi-square and Fisher's exact tests, and Kaplan-Meier survival curves.

RESULTS

A total of 114 patients were evaluated (63.9 ± 13.1 years of age, 67.5 % male, 32.5 % with head and neck cancer, and 86.8 % at nutritional risk). During the 5-day evaluation period, only 14 % of the patients received the mean volume, proteins, and calories according to the EN prescription. A relationship was observed between inadequate EN (<80 %) and 30-day in-hospital mortality. This result was confirmed by Kaplan-Meier survival analysis (p = 0.020), which showed a survival benefit in patients at nutritional risk who received adequate calories and protein.

CONCLUSION

This study demonstrated significant caloric and protein deficits related with EN. Furthermore, adequate calorie and protein administration could contribute to improved survival in patients with cancer who are at a risk of malnutrition, however, randomized controlled trials are required to confirm whether adequate calorie administration could contribute to improved survival.

Body image distress among cancer patients: needs for psychosocial intervention development

Objectives

This study examines the body image distress among patients with head and neck cancer (HNC) visiting a tertiary care hospital for follow-ups.

Design

A cross-sectional survey purposively enrolled 170 head and neck cancer (HNC) patients who had undergone cancer surgery at a newly established tertiary care hospital, North India.

Methods

A structured pre-tested socio-demographic and clinical profile checklist and the Derriford Appearance Scale-24 (DAS-24) were used to collect information. An appropriate descriptive and inferential statistic was applied to compute the findings.

Results

The median age of the participants was 46.0 years, and 80% of the participants were unemployed. The mean body image distress score was 57.95 (SD = 10.3, 47–66.75, range 42–77). The body image distress shows a significant association with age (p < .001), gender (p = 0.003), and working status (p = 0.032) of the HNC patients. Multilinear regression reported gender as an independent predictor (95% CI: 0.615–8.646, p = 0.025) for body image distress in HNC patients.

Conclusions

HNC patients reported substantial body image distress due to changes in body appearance. Female patients who had undergone surgery at young age reported higher body image distress. Recommending cosmetic surgery and nurse-led psychosocial nursing intervention on routine follow-ups are other potential strategies to improve facial appearance to overcome the negative impact of body image.