Abstract:
Background: Patients with head-and-neck cancer (HNC) often require some form of enteral feeding during their treatment due either to the presence of the tumor or as a result of radiation treatment (RT). Because of the catabolic nature of the disease and severe consequences of the radiation treatment, many patients benefit from enteral nutrition (EN). This improves the nutritional status of the patient and allows the patient to continue with their treatments. Studies have identified clinical predictors associated with the decision to initiate EN, but there is a dearth of information regarding demographic correlates. Objective: The purpose of this study was to identify whether demographic variables, such as age, gender, religious affiliation, marital status, and ethnicity of patients with HNC are predictors of the decision to initiate EN feedings. Methods: A retrospective chart review of 123 patients with HNC was conducted. Patients were excluded if there was no information of RT, EN initiation prior to the start of RT, or no primary diagnosis of HNC. Demographic information, anthropometrics, and enteral feeding initiation date were recorded from the Registered Dietitian and oncologist’s notes. Percent body weight loss was calculated from the recorded weights at four points throughout the treatment. Results were analyzed with Spearman’s correlation, chi square tests, Mann-U Whitney Tests, and linear regression models. Results: Religious affiliation, weight change from diagnosis to RT completion, and weight change from the start to completion of RT were the only significant predictors of EN initiation (p=0.008; p=0.01; p=0.001). Age, ethnicity, and marital status were not related to EN initiation or the timing of EN initiation. Conclusions: Religious affiliation and weight loss were significant predictors of EN initiation. Because of an informal guideline internal to the cancer treatment center monitoring and recommending EN to patients with >5% weight loss, bias was reduced. Therefore, policies that are based on percent body weight loss may be helpful in reducing EN placement bias.
