Prevalence of side-effects and change in nutritional status duringradical radiotherapy for head and neck malignancies at TygerbergAcademic Hospital, Western Cape, South Africa

[摘要] BackgroundThis study aimed to define the prevalence of side-effects and the change in weight andBMI during radical radiotherapy for head and neck malignancies (HNM) at TygerbergAcademic Hospital (TBH), Western Cape, South Africa. Acute side-effects maydelay or prevent the delivery of a complete curative radiotherapy dose. Weight losshas been shown to significantly worsen prognosis and increase prevalence oftreatment complications. However, weight maintenance may lead to beneficialoutcomes. Assessing the impact of radical radiotherapy on patients with HNM istherefore critical and can promote development and implementation of medical andnutritional interventions.MethodsPatients were weighed before and weekly during radiotherapy. Blood was drawnbefore, during and at the end of radiotherapy so that the Prognostic Inflammatory andNutritional Index (PINI) could be calculated. Selected clinical data, clinical grades ofmucositis and the diagnosis of a fungal infection of the oral cavity were extractedfrom clinical records. The McMaster Head and Neck Radiotherapy Questionnaire anda Lifestyle and Dietary Questionnaire were administered weekly. Descriptivestatistics and the following were used: ANOVA, Repeated Measures ANOVA andMcNemar Chi-square tests.ResultsThirty-eight patients were recruited and 21 completed the study. Follow-up occurredover a maximum of nine weeks. A decrease in the weight (p = 0.01) and BMI (p =0.01) and increase in the PINI (p = 0.04) occurred during radiotherapy. The meanabsolute weight loss was 3.2kg (4.8), the mean percentage weight loss was 4.5% (6.7)and the mean decrease in BMI was 1.2kg/m2 (1.8). There was an increase in theprevalence of malnutrition (p = 0.02), as defined in this study. Oral mucositisoccurred in all participants from Week 4; the majority developing Grade II or IIIMucositis. Fungal infection of the oral cavity was prevalent throughout radiotherapy,with the highest prevalence (30%) in Week 4. Increases in severity of symptomsrelated to the mouth (p = 0.0000), throat (p = 0.05) and skin domains (p = 0.0000) occurred. Fifty-nine percent of inpatients and 45% of outpatients were prescribedsupplementation drinks and most participants reported that a dietitian had notconsulted them, in each week of radiotherapy.DiscussionSevere side-effects in the mouth, throat and skin were experienced and a decline innutritional status was observed. The poor nutritional status prior to commencing andweight loss during radiotherapy could have increased the severity of side-effects. Theinduction of the acute phase response indicated that this could have contributed to thedecline in nutritional status observed. In addition, the infrequent nutritional support islikely to have further contributed to the lack of weight maintenance.ConclusionThis first study conducted in South Africa has demonstrated the prevalence ofsignificant side-effects and change in weight and BMI in this patient population. It isrecommended that more effective analgesic medication is prescribed and thatmeasures are taken to improve oral hygiene of participants to prevent fungal infectionof the oral cavity. Improved nutritional support in terms of regular dietetic follow-upof all patients and more frequent prescription of supplementation drinks duringradiotherapy is also recommended.

[发布机构] Stellenbosch University