From Medscape Medical News
Zosia Chustecka
April 22, 2009 (Denver, Colorado)
quote:

AACR 2009: Diet, Nutrition, and Cancer — Don't Trust Any Single Study


Numerous studies on diet and cancer were presented here at the American Association for Cancer Research (AACR) 100th Annual Meeting, but several of the findings that were highlighted in AACR press releases — and thus are likely to be picked up by the lay media — run counter to the accumulated body of evidence, and some of the comments based on these studies are untrue or premature. So said Walter Willet, MD, DrPH, from the department of nutrition at Harvard School of Public Health, in Boston, Massachusetts, in an exclusive interview with Medscape Oncology.

"No conclusions should be made on the basis of a single study," he said.

Dr. Willett presented an overview entitled "Diet, Nutrition, and Cancer: The Search for Truth," in which he reviewed many of the associations that have been suggested by epidemiologic studies. These include consumption of red meat, meat cooked at a high temperature, a high-fat diet, and alcohol all increasing the risk, and fruit and vegetables decreasing the risk. However, much of the evidence for these links is rather weak, he said; the most robust evidence supports a link between obesity and an increased risk for cancer.

"The estimate that diet contributes to around 30% to 35% of cancers is still reasonable," Dr. Willet said, "but much of this is related to being overweight and inactive."

"At this point in time, being overweight is second only to smoking as a clear and avoidable cause of cancer," he said. "People should stay as lean as they can, recognizing that it is more difficult for some than for others."

Beyond this clear message about obesity, there are only hints from the rest of the data. One of the main limitations of all of the studies so far is that they have looked at a specific time of life — for example, women after menopause — and they have had fairly short follow-ups, often less than 10 years. "So what we are looking at are little slices of life," Dr. Willet said, whereas the effect of diet is lifelong, and might be particularly important in the years before adulthood (e.g., during adolescence).

Barbequing and Other High-Temperature Cooking

One suspect that has been extensively studied as potentially increasing the risk for cancer is the high-temperature cooking of meat, such as barbequing, grilling, frying, and roasting, during which the meat is charred and can form carcinogens.

"But after more than 30 years of study, this link has not been refuted or confirmed in any clear way," Dr. Willet commented. "If there was a strong association we would have seen it by now, but we cannot exclude a mild or moderate effect."

One of the studies highlighted in an ACCR press release suggests that charred meat increases the risk for pancreatic cancer. The finding comes from a prospective analysis of 62,581 participants of the Prostate, Lung, Colorectal, and Ovarian multicenter screening trial, and was presented by Kristin Anderson, PhD, associate professor at the University of Minnesota School of Public Health, in Minneapolis. Her team looked at 208 cases of pancreatic cancer, and found that individuals who preferred very well done steak were almost 60% more likely to develop pancreatic cancer than those who ate their steak less well done or who did not eat steak at all. When the researchers considered overall consumption and doneness preferences, this rose to a 70% higher risk for pancreatic cancer.

"We cannot say with absolute certainty that the risk is increased due to carcinogens formed in burned meat," Dr. Andersen said in the AACR press release. "However, those who enjoy either fried or barbequed meat should consider turning down the heat or cutting off the burned portions when it's finished."

Dr. Anderson also advised "cooking meat sufficiently to kill bacteria without charring," and microwaving meat for a few minutes and pouring off the juices before cooking it on the grill to reduce the precursors of cancer-causing compounds.

But Dr. Willet said that these are very specific recommendations, and "I just don't think that this is appropriate on the basis of a single study."

Alcohol — Even 1 Glass Might Increase Risk

For alcohol, there have now been dozens of studies showing an increase in the risk for breast cancer, even with very low levels of consumption, "so this is now an established relationship," Dr. Willet said in his talk.

It's been known for a long time that alcohol increases the risk for cancers of the upper aerodigestive organs, but this is at high levels of consumption (around 3 or 4 glasses a day), he told Medscape Oncology. "What's unique about breast cancer is that the risk is increased at very modest levels of consumption," he said.

