C. Claunch1, R. Neuberger2, A. N. Chavana2, P. Pathak3, H. Shepard4, A. S. Mohamed5, and A. N. Hanania6; 1Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 2Baylor College of Medicine, Houston, TX, 3Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, 4Harris Health System, Houston, TX, 5Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Radiation Oncology, Dan. L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
Purpose/Objective(s): Head and neck cancer (HNC) patients with decreased muscle mass, or sarcopenia, exhibit worse survival and tumor control and impaired tolerance to radiotherapy (RT) and chemotherapy toxicity. Our aim was to determine the clinical impact of active, weekly nutritional intervention by a registered dietitian (RD) during RT on-treatment visits (OTVs) Materials/
Methods: We performed a retrospective, single-institution cohort study in a high-volume safety net healthcare system where most patients are racially diverse, under-represented and uninsured. We abstracted data from an intervention cohort from (September 2022 to August 2023) following the adoption of weekly RD visits during the OTVs in our radiation center. Feeding tube (FT) use during RT and 6 months following treatment, absolute weight loss, BMI, RT intent, stage, subsite, age, radiation intent and survival were analyzed. Patients were matched for similar clinical characteristics to historical patients without RD intervention based on age, overall stage, cancer subsite, HPV status and radiation intent and in a reverse chronological order. Patients with metastatic disease, another active cancer, no follow-up data or who did not complete radiotherapy were excluded. Differences were calculated using Mann-Whitney, chi-squared or Fishers exact test when appropriate. Results: A total of 66 patients were included in this study. Cohorts were confirmed to not be significantly different with respect to age, cancer subsite, overall stage, HPV status, radiation intent (p>0.10). Mean radiation dose was 6627 cGy (IQR:6000-7000) and 6459 cGy (IQR:6000-7000) in the control versus intervention groups, respectively. FTs were utilized in 82.8% and 78.4% of the total control and dietitian intervention population, respectively (NS). FT use persisted at 6 months in 95.8% versus 75.9% of patients who had a FT at time of treatment in the control versus intervention group (p=0.047). Absolute weight loss and changes in body mass index were not significantly different between the cohorts. Conclusion: HNC patients who underwent radiotherapy without RD intervention had a 20% greater need for ongoing enteral support by FT at six months from treatment, suggestive of greater toxicity, compared to a matched cohort of patients who underwent weekly RD intervention during OTVs. Strategies to improve multi-disciplinary care of patients with RDs in RT clinics are necessary to optimize treatment outcomes.
