Perioperative immunonutrition in head and neck cancer: a feasibility study
McCarthy, Mary Agnes Smith
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Problem. Head and neck cancer (HNCA) has one of the highest associated mortality rates of all cancers. Immune-modulating nutrition (IMN) support before and after surgery has the potential to promote host defense, antitumor activities, and wound healing.Aims. The aim of this study was to establish the feasibility of providing perioperative IMN support to HNCA patients in a regional referral center. Recent studies have demonstrated that perioperative IMN support results in enhanced cell-mediated immunity, decreased infectious complications, and shortened postoperative hospital stay. Secondary aims will examine nutritional, immunologic, and wound healing outcomes.Design. This pilot study used a prospective, blinded, randomized design.Methods. Twelve patients with HNCA received either an IMN formula (Impact RecoverRTM/Impact GlutamineRTM ; TG) or a standard stress formula (Isosource 1.5RTM; CG) for a period of 7 days pre- and post-operatively. Nutritional outcomes, albumin and prealbumin, were measured at baseline and 4 later time points. Immunologic outcomes were measured by DTH skin testing twice, and TLC and lymphocyte subset counts at 5 time points. Wound healing was assessed using the ASEPSIS scoring tool and infectious complications were documented when present.Results. Perioperative nutrition support was favorably accepted by patients and staff. Subjects did not vary in demographics at baseline except for C-reactive protein (CRP) levels; BMI (M=22; SD=3.8), % weight loss (M=9.1; SD=9.3), nutritional risk (M=2.27; SD=.65), and CRP (TG 6.87 + 8.3 vs. CG 39.5 + 13.8, p=.02). Based on diary entries the majority of patients consumed ≥75% of their preoperative nutritional supplement. CD56 (Natural Killer cells) demonstrated a more rapid return to baseline on POD 1 in the TG (p=.02). Wounds in the TG had less serous drainage and erythema on POD 3 (p=.05), POD 5 (p<.0001), and POD 6 (p=.01). Hospital LOS was considerably longer (TG M=5.7, CG M=14.7; p=0.04) in the CG; feeding issues postoperatively may have contributed to this outcome.Conclusions. This pilot study provided crucial information regarding preoperative interventions, timing of biomarkers, and measurement of outcomes that can be used for planning a multisite RCT of perioperative immunonutrition for any surgical population vulnerable to nutritional and immunologic compromise.
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