"There is strong evidence that even 1 glass a day can cause a small but significant increase in the risk of breast cancer," he said. A recent study from the United Kingdom suggests that the risk for many different cancers is increased with even 1 drink a day, and that the risk increases in a dose-dependent fashion, as reported by Medscape Oncology.

So the finding from another study highlighted by the AACR, that "drinking wine may increase survival among non-Hodgkin's lymphoma patients," is somewhat surprising. "This conclusion is controversial," admits first author Xuesong Han, a doctoral candidate at the Yale School of Public Health, in New Haven, Connecticut. "However, we are continually seeing a link between wine and positive outcomes in many cancers," she noted in the AACR press release.

"This is not true," said Dr. Willet. There have been benefits shown consistently for cardiovascular disease, but not for cancer, he told Medscape Oncology.

The study conducted by Han and colleagues involved 546 women with non-Hodgkin's lymphoma. Those who drank wine had a 5-year survival rate of 76%, and those who did not had a 5-year survival rate of 65%. In a subanalysis, the researchers found that the strongest link was seen in patients with diffuse large B-cell lymphoma. These patients had a 40% to 50% reduced risk for death, relapse, or secondary cancer.

The researchers also asked the patients about their wine-drinking habits in the 25 years before their diagnosis. In the overall group, patients who had been drinking wine at least this long had a 25% to 35% reduced risk for death, relapse, or cancer, whereas in the subgroup of patients with large B-cell lymphoma, this reduction was 60%.

"We cannot look at this 1 study is isolation," said Dr. Willet.

Specific Foods and Anticancer Effects

So far, there have been no specific foodstuffs that have been identified as having proven anticancer effects, Dr. Willet told Medscape Oncology.

Even the case for eating more fruit and vegetables, a message widely promulgated by many authorities, including the World Cancer Research Fund, is fairly weak when it comes to cancer. There have been studies showing a decrease in the risk for colon and breast cancer, but other studies have shown insignificant or no appreciable effects, Dr. Willet told the meeting. A 2004 meta-analysis by Hsin-Chia Hung and colleagues concluded that eating more fruits and vegetables decreases the risk for cardiovascular disease, but not the risk for cancer (J Natl Cancer Inst. 2004;96:1577-1584).

"So the message to eat fruits and vegetables is still a good message, but there appears to be more benefit for cardiovascular disease than for cancer," he said.

In that context, the claim made in another AACR press release, that "walnuts may prevent breast cancer" is premature, especially because it is based on an animal study, Dr. Willet said. The study was conducted in a mouse model of breast cancer, and mice fed a diet estimated to contain the human equivalent of 2 ounces of walnuts per day showed a significant decrease in the incidence of tumors, a significant decrease in tumor size, and a delay in the development of these tumors by about 3 weeks..

Lead researcher Elaine Hardman, PhD, associate professor of medicine at Marshall University School of Medicine, in Huntington, West Virginia, said: "It is clear that walnuts contribute to a healthy diet that can reduce breast cancer."

"That's a premature leap, that's for sure," said Dr. Willet.

Maybe the only foodstuff that does have some evidence suggesting a preventive anticancer effect is soy products. Its antiestrogen properties might protect against prostate cancer in men and against breast cancer in women, especially in premenstrual women, Dr. Willet noted. "But this is not yet in the category of convincing — it's possible," he said.

Dr. Willet has disclosed no relevant financial relationships.

American Association for Cancer Research (AACR) 100th Annual Meeting: Abstracts LB-224, LB-243, and LB-247. Presented April 21, 2009.
Original Post
Hi Dr Joshi,

I read your post with interest. There have been a lot of literature on the link between nutrition and cancer. There's one doctor in the hospital in Alor Star where I was treated who strongly advocate cancer patients turning vegetarian. He is so much against taking animal based food. Does it mean that there's no point in changing your diet where cancer is concerned?

Another thing, was there any mention of the blood acidity or alkalinity in relation to cancer?

