Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area

Background: Malnutrition occurs frequently in patients with cancer of the gastrointestinal or head and neck area and can lead to negative outcomes. Objective: To determine the impact of early and intensive nutrition intervention on body weight, body composition, nutritional status, global quality of life and physical function compared to usual practice in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Design: Outpatients commencing at least 20 fractions of radiotherapy to the gastrointestinal or head and neck area were randomised to receive intensive, individualised nutrition counselling by a dietitian using a standard protocol and oral supplements if required, or the usual practice of the centre (general advice and nutrition booklet). Outcome parameters were measured at baseline and four, eight, and twelve weeks after commencing radiotherapy using valid and reliable tools. Results: Sixty patients (51M;9F; mean age 61.9 yr +/- 14.0) were randomised to receive either nutrition intervention (n=29) or usual care (n=31). The nutrition intervention group had statistically smaller deteriorations in weight (p < 0.001), nutritional status (p = 0.020) and global quality of life (p = 0.009) compared with those receiving usual care. Clinically, but not statistically significant differences in fat-free mass were observed between the groups (p = 0.195). Conclusions Early and intensive nutrition intervention appears beneficial in terms of minimising weight loss, deterioration in nutritional status, global quality of life and physical function in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Weight maintenance in this population leads to beneficial outcomes and suggests that this, rather than weight gain, may be a more appropriate aim of nutrition intervention

Admission prevention in COPD:non-pharmacological management

Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the commonest causes of hospital admission in Europe, Australasia, and North America. These adverse events have a large effect on the health status of the patients and impose a heavy burden on healthcare systems. While we acknowledge the contribution of pharmacotherapies to exacerbation prevention, our interpretation of the data is that exacerbations continue to be a major burden to individuals and healthcare systems, therefore, there remains great scope for other therapies to influence exacerbation frequency and preservation of quality of life. In this review, the benefits and limitations of pulmonary rehabilitation, non-invasive ventilation, smoking cessation, and long-term oxygen therapy are discussed. In addition, supported discharge, advanced care coordination, and telehealth programs to improve clinical outcome are reviewed as future directions for the management of COPD. Please see related article: http://www.biomedcentral.com/1741-7015/11/181