Value of a nutritional store for patients with advanced carcinoma of the head and neck

Background and objective. Patients with advanced head and neck cancer often suffer from malnutrition even before the start of therapy. Hence, the dema nd for nutritional support increases particularly before and during radioch emotherapy. Though nutritional therapy has been shown to substantially impr ove individual outcome, neither the criteria for patient candidacy nor the indications for therapeutic intervention have been established. We performe d a retrospective analysis to determine the indications for nutritional sup port and <0 evaluate the benefits of measures actually taken against malnut rition before and during radiochemotherapy as well as perioperatively. Patients/methods. Data taken from a prospective study for the evaluation of oral mucositis during radiochemotherapy was analysed retrospectively. To c alculate the indication for nutritional support,a nutritional scoring syste m (Hackl) was employed for the first time,which contained biochemical and a nthropometric parameters as well as the period of starvation. The results w e re then compared to a nutritional support program implemented by the subj ective examinations of the attending physician. Results. Changes in body weight and body mass index (BMI) remained the most impressive parameters. Catabolic metabolism developed preoperatively and a significant loss of whole-body protein followed surgical therapy. Clinical ly, the results of the nutritional score correlated with the observation of malnutrition. Furthermore, our findings suggest that nutritional therapy w as commonly delayed until late in the clinical course. Conclusion. The results indicate the necessity of objective and reproducibl e diagnosis and control of malnutrition. The scoring system used may provid e a useful and yet simple tool for assessing individual indications for tim ely nutritional support.