Thanx Dr Joshi

Sharifah
Was reading through these posts looking for recipes and this article interested me. I would just like to add to Sharifahs reply that I had been vegetarian for the past 21 years prior to my diagnosis. (I also drink very occasionally and have never smoked) I was reading a macro biotic cookery book recently and although I took it with a pinch of salt I did read that vegetarians leave them selves exposed to getting cancer due to not having the right amount of vitamin B12 in their bodies. Personally I have come to the conclusion that when we are born we are all given a cancer lottery ticket, If we choose to smoke, drink etc we get extra tickets and we can take steps to reduce the risks but in the end someones number has to come out.
I agree. The truth is that @*#& happens and for some poor souls it happens in spades. I think we all have to be vigilant for any signs of disease (whatever it might be), do our best to stay healthy. If we choose to do the things that are said to put us at risk then we have to take it on the chin if we find ourselves with a diagnosis we aren't happy with. Being alive is the first risk factor and anything after that puts you in the crosswires.
I think the trick is to count our blessings and make the most of everything because there are no guarantees we will be in the line when they are next handed out!
A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer
Martin R. Chasen and Ravi Bhargava
from Supportive Care in Cancer, Volume 17, Number 11 / November, 2009
quote:


Abstract
Introduction Malnutrition has been known to be associated with adverse outcomes in cancer patients. Patients who have been and/or are being treated for head and neck cancer have a compromised nutritional status. Nutritional deficits have a significant impact on mortality, morbidity, and quality of life.
Discussion The wasting in cancer cachexia involves loss of muscle and fat and reflects a catabolic metabolism induced by an abnormal host response to tumor presence and/or tumor factors. Disturbances of various physiological functions like taste, smell, dysphagia, xerostomia apart from cachexia can contribute to long-term nutritional complications and outcome.
Conclusion Improved management of patients in posttreatment for head and neck cancer may require a multimodal approach by a multidisciplinary team and is best commenced earlier in the trajectory of the disease.

Introduction
Patients who have been and/or are being treated for head and neck cancer have a compromised nutritional status. Nutritional deficits have a significant impact on mortality, morbidity, and quality of life in patients with cancer. An overall 3-year survival of 55% and a disease-specific survival of 61% were found for patients with advanced head and neck cancer. Evidence shows that many persons in this population continue to experience sequelae of their treatment for months to years afterwards that are life altering. Most of these quality-of-life studies report clinically significant changes in perceived quality-of-life scores at 3, 6, and 12 months. Persons who have shorter survival times have lower quality of life and potentially more suffering than persons with longer survival. More than 50% of patients with advanced head and neck cancer have a markedly impaired nutrition and a significant involuntary weight loss at the time of diagnosis and before beginning treatment. Progressive depletion of lean body mass, muscle wasting, edema, and decline in motor and mental functions are also noted at the time of diagnosis. During the course of treatment, severe weight loss has been observed in up to 58% of patients in the absence of intensive nutrition support. Chronic dysphagia has been reported to occur in 12–69% of patients 6–9 months following treatment. In another study by Ward et al. 3 years after surgery, 42% of laryngectomy and 50% of pharyngolaryngectomy patients experienced long-term dysphagia leading to nutritional deficits and requiring a modification of their diet or tube feeding. Chronic xerostomia, which also impairs swallowing, can occur in patients up to 5 years after treatment.

Of the six important nutritional indicators, viz. percentage of weight loss, percentage of ideal body weight, nutrition index, serum albumin, total lymphocyte count, and body fat (20–67% range of abnormal scores), the one which has emerged as the most powerful predictor of major postoperative complications is a weight loss of >10% in the 6 months before surgery. An early prospective study of 114 patients showed that 38% with a nutritional deficit had a 2-year survival of only 7.5% compared with over 57% in the remainder of the cohort [13]. This manuscript will review both altered physiology in patients with head and neck cancers and the clinical consequences of those changes.

Physiological functions and changes that contribute to long-term nutritional complications

Taste and smell
The four modalities of taste (salt, sour, bitter, and sweet) are mediated via taste buds, which are present predominantly on the tongue. Studies have shown that the tip of the tongue is most sensitive to sweet or salty stimuli, whereas the lateral edges and posterior aspects of the tongue respond predominantly to sour and bitter substances, respectively. However, it is now known that all four taste qualities can be perceived in all areas of the tongue and palate where taste buds are located. The taste sensation in patients with head and neck cancer can be affected by antineoplastic drugs, e.g., cisplatin, carboplatin, 5-fluorouracil, and methotrexate. Since taste and olfactory receptors proliferate rapidly (every 10 and 30 days, respectively), they too may be sensitive to the cytotoxic effects of chemotherapy. This leads to not only altered smell but taste as well. Hypogeusia is a most common complaint in which patients describe a generalized loss of flavor. Dysguesia is an altered taste sensation that may be either heightened or suppressed.

