Nutritional status among head and neck cancer patients at Muhimbili National Hospital

Abstract

Background: Studying nutrition in cancer patients is a challenging task. Some of the issues brought by this subject were related to socioeconomic status of patient which influences access to food. Therefore, before one concludes that cancer is the culprit to malnutrition one had to rule out access to food as a factor. Head and Neck region is involved with intake and initial processing of the food. Therefore, presence of tumor in any subsite has a direct effect on nutritional status of the patient. HNC has been shown to be associated poor nutritional status since the first presentation of patients to health facility. Aim: This study aimed to establish nutritional adequacy among HNC patients accessing services at ENT department at MNH. Materials and Methods: This was cross sectional descriptive involving all HNC patients attended at MNH ENT department from 1st August,2020 to 31st January,2021.The study collected background information about access to food i.e. with the use of Dietary Screening Tool(DST) and later nutrition was measured by anthropometric measurements(weight and height) and biochemical test(serum albumin levels).The later was used to compute Nutritional Risk Index obtained by the formula Nutritional Risk Index=(1.519 X serum albumin, g/L) + 0.417 X (present weight/usual weight x 100). A Nutritional Risk Index>100 indicated that the patient is not malnourished, 97.5–100 indicated mild malnourishment, 83.5-<97.5 indicated moderate malnourishment and <83.5 indicated severe malnourishment. After data collection the later was checked for correctness by running frequency tables and analyzed by SPSS version 26. Results: The study involved a total of 113 participants. Age ranged from 15 to 93 years old with mean age of 51.81+/-17.439 years. There were 74 males and 39 female making a ratio of 1.9:1. Majority of participants were having Laryngeal tumor (46%), followed by sinonasal and Hypopharygeal tumor which made 24% and 15% respectively. Significant proportion of patients (85.6%) in the study had an advanced disease(Stage III& IV)+, with stage IV involving more than half of participants (52.2%).Stage I disease only involved 1.8% of participants. About 17% of patients presented to MNH with a pre-existing dietary risk i.e. DST score of less than 60 points. This study found that 36.3% of patients had severe malnourishment at presentation as they scored less than 83.5 points based on NRI score. Highest percentage of malnutrition was found in Oropharyngeal tumor (75%),followed closely by Hypopharyngeal and Nasopharyngeal tumor each with 66.7%.The difference was however not significant( χ2 =27.577 P=.069).Stage IV patients were severely malnourished in greatest percentages and this finding was significant(57.6%) χ2 =64.414 P=.000 Conclusion: Laryngeal tumor has been shown to be more common in men and is much related to an advanced age. Most of patients with HNC had severe malnourishment at presentation. Poor nutrition prior to disease predisposes HNC patients to severe malnourishment during illness. Recommendation: Health care practitioners should address patients with HNC tumors with care by providing adequate nutritional support as required. The public should have tendency to good dietary behaviors as this practice has impact on disease state. Again literature links good diet to promotion of immunity against various pathologies including HNC. There’s a role of health practitioners and ministry of health to educate the public against late attendance to health facilities when the disease is at an advanced stage.