CASE STUDIES
Preventing Malnutrition in Head and Neck Cancer Treatment
The Background
Head and neck cancer treatments can be brutal.
Surgery can be disfiguring and damage a patient's ability to swallow. Chemotherapy can be nauseating and reduce appetite. Radiotherapy can cause taste changes, pain and mucositis. When all this is occurring in the mouth and throat, it's not surprising that up to 80% of head and neck cancer patients become malnourished during treatment. Unfortunately this can lead to worse side effects, poorer recovery and increased mortality.
These deaths are preventable
“I had no idea it would be this hard”
- QLD Oropharyngeal Cancer Patient
“We could keep them going, if they would just do what we recommended”
The Problem
Dietitians working in oncology have effective treatments to prevent malnutrition and dehydration. However the treatments require significant behavioural intervention for the patient to overcome pain, nausea, lack of appetite and significant discomfort. Unfortunately many patients are not able to overcome these issues and die as a result of complications of malnutrition rather than the cancer.
What Worked
We developed Eating As Treatment (EAT), a complex behaviour change intervention developed specifically for dietitians aiming to change the behaviour of head and neck cancer patients receiving radiotherapy.
Dietitians around Australia were trained in EAT and integrated it into their clinical practice.
It took no extra time and was cheap to implement. Training an entire department was cheaper than inserting one PEG feeding tube.
The Result
EAT worked. Clinician's changed the way they interacted with patients, and patients changed their eating behaviours. They had better nutrition, lost less weight, were less depressed and improved their quality of life. Importantly, they also had less interruptions to their radiotherapy.
EAT was a major success and was published in the number one journal in Radiation Oncology. It has led to several refinements, iterations and new collaborations. It is still our most requested intervention from hospitals and clinicians around the world.
References:
https://doi.org/10.1016/j.ijrobp.2018.09.027