Some patients will complain of a bitter taste during administration of the cytotoxic drug. Although such taste changes may last for a few hours to several days, there have been reports of these changes lasting for weeks or months. For example, 77% of patients treated with cisplatin experienced a metallic taste, which lasted for a few hours to 3 weeks. Many patients develop food aversions or loss of taste sensation due to radiation-induced damage to the taste buds. Radiation-induced salivary gland dysfunction also affects dentition and taste. It can be a factor in poor nutrition as a result of reduced tolerance to various food textures, temperatures, and acidities. The effect of radiation on taste in one of the study shows that taste loss was significantly associated with the proportion of tongue contained within the radiation treatment field. These data are in agreement with that of Conger and Wells, who suggested that taste loss is related more to area of tongue irradiated than of mouth dryness. Several investigators have observed complete recovery of taste function in patients 1–3 months after treatment while others like Schwartz et al. investigated the upper limit of taste detection thresholds from 6 months to 19 years (median, 2.4 years) after completing radiotherapy (RT; total radiation dose range, 36–72 Gy; median, 60 Gy) in 15 patients with head and neck cancer [4, 22–24]. They observed a return of nearly normal suprathreshold taste intensity perception. In contrast, others have not observed complete recovery of taste function in patients. Mossman et al. indicated that impairment of taste function may persist in some patients up to 7 years after RT and concluded that curative intent of RT for tumors of the head and neck may result in long-term changes in taste function. The complicated process of smelling begins when molecules released by the substances stimulate special nerve cells in the nose. These cells transmit messages to the brain, where specific smells are identified. Altered smell (dysosmia) during or after the administration of antineoplastic drugs is thought to occur as a result of the compound diffusing from the nasal capillaries to the olfactory receptors. Low doses of radiation have also been found to affect the olfactory system. Olfactory loss resulting from the direct toxic effects of radiation therapy may take over 6 months to resolve.

Oral mucosa and saliva
Saliva is important in preparing food for mastication, for swallowing, and for normal taste perception. Without saliva, mealtimes are difficult, uncomfortable, and embarrassing. The parotid salivary glands produce the majority (60–65%) of the oral salivary output. Radiation to the head and neck regions can cause xerostomia (dryness of mouth due to dysfunction of the salivary gland), stomatitis (inflammation of oral tissue, mucosa, dentition, and periodontium), anorexia, nausea/vomiting, and pain from mucosal ulcerations. Xerostomia may become progressively worse during and after treatment. Even a low dose of radiation can cause a change in the quantity and quality of saliva, and up to 100% of patients who undergo RT for head and neck cancer develop some degree of xerostomia. The symptoms of radiation-induced xerostomia are often permanent and lead to difficulty in mastication and swallowing. Other consequences include stomatitis, taste dysfunction, and increased susceptibility to dental caries. In addition, thick ropey secretions may interfere with food intake. These side effects can be severe. They occur in the majority of patients who undergo chemoradiation (CR) treatment for head and neck cancer during or after treatment and these problems limit a patient’s ability to eat in the long term and also affects the quality of life of patients. A recent study of oropharyngeal cancer patients revealed that reduction in saliva production continued for well over 1 year after chemoradiation therapy. Although the reduction of saliva production observed in this study did not correlate with inefficient swallowing, it did change patients’ perceptions of their ability to swallow. Xerostomia and/or altered taste perception may predispose the patient to decreased nutritional intake for many months after treatment. This further worsens the prognosis of the cachectic cancer patient .

Swallowing/dysphagia
The bolus of food or drink in the oropharynx sets off a chain reaction beginning with relaxation of the upper esophageal sphincter followed by waves of coordinated peristalsis that propels the bolus to the lower esophagus and then through a relaxed lower esophagogastric sphincter into the stomach. Extrinsic and intrinsic innervations, smooth muscle properties (response to distension), and humoral properties are all involved in the coordination of this event.

