Aims:
To describe contemporary nutrition care practices and outcomes in patients with head and neck cancer (HNC) undergoing radiotherapy (RT), a decade after implementation of an evidence-based nutrition model of care.
Methods:
A retrospective audit of consecutive patients receiving curative-intent adjuvant or definitive RT ± systemic therapy at a quaternary HNC centre (January 2023-December 2024) was undertaken. Patient, tumour and treatment characteristics; evidence-based guideline (EBG)-recommended nutrition care processes, interventions, clinical outcomes and health service utilisation were extracted from electronic medical records into REDCap. Adherence to EBG recommendations was classified as met (≥80%), partially met (50–<80%) or not met (<50%). Descriptive statistics summarised practices and outcomes, while comparative analyses assessed associated clinical and service factors.
Results:
The cohort comprised 151 patients (74% male, mean (SD) age 62 (15) years, 78% stage III-IV). Common tumour sites were oral cavity (36%), oropharynx (25%) and nasopharynx (12%). Treatment included adjuvant RT (32%), definitive chemoRT (30%) and adjuvant chemoRT (15%). EBG adherence was met for early nutrition assessment (91.4%) and partially met for weekly review (58.3%) with high weekly coverage (78-94%). Validated nutrition assessment tool use was met at baseline (81%) but not mid-RT (31%) or end-RT (45%). Enteral nutrition was required by 39% (85% prophylactic gastrostomy). Median (Q1, Q3) weight change (%) was -6 (-10, -2) during RT and -8 (-13, -4) by third review post-RT. Advanced disease stage and malnutrition were associated with increased service utilisation (IRR 1.50 and 1.59–2.93, respectively; both p<0.001). Unplanned admission occurred in 21% (11% nutrition/hydration-related); those admitted required more dietetic occasions of service: median (Q1, Q3) 16 (10, 22) versus 12 (8, 17).
Conclusion:
Contemporary nutrition care demonstrated high adherence to EBG-recommended early assessment, use of validated nutrition assessment and responsive service delivery according to need, while identifying areas for service improvement during and following RT.