Good clinical practice in nutritional management of head and neck cancer patients

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve th equalit y of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by multidisciplinary group of e xperts, with feedback from specialists in cancer care delivery. objective: To develop clinical practice guidelines according to the definitions of Sta ndards, Options and Recommendations for the nutritional management of the h ead and neck cancer patients. Methods: Data have been identified by literat ure search using Medline and the expert groups personal reference lists. On ce the guidelines were defined, the document was submitted for review to 12 1 independent reviewers, and to the medical committees of the 20 French Can cer Centres. Results: The main recommendations for the nutritional manageme nt of head and neck cancer patients are that: 1) Nutritional management pre vents undernutrition, improves quality of life, reduces adverse effects of the treatment and prevents treatment delay: 2) The nutritional management o f the head and neck cancer patient must be done before, during and after ca ncer treatment: 3) Before treatment, the weight of the patient must be asse ssed: 10% of weight loss in 6 months requires to an urgent nutritional inte rvention: 4) during radiation therapy, feeding should be adapted to various characteristics such as swallowing mechanism, side effects of the treatmen t, age; 5) During chemotherapy, nutrition must be checked and assessed at e ach cycle; 6) During surgery, enteral feeding must be stopped and nasogastr ic feeding progressively introduced starting on day 1 post-operatively. The quality of feed must be adequate during all the healing period. close surv eillance of fever and regurgitation allows regular review of the amount and nature of enteral feed to be given: 7) The patients are given individualis ed and written advice at the end of treatment and the nutritional follow-up must be planned.