Dysphagia implies disruption in the swallowing process during bolus transport from the oral cavity to the stomach and is considered as the most common nutrition-related problem resulting from head and neck cancer and its therapy. Dysphagia may be caused by surgical ablation of muscular and nervous structures or may be attributable to the effects of antineoplastic agents including radiation and/or chemotherapy. The severity of the swallowing deficit is dependent on the size and location of the lesion, the degree and extent of surgical resection, and the nature of reconstruction and/or the side effects of medical treatments.

In a study by Ekberg and Nylander, five patients treated with radiotherapy were studied 1 year or more after completion of radiation therapy. These patients exhibited significant changes in pharyngeal peristalsis, presumably related to decreased flexibility in the pharyngeal constrictors because of increased fibrosis. As a result of the reduced peristalsis, patients exhibit residual food in the pharynx after the swallow and a tendency to inhale this residue into the airway after the swallow. Reduced pharyngeal peristalsis can become severe enough that it is difficult for the patients to move any food other than liquid through the pharynx and into the esophagus. The critical dose level of radiation, beyond which these permanent and long-term effects on the pharynx are created, has not been defined. The only patient in the Ekberg study who exhibited normal swallowing after radiation therapy had received less than 3,000 rads. It is reported that combined CR can increase the nutritional risk due to the combined toxicities of the two modalities and their effects on swallowing. In one report, 76% of patients with head and neck cancer treated with RT or CR therapy had significant mucositis, and 87% had significant dysphagia 1 month after beginning chemoradiation. In another report, over 40% of head and neck cancer patients continued to have dysphagia 3 years after surgery and radiation treatments. Esophageal strictures following chemoradiation occurs in 3.4–14% of head and neck cancer patients. The strictures can cause partial or complete obstruction of the esophagus. Compromised quality of life, anxiety, and depression are correlated with the severity of dysphagia as well as the patient perception of swallowing difficulties.

Cachexia
Cancer cachexia is defined by an aberrant energy and protein balance driven by a variable combination of reduced food intake and hypermetabolism. Over its course, cachexia is associated with functional impairment and fatigue. A key defining feature is ongoing loss of skeletal muscle mass which is not fully reversed by conventional nutritional support. Cachexia is classified depending on its cause as either primary or secondary. Primary cachexia is principally caused by a tumor-induced chronic inflammation involving aberrant cytokine and prostaglandin activation. Consequences include anorexia and poor food intake mediated through the effect of cytokines on the hypothalamus. Secondary cachexia stems from problems that may not be related to chronic inflammation; these problems impact on nourishment and must be identified.

The pathogenesis of cachexia is not simply an imbalance between energy intake and expenditure. Cachectic cancer patients have been shown to consume as many as 3,200 kJ (800 cal) less per day than patients without cachexia. However, the provision of energy alone in the cachectic patient does not result in weight gain, as demonstrated by the ineffectiveness of conventional nutrition support. People who are starved preserve muscle and weight is lost preferentially in the fat component of the body. Patients with cachexia, however, lose weight both in the muscle and fat component of the body. Weight loss in starvation, as encountered in some cancer patients with gastrointestinal obstructions is reversible by enteral and/or parenteral feeding, whereas no such techniques can currently reverse primary cancer cachexia.

Primary cachexia is the least understood cause of weight loss, and yet it is responsible for the greatest morbidity among patients with head and neck cancer. Secondary cachexia in patients with head and neck cancer is a multifactorial malnutrition. Firstly, the site of the primary tumor may mechanically obstruct the aerodigestive tract or cause odynophagia or dysphagia. Secondly, head and neck cancer patients may have underlying chronic malnutrition at presentation due to alcohol, tobacco abuse, and poor nutritional habits. Finally, treatment-related toxicities, such as radiation exposure to the aerodigestive tract and chemotherapeutic agents, may further impair the patient’s ability to obtain adequate nutrition due to mucositis or xerostomia. Contributors to secondary cachexia are discussed at length in other sections.

