Nutritional counseling was insufficient to maintain dietary intake and nutritional status in head and neck cancer patients undergoing radiotherapy: A historical control study for future intervention in China

OBJECTIVE: To determine whether nutritional counseling (NC) affects the dietary intake and nutritional status of head and neck cancer (HNC) patients undergoing radiotherapy (RT) in China. METHODS: This historical control study enrolled 139 HNC patients in the NC group and 146 patients in the control group. Before RT, the latter received usual education about side effects. The former received three sessions (T(1), before RT; T(2), 3 weeks of RT; and T(3), 6 to 7 weeks of RT) of individualized NC. Outcome measures were dietary intake, weight, body composition, and nutritional status. Generalized estimating equation (GEE) models were used to analyze intergroup differences. RESULTS: The NC group had higher energy (P ​< ​0.001) and protein intake (P ​= ​0.003). However, some patients in the NC group still could not reach 60% of the recommended caloric goals (22.3% at T(2) and 32.4% at T(3)) or protein goals (23.0% at T(2) and 27.3% at T(3)). Although the NC group had a lower weight loss rate (β ​= ​−0.555, P ​= ​0.037), they still lost 6.15% ​± ​4.08% of weight at T(3). At T(2), more patients in the control group lost ≥ 5% of weight (26.0% vs 15.8%, P ​= ​0.049). More patients in the control group had malnutrition (P ​= ​0.045), but 77% of the NC group had malnutrition at T(3). CONCLUSIONS: NC could effectively improve dietary intake, weight loss, and malnutrition in HNC patients receiving RT. Nevertheless, only NC was insufficient to maintain adequate intake and well-nourished status. We should adopt intensive nutritional intervention with a multidisciplinary team to enhance patients’ nutritional status.