Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Background
This study aimed to define the prevalence of side-effects and the change in weight and
BMI during radical radiotherapy for head and neck malignancies (HNM) at Tygerberg
Academic Hospital (TBH), Western Cape, South Africa. Acute side-effects may
delay or prevent the delivery of a complete curative radiotherapy dose. Weight loss
has been shown to significantly worsen prognosis and increase prevalence of
treatment complications. However, weight maintenance may lead to beneficial
outcomes. Assessing the impact of radical radiotherapy on patients with HNM is
therefore critical and can promote development and implementation of medical and
nutritional interventions.
Methods
Patients were weighed before and weekly during radiotherapy. Blood was drawn
before, during and at the end of radiotherapy so that the Prognostic Inflammatory and
Nutritional Index (PINI) could be calculated. Selected clinical data, clinical grades of
mucositis and the diagnosis of a fungal infection of the oral cavity were extracted
from clinical records. The McMaster Head and Neck Radiotherapy Questionnaire and
a Lifestyle and Dietary Questionnaire were administered weekly. Descriptive
statistics and the following were used: ANOVA, Repeated Measures ANOVA and
McNemar Chi-square tests.
Results
Thirty-eight patients were recruited and 21 completed the study. Follow-up occurred
over a maximum of nine weeks. A decrease in the weight (p = 0.01) and BMI (p =
0.01) and increase in the PINI (p = 0.04) occurred during radiotherapy. The mean
absolute weight loss was 3.2kg (4.8), the mean percentage weight loss was 4.5% (6.7)
and the mean decrease in BMI was 1.2kg/m2 (1.8). There was an increase in the
prevalence of malnutrition (p = 0.02), as defined in this study. Oral mucositis
occurred in all participants from Week 4; the majority developing Grade II or III
Mucositis. Fungal infection of the oral cavity was prevalent throughout radiotherapy,
with the highest prevalence (30%) in Week 4. Increases in severity of symptoms
related to the mouth (p = 0.0000), throat (p = 0.05) and skin domains (p = 0.0000) occurred. Fifty-nine percent of inpatients and 45% of outpatients were prescribed
supplementation drinks and most participants reported that a dietitian had not
consulted them, in each week of radiotherapy.
Discussion
Severe side-effects in the mouth, throat and skin were experienced and a decline in
nutritional status was observed. The poor nutritional status prior to commencing and
weight loss during radiotherapy could have increased the severity of side-effects. The
induction of the acute phase response indicated that this could have contributed to the
decline in nutritional status observed. In addition, the infrequent nutritional support is
likely to have further contributed to the lack of weight maintenance.
Conclusion
This first study conducted in South Africa has demonstrated the prevalence of
significant side-effects and change in weight and BMI in this patient population. It is
recommended that more effective analgesic medication is prescribed and that
measures are taken to improve oral hygiene of participants to prevent fungal infection
of the oral cavity. Improved nutritional support in terms of regular dietetic follow-up
of all patients and more frequent prescription of supplementation drinks during
radiotherapy is also recommended.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/3105 |
| Date | 12 1900 |
| Creators | De Pomeroy-Legg, Jeanita |
| Contributors | Labadarios, D., Visser, J., Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Rights | Stellenbosch University |
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