Psychological effects of nutritional compromise on quality of life[/b]
Patients with head and neck cancers who undergo surgery often report considerable psychological and emotional distress with impaired social functioning and experience malnutrition due to a decreased ability to ingest food. Difficulties with eating, chewing, and swallowing as well as changes in taste, smell, and drooling are all reported to play a major role in impairing the nutritional status of the patients after the treatment of head and neck cancer. This can lead to social isolation and reticence to eat with other people. When these alterations are severe, they do contribute to eating problems, weight loss and an altered perception of body image. In addition, cachexia can also lead to mental depression, lower quality of life, and a change in self-image.

Poor psychosocial status also affects the appetite and impacts long-term well-being of the patients. Such findings have been replicated in other studies, which demonstrate that anxiety and depression is also experienced by approximately 30% to 40% of patients following treatment for head and neck cancer. Malnutrition has also been linked to depression in several studies. One outcome of emotional distress is suicide, with Boulnd noting that patients with head and neck cancer form a relatively large proportion of suicide cases in cancer patients. This has also been acknowledged by Farberow et al., who concluded that two head and neck sites alone (tongue and pharynx) accounted for almost 20% of the total suicides among male patients with cancer. None of these studies have indicated that malnutrition alone was the cause of suicide but it certainly played a role among the constellation of symptoms that lead to this devastating outcome.

While psychosocial dysfunction is often the major concern for patients with head and neck cancer, relatively limited, systematic, and prospective investigation has been performed, and, therefore, little progress has been made to develop an effective rehabilitation program to enhance the quality of life for this group of patients.

Many patients with advanced head and neck cancer have percutaneous endoscopic gastrostomy (PEG) placed as a part of their therapeutic interventions [67] and it is appropriate therefore to discuss this topic.

PEG placement and long-term complications in patients with potentially curable disease
PEG tubes, first described by Gauderer et al. in 1980, are able to provide nutritional support in patients unable to feed orally. PEG placement is technically simple and can be performed in an outpatient setting. Compared with PEG tubes, radiologically placed gastrostomies often have inferior tube function and surgically placed tubes are associated with high morbidity and mortality. PEG tubes have been placed in head and neck cancer patients, with a success rate of 95% to 98%.

PEGs may be inserted because of the following reasons:

  • 1. Major causes of malnutrition during and after radiotherapy are painful mucosal inflammation of the oral cavity and pharynx, xerostomia, and taste alterations. In addition, severe mucositis normally occurs between 3 and 5 weeks after a dose of 30–50 Gy during a radiotherapy regimen with standard fractionation (single dose of 2 Gy, five fractions weekly). Chemotherapy can lead to severe mucositis up to 10 days after its application, depending on the substances used and their toxicity to the mucous membrane.
  • 2. Specific tumor-induced anorexia and metabolic dysfunction such as accelerated catabolism contribute to further deterioration of the nutritional state Piquet et al. suggest that the main objectives in providing nutritional support in this group of patients with head and neck cancer are to prevent or correct nutritional deficiencies and to achieve and maintain a desirable weight.

The complication rate of PEG placement is 4.9–10.8%. Infections at the PEG site occur in about 6% of patients. PEGs are suitable for long-term enteral nutritional support. If cared for properly, PEG tubes are durable, with an average longevity of approximately 1–2 years. Complications associated with long-term home enteral nutrition include diarrhea, constipation, leakage from the fistula tract, tube site infection, tube dislodgement, and tube clogging. In a study of 210 patients receiving PEG feeding (head and neck cancer accounting for 70% of the malignant diseases in the group), 21.9% had minor gastrointestinal problems (vomiting, diarrhea, constipation), which resolved after conservative management. In another study of patients receiving home PEG feedings (16% with head and neck cancer), 51% had no complications during the period of enteral support (mean 175 days). PEG site infections usually resolved with antibiotics. Patients with more severe PEG complications, e.g., embedded bumper, may require hospitalization. Variable hospitalization rates have been reported in the literature, ranging from 1% to 40%. Complication rates have fallen as expertise in gastrostomy insertion has improved. Patients who experience long-term difficulties with feeding require continued enteral feeding beyond the immediate treatment period. The duration of PEG dependence in this population varies according to the chronicity of dysphagia. In one of the reports, PEG tubes placed in head and neck cancer patients before RT were used for a median of 165 days. Another study, evaluating 36 patients treated with chemoradiation, reported a median duration of PEG use of 7 months. In a further study of 82 patients, 72% required enteral support for 1 year. It is noted however that, in up to 24% of patients receiving long-term enteral tube feedings, oral intake was resumed with a discontinuation of home enteral nutrition.

