Feasibility study of smartphone application for self-monitoring dietary intake among cancer patients

Objective: Evidence accumulates that optimal nutrition status positively influences cancer treatment outcomes. A "smartphone application" (intelligent dietitian support apps, iDSA) was developed to act as a tool to assist patients in terms of dietary monitoring. This study aimed to examine the feasibility of iDSA for self-monitoring dietary intake among cancer patients. Method: This was a pilot study. Eligible patients were approached and recruited. Dietitian entered individual estimated energy protein requirement into iDSA after installation. Participants recorded and monitored own daily dietary intake. Dietitian arranged for a two-week follow up to monitor nutritional status (weight and dietary intake). Results: This study enrolled 14 participants, six males and eight females, with a mean age of 36.4 ± 10.1 years. iDSA improved participants’ nutritional outcomes significantly; weight gained 1.2 ± 0.2 kg, increased energy intake 215 ± 100 kcal/day and protein intake 8 ± 5.1 g/day. There were 92.9% of participants agreed or totally agreed that they were able to monitor and increase dietary intake during using iDSA. However, about 57.1% reported that it was burdensome to record their diet daily and sometimes they forgot to record their food intake. Conclusion: Self-monitoring dietary intake via intelligent dietitian support apps was feasible among cancer patients. With compliance to iDSA resulted in an increase in dietary intake and body weight after two-week. iDSA usability was rated good and can be used to study dietary intake among cancer patients

Changes in nutrition impact symptoms, nutritional and functional status among head and neck cancer patients receiving radiotherapy or chemoradiotherapy at selected hospitals

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the primary treatment for head and neck cancer (HNC). Any loss of weight during RT or CCRT will result in inconsistent radiation to the target region, which may decrease treatment efficacy. The study aimed to determine the changes in nutritional impact symptoms (NIS), nutritional and functional status and their associations with weight loss during treatment (RT or CCRT). This is an observational prospective study with weekly dietitian follow up HNC patients throughout the seven weeks of treatment; NIS, nutritional and functional status of patients were assessed along the treatment. The study subjects were HNC patients who hospitalized undergoing treatment at the National Cancer Institute, Putrajaya. Nutritional status was assessed with the Patient Generated Subjective Global Assessment (PG-SGA) at the baseline and end of the treatment. Head and Neck Symptoms Checklist (HNSC©) evaluated weekly NIS, 24-hour diet recall determined weekly dietary intake and Jamar Dynamometer measured weekly functional status of handgrip strength. Information on sociodemographic and clinical characteristics of the patients was obtained using a structured questionnaire. Data collection was done from March to December 2018. Primary analysis of dietary intake was conducted with Nutritionist Pro software. Statistical data analysis of changes over time was conducted with general linear model of repeated measures using IBM SPSS version 23. Fifty HNC patients, including 39 males (78%) and 11 (22%) females were recruited during data collection. The median age of HNC patients were 60 years old and the age range was 21 to 78 years old. At the end of treatment, the mean weight loss was 4.53 ± 2.87 kg (7.4%) and all patients were malnourished, where 32% were moderately malnourished and 68% were severely malnourished. Muscle mass decreased starting from week 4 (p = 0.002); fat mass and dietary intake decreased starting from week 3 (p=0.022; p <0.001); while oral nutritional supplements (ONS) intake increased from week 3 (p <0.001). At the end of treatment, all HNC patients had xerostomia, altered taste and required ONS. The weight loss percentage was significantly related to change in NIS scores (r = 0.434, p =0.002), indicating the higher NIS score difference during treatment in HNC patients, the greater weight loss percentage. A significant relationship between changes in total energy intake with weight loss percentage was found (r = 0.297, p = 0.036). It can be concluded that intensive nutrition intervention should began before the week 3 of treatment due to a significant change in muscle mass and fat mass. A minimum ONS recommendation of 500kcal starting at baseline, 800kcal at week 2, 1000 kcal at week 3, 1300kcal at week 4, and 1500kcal from week 5 until the end of treatment, by considering any NIS that interferes with eating. A routine biweekly nutrition intervention with NIS monitoring and ONS recommendation is suggested based on the results. Further research by implementing recommendation above should be done in intervention study to improve effectiveness of treatment outcomes by prevent high percentage of weight loss during treatment

