DC ORAL 4 - DELIVERING QUALITY NUTRITION CARE FOR HEAD AND NECK CANCER PATIENT Jee Cheng Ooi

Jee Cheng Ooi1

 

1Sunway Medical Centre

 

Assessment

A middle-aged Chinese Malaysian businessman with normal body mass index (BMI) commenced on concurrent chemoradiation therapy (CCRT) 6 weeks following his extensive partial right glossectomy due to Stage 4 oral tongue cancer. Patient is known to have hyperlidemia and he was an ex-smoker. At the start of CCRT, patient was referred by oncologist to dietitian and speech, language and swallowing therapist (SLT) for optimisation of nutrition care and oral intake.

 

Diagnosis

Inadequate protein energy intake related to increased nutrients need during CCRT and swallowing difficulty as evidenced by existing oral intake only meeting 60% and 64% of estimated energy and protein requirements respectively.

 

Intervention

A nutrition plan consisted of high energy and high protein diet advice was given to the patient with flexibility to modify the texture and consistency of food and drinks to cope better with the side effects from his cancer treatment. At week 3, due to worsening of his mucositis, eventually full liquid diet comprising of adequate amount of oral nutrition supplementation (ONS) is used to help patient meet his nutritional needs when other textures and consistencies are no longer tolerable. Texture and consistency food and drinks were modified based on SLT’s suggestion.

 

Monitoring & Evaluation

Changes in anthropometric, biochemical, clinical, dietary and functional data were closely reviewed and nutrition prescription is adjusted on a weekly basisto minimise weight loss and disturbances to patient’s cancer treatment. Nutrition management is then continued beyond the acute treatment phase to assist patient with the possible long term side effects from CCRT.