In some patients, dysphagia may persist long after eradication of the underlying cancer. Permanent enteral nutrition is then required to provide adequate nutrition and hydration. It is estimated that 10% of long-term head and neck cancer survivors require permanent enteral nutrition. Various studies demonstrate that the early use of enteral feedings during head and neck cancer treatment reduces weight loss, dehydration, malnutrition, and the associated need for hospitalization. An early prospective study of 114 patients showed that 38% with a nutritional deficit had a 2-year survival of only 7.5% compared with over 57% in the remainder of the cohort. Home enteral nutrition by PEG infusion has been well received by patients, with 80% reporting a positive experience. A prospective study of 212 head and neck cancer patients assigned to oral feeding vs. PEG feeding before RT demonstrated improvements in quality of life among those receiving enteral nutrition support. The quality-of-life scores in the oral nutrition group deteriorated during RT and showed only slow improvement after therapy, whereas the PEG-fed group maintained their quality of life. Another prospective study confirmed these findings that enteral nutrition improves the quality of life in patients with dysphagia.

Treatment
Treatment of malnutrition in patients with head and neck cancer is supportive in nature and directed against a specific cause and prevention such as minimizing the volume and dose of radiation or adequate adjunctive measures such as analgesia for pain which could facilitate swallowing in patients with painful stomatitis. Different nutrition supplementations used and anticachectic agents may also play a role in alleviating some of the factors that contribute to nutritional compromise. Details fall outside the scope of this article. A very important component of treatment not discussed here is the value of the cancer rehabilitation team which includes physician, nurse, dietician, psychologist, and others health care professionals whose aim is to empower individuals who are experiencing loss of function, fatigue, malnutrition, psychological distress, and other symptoms as a result of cancer or its treatment to improve their own quality of life.

Conclusion
Nutritional compromise severely impacts on the short- and long-term outcome of patients with head and neck cancers. Many of the above-mentioned mechanisms which lead to the development of these long-term alterations of normal physiology are caused by the effects of the cancer and/or the different treatments on the normal physiology.

Disease control has improved over the past decades as we have started integrating multimodal therapies which are impacting the duration of survival of these patients. Increased acute toxicities have also translated into increased late toxicities which have impacted on the patient’s ability to maintain an adequate nutritional intake and acceptable social interaction. The goal for the future must surely be to maintain or improve the long-term mortality of these patients while decreasing their morbidity especially as it relates to nutrition.
Thank you for posting this, Dr Joshi. I found it both encouraging and worrying. I guess I have only been suffering from secondary cachexia, and I'm pleased about that; but it is still worrying enough. However since I am improving, I am going to assume that I am not on the death list from cachexia issues.
Hey Guys you know that there are a few nutritional concerns with cancer patients, but this will depend are the needs of each person. If a person is getting rays and radiation,they often reduce their hunger. In this situation, you would need to focus calorie consumption in the meals they do eat.Thanks a lot!!
Hi Brown, I noticed in your first post to the forum that it says you live in the USA but on your posts it says Australia. #confused!!!!!
We have dieticians to advise us on diet when we go through treatment and your advice seems very basic and quite obvious. Are you qualified in any form of cancer care or do you have personal experience of the disease?.
Hagg.
Good Evening Mr Brown,
I noticed that you resurrected a thread last used five and a half years ago (now covered by this reply)to inform us that you like omelettes. Whilst I am sure that most people will find this revelation most uplifting it would, perhaps, be more helpful to give us an answer to Hagg's question concerning your qualification/experience in cancer care and also the question which Dr. Joshi asked about the basis of your advice regarding salt water.
John Spencer

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