{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:52:19Z","timestamp":1793656339283,"version":"4.5.1"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"S2","license":[{"start":{"date-parts":[[2016,5,12]],"date-time":"2016-05-12T00:00:00Z","timestamp":1463011200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2016,5]]},"abstract":"Abstract<\/jats:title>\n Nutritional support and intervention is an integral component of head and neck cancer management. Patients can be malnourished at presentation, and the majority of patients undergoing treatment for head and neck cancer will need nutritional support. This paper summarises aspects of nutritional considerations for this patient group and provides recommendations for the practising clinician.<\/jats:p>\n \n Recommendations<\/jats:title>\n \u2022 A specialist dietitian should be part of the multidisciplinary team for treating head and neck cancer patients throughout the continuum of care as frequent dietetic contact has been shown to have enhanced outcomes. (R)<\/jats:p>\n \u2022 Patients with head and neck cancer should be nutritionally screened using a validated screening tool at diagnosis and then repeated at intervals through each stage of treatment. (R)<\/jats:p>\n \u2022 Patients at high risk should be referred to the dietitian for early intervention. (R)<\/jats:p>\n \u2022 Offer treatment for malnutrition and appropriate nutrition support without delay given the adverse impact on clinical, patient reported and financial outcomes. (R)<\/jats:p>\n \u2022 Use a validated nutrition assessment tool (e.g. scored Patient Generated\u2013Subjective Global Assessment or Subjective Global Assessment) to assess nutritional status. (R)<\/jats:p>\n \u2022 Offer pre-treatment assessment prior to any treatment as intervention aims to improve, maintain or reduce decline in nutritional status of head and neck cancer patients who have malnutrition or are at risk of malnutrition. (G)<\/jats:p>\n \u2022 Patients identified as well-nourished at baseline but whose treatment may impact on their future nutritional status should receive dietetic assessment and intervention at any stage of the pathway. (G)<\/jats:p>\n \u2022 Aim for energy intakes of at least 30 kcal\/kg\/day. As energy requirements may be elevated post-operatively, monitor weight and adjust intake as required. (R)<\/jats:p>\n \u2022 Aim for energy and protein intakes of at least 30 kcal\/kg\/day and 1.2 g protein\/kg\/day in patients receiving radiotherapy or chemoradiotherapy. Patients should have their weight and nutritional intake monitored regularly to determine whether their energy requirements are being met. (R)<\/jats:p>\n \u2022 Perform nutritional assessment of cancer patients frequently. (G)<\/jats:p>\n \u2022 Initiate nutritional intervention early when deficits are detected. (G)<\/jats:p>\n \u2022 Integrate measures to modulate cancer cachexia changes into the nutritional management. (G)<\/jats:p>\n \u2022 Start nutritional therapy if undernutrition already exists or if it is anticipated that the patient will be unable to eat for more than 7 days. Enteral nutrition should also be started if an inadequate food intake (60 per cent of estimated energy expenditure) is anticipated for more than 10 days. (R)<\/jats:p>\n \u2022 Use standard polymeric feed. (G)<\/jats:p>\n \u2022 Consider gastrostomy insertion if long-term tube feeding is necessary (greater than four weeks). (R)<\/jats:p>\n \u2022 Monitor nutritional parameters regularly throughout the patient's cancer journey. (G)<\/jats:p>\n \u2022 Pre-operative:<\/jats:p>\n \u25cb Patients with severe nutritional risk should receive nutrition support for 10\u201314 days prior to major surgery even if surgery has to be delayed. (R)<\/jats:p>\n \u25cb Consider carbohydrate loading in patients undergoing head and neck surgery. (R)<\/jats:p>\n \u2022 Post-operative:<\/jats:p>\n \u25cb Initiate tube feeding within 24 hours of surgery. (R)<\/jats:p>\n \u25cb Consider early oral feeding after primary laryngectomy. (R)<\/jats:p>\n \u2022 Chyle Leak:<\/jats:p>\n \u25cb Confirm chyle leak by analysis of drainage fluid for triglycerides and chylomicrons. (R)<\/jats:p>\n \u25cb Commence nutritional intervention with fat free or medium chain triglyceride nutritional supplements either orally or via a feeding tube. (R)<\/jats:p>\n \u25cb Consider parenteral nutrition in severe cases when drainage volume is consistently high. (G)<\/jats:p>\n \u2022 Weekly dietetic intervention is offered for all patients undergoing radiotherapy treatment to prevent weight loss, increase intake and reduce treatments interruptions. (R)<\/jats:p>\n \u2022 Offer prophylactic tube feeding as part of locally agreed guidelines, where oral nutrition is inadequate. (R)<\/jats:p>\n \u2022 Offer nutritional intervention (dietary counselling and\/or supplements) for up to three months after treatment. (R)<\/jats:p>\n \u2022 Patients who have completed their rehabilitation and are disease free should be offered healthy eating advice as part of a health and wellbeing clinic. (G)<\/jats:p>\n \u2022 Quality of life parameters including nutritional and swallowing, should be measured at diagnosis and at regular intervals post-treatment. (G)<\/jats:p>\n <\/jats:sec>","DOI":"10.1017\/s0022215116000402","type":"journal-article","created":{"date-parts":[[2016,5,12]],"date-time":"2016-05-12T06:37:06Z","timestamp":1463035026000},"page":"S32-S40","source":"Crossref","is-referenced-by-count":286,"title":["Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines"],"prefix":"10.1017","volume":"130","author":[{"given":"B","family":"Talwar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Donnelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Skelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Donaldson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,12]]},"reference":[{"key":"S0022215116000402_ref18","first-page":"12","article-title":"Nutritional management of chyle leaks: an update","volume":"94","author":"McRay","year":"2011","journal-title":"Pract Gastroenterol"},{"key":"S0022215116000402_ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-009-0717-0"},{"key":"S0022215116000402_ref17","doi-asserted-by":"publisher","DOI":"10.1177\/0884533608323424"},{"key":"S0022215116000402_ref3","doi-asserted-by":"publisher","DOI":"10.1177\/0003489414523564"},{"key":"S0022215116000402_ref7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a301"},{"key":"S0022215116000402_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20221"},{"key":"S0022215116000402_ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-009-0686-3"},{"key":"S0022215116000402_ref6","unstructured":"Radbruch L , Elsner F , Trottenberg P , Strasser F , Fearon K. 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