Perioperative Immunonutrition in Head and Neck Cancer

Purpose: The purpose of this study was to establish the feasibility of providing perioperative IMN support to HNCA patients in a regional referral center. Secondly, the study examined nutritional, immunologic, and wound-healing outcomes.

Design: A prospective, blinded, randomized design was used for this study.

Sample: Fourteen patients with HNCA received either an IMN formula (treatment group, TG) or a standard stress formula (control group, CG) for a period of 7 days pre- and post-operatively.

Methods: Nutritional assessment was performed by an RD using the Patient-Generated Subjective Global Assessment (PG-SGA) tool and a risk score was assigned. Albumin and prealbumin were measured at baseline, day of surgery (DOS), and postoperative days (POD) 1, 4, and 8. Immunologic outcomes included C-reactive protein (CRP) and total lymphocyte count with lymphocyte subset counts (CD3, CD4, CD8, CD4:CD8 ratio, CD19, CD56) at baseline, DOS, and POD1, 4, and 8. Wound healing was assessed using the ASEPSIS tool and photographic images. Infectious complications and length of stay were documented.

Analysis: Independent t tests were used to compare baseline values between groups. Using baseline values as the covariate, ANCOVAs were used to look for differences between groups in all biochemical parameters. Frequencies and means are reported for PG-SGA Score and Nutritional Risk Score; Fisher's exact test and t tests were used to calculate probabilities.

Findings: Demographics of the two groups did not vary at baseline. The average age of the 14 male subjects was 60.6 years, the most common tumor type and location was squamous cell carcinoma of the oropharynx and tongue, with 50% of tumors staged as III or IV. The majority of patients consumed >= 75% of their preoperative supplement. Nutritional and immunologic outcomes were similar in both groups with an immediate suppression following surgery and a rebound toward baseline levels beginning POD 4 and continuing through POD 8. This trend was evident in almost all parameters and has been reported previously in similar clinical trials. CD56 natural killer cell counts revealed less suppression on POD 1 in the treatment group (p = .02). In general, wounds healed without complications except for tracheal-esophageal fistula development in two patients in the CG. Hospital mean LOS was 6.4 days for the TG and 16.7 days for the CG, a clinically significant outcome in today's health care environment.

Nursing Implications: The trend toward less immune suppression in patients receiving IMN is supported by other recent studies. A lower risk for infectious complications and a shorter hospital stay means patients will be able to begin adjuvant therapies such as chemotherapy and radiation treatment sooner in hopes of achieving a cure for their cancer.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2008112222.xhtml