Changes in nutrition impact symptoms, nutritional and functional status during head and neck cancer treatment

Background: The purpose of this study is to evaluate changes in nutrition impact symptoms (NIS) and nutritional and functional status that occur throughout radiotherapy in head and neck cancer (HNC) patients. Methods: A prospective observational study of HNC inpatients who underwent radiotherapy with or without chemotherapy were recruited to participate. Fifty patients were followed for the periods before, in the middle and at the end of radiotherapy. Nutritional parameters were collected throughout radiotherapy. Results: According to Patient-Generated Subjective Global Assessment (PG-SGA), there was an increase from a baseline of 56% malnourished HNC patients to 100% malnourished with mean weight loss of 4.53 ± 0.41kg (7.39%) at the end of radiotherapy. Nutritional parameters such as muscle mass, fat mass, body mass index, dietary energy and protein intake decrease significantly (p < 0.0001) while NIS score, energy and protein intake from oral nutritional supplements (ONS) increased significantly (p < 0.0001). Hand grip strength did not differ significantly. All HNC patients experienced taste changes and dry mouth that required ONS at the end of treatment. ONS compliance affected the percentage of weight loss (p = 0.013). Conclusions: The intensive nutritional care time point was the middle of RT. The PG-SGA and NIS checklist are useful for monitoring nutrition for HNC patients

Weight loss in post-chemoradiotherapy head and neck cancer patients

Background: Weight loss is well-known among head and neck (HNC) patients during radiotherapy and could continue after the treatment is completed. Weight monitoring is essential for treatment outcomes and cancer surveillance. The purpose of the study is to evaluate the weight loss during and post-treatment among HNC patients. Methods: A total of 45 out of 50 patients post-treatment were included in this secondary treatment. Data were collected at baseline, at the completion of radiotherapy and one month after completion of radiotherapy. Results: The mean weight loss was 4.53 ± 2.87 kg (7.4%) during treatment and 1.38 ± 2.65 kg (2.1%) post-treatment. There were significant improvements one month after completion of radiotherapy in Patient-Generated Subjective Global Assessment (PGSGA), muscle mass, nutrition impact symptoms (NIS) score, energy and protein from oral intake (p < 0.0001). Energy and protein from oral nutritional supplements (ONS) decreased significantly (p < 0.0001). Conclusions: The results of this study underline the importance of early identification and monitoring post-treatment in HNC patients. The post-treatment recovery stage is very important for HNC patients to ensure a healing process

Weight Loss in Post-Chemoradiotherapy Head and Neck Cancer Patients

Background: Weight loss is well-known among head and neck (HNC) patients during radiotherapy and could continue after the treatment is completed. Weight monitoring is essential for treatment outcomes and cancer surveillance. The purpose of the study is to evaluate the weight loss during and post-treatment among HNC patients. Methods: A total of 45 out of 50 patients post-treatment were included in this secondary treatment. Data were collected at baseline, at the completion of radiotherapy and one month after completion of radiotherapy. Results: The mean weight loss was 4.53 &plusmn; 2.87 kg (7.4%) during treatment and 1.38 &plusmn; 2.65 kg (2.1%) post-treatment. There were significant improvements one month after completion of radiotherapy in Patient-Generated Subjective Global Assessment (PGSGA), muscle mass, nutrition impact symptoms (NIS) score, energy and protein from oral intake (p &lt; 0.0001). Energy and protein from oral nutritional supplements (ONS) decreased significantly (p &lt; 0.0001). Conclusions: The results of this study underline the importance of early identification and monitoring post-treatment in HNC patients. The post-treatment recovery stage is very important for HNC patients to ensure a healing process

Factors associated with malnutrition among head and neck cancer in-patients before radiotherapy in National Cancer Institute, Putrajaya

Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes