Nutrition and Dietetics, University of Queensland, St Lucia, QLD, Australia.
Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
J Hum Nutr Diet. 2022 Feb;35(1):223-233. doi: 10.1111/jhn.12919. Epub 2021 Jun 18.
Head and neck cancers (HNC) are strongly associated with malnutrition. This systematic review aimed to investigate the optimal frequency of individualised nutrition counselling (INC) pre-, peri- and post-treatment for patients with HNC.
Pubmed, EMBASE, Cinahl and Scopus were searched from inception through to April 2020 to identify randomised controlled trials (RCTs) that focused on the INC frequency for adult patients with HNC (Registration no. 178868). The outcomes assessed were nutritional status, dietary intake, weight change, treatment interruptions, unplanned hospital admissions, quality of life, complications and morbidity. Certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE).
Four RCTs were identified with five papers (n = 500 total participants). The certainty of evidence was 'high' for nutritional status and quality of life, 'moderate' for treatment interruptions and unplanned hospital admissions, and 'low' for percentage weight change, complications/morbidity and dietary intake. Compared to control groups, there were consistent improvements for nutritional status, quality of life, treatment interruptions, unplanned hospital admissions, dietary intake, percentage weight change and morbidity when weekly INC was provided peri-treatment and fortnightly INC was provided post-treatment. No statistical significance was found for treatment interruptions, dietary intake and weight change when INC was provided fortnightly peri-treatment only. There were no RCTs in the current review that offered INC pre-treatment.
This systematic review shows beneficial effects with weekly INC peri-treatment and fortnightly INC post-treatment for patients with HNC in all outcomes studied. Future research should focus on models of care to address the optimal frequency of pre-treatment INC as well as the duration of post-treatment INC.
头颈部癌症（HNC）与营养不良密切相关。本系统评价旨在探讨 HNC 患者治疗前、治疗中和治疗后个体化营养咨询（INC）的最佳频率。
从建库至 2020 年 4 月，通过 Pubmed、EMBASE、Cinahl 和 Scopus 检索随机对照试验（RCT），以确定针对 HNC 成年患者 INC 频率的 RCT（注册号：178868）。评估的结局包括营养状况、饮食摄入、体重变化、治疗中断、非计划住院、生活质量、并发症和发病率。使用推荐、评估、开发和评估（GRADE）等级评估证据确定性。
确定了 4 项 RCT，共涉及 5 篇论文（共 500 名参与者）。营养状况和生活质量的证据确定性为“高”，治疗中断和非计划住院的证据确定性为“中”，体重变化百分比、并发症/发病率和饮食摄入的证据确定性为“低”。与对照组相比，在治疗期间每周提供 INC，治疗后每两周提供 INC 时，营养状况、生活质量、治疗中断、非计划住院、饮食摄入、体重变化百分比和发病率均有持续改善。仅在治疗期间每两周提供 INC 时，治疗中断、饮食摄入和体重变化无统计学意义。目前的综述中没有 RCT 提供 INC 治疗前。
本系统评价表明，治疗期间每周提供 INC 和治疗后每两周提供 INC 对 HNC 患者所有研究结局均有益。未来的研究应侧重于提供护理模式，以确定 INC 治疗前的最佳频率以及 INC 治疗后的持续时间。
