1. Mrs. Anjali B. Nair Chief Dietician Tata Cancer Hospital NUTRITION IN HEAD AND NECK CANCER

2. Oral cancer is the sixth most common cancer in the world

3. Head and neck cancer refers to a group of biologically similar cancers originating from the upper aero digestive tract including lip, oral cavity, nasal cavity, paramucosal sinuses, pharynx, larynx, oropharynx and Hypopharynx

4. Cancer of lip Cancer of tongue Cancer of hard palate Cancer of bucal mucosa Cancer of mandible

15. Avoid cooking smell and food with strong odors Have dry meals with drinks taken separately Biscuits, dry toast and cold foods Avoid very sweet and fatly foods Nausea Frequent small quantity and variation in meals Nutritious snacks and drinks between meals Supplementation of high calorie and proteins Anorexia Dietary intervention Symptoms

16. Avoid food that worsen the unpleasant taste mainly because of zinc deficiency Altered taste Small frequent feed with soft and liquid diets with nutritious drinks after food Difficulty in swallowing (Dysphasia) Dietary intervention Symptoms

17. Eat foods that are easy to chew and swallow with cool temperature and soft fruits like bananas stewed apple and peach, cottage cheese, mashed potatoes, scramble eggs, cooked cereals, and milk shakes Mouth sores Eat moist foods with extra sauces, butter or margarine and avoid liquids and food that contain lots of sugars and dry fruit nectar instead of juice Dry Mouth Dietary intervention Symptoms

20. Approach to nutrition support PRETREATMEN T -Nutrition screening, History( weight loss), Physical examination( BMI) , Lab studies(Serum albumin) Malnourished Is therapy intensive Oral supplements NO Moderately or severely malnourished Aggressive nutritional support Is GI tract functional Oral supp or Enteral tube feeding Parenteral nutrition YES NO

21. ROUTES OF FEEDING

23. COMPARISION BETWEEN PRODUCTS Rs 240 Cost Rs 215 546mg K 800mg 360mg Na 500mg 45 gms PRO 41gms 338 kcals ENE 374kcals ACTIBASE NEUTRAL (100gms) RESOURCE HIGH PROTEIN (100gms)

24. Case studies

25. MRS RKT 43 YR/F CA UPPER LIP --- T4 N0 M0 STAGE IV COMPLAINED OF SWELLING IN UPPER LIP ADMITTED TO TMH---24/5/10 DIAG: SPINDLE CELL CARCINOMA BIOCHEMICAL NORMAL EXCEPT FOR Na OPERATED ON 31/5/10 PT ON RT FEEDS SINCE 1/6/10

26. HT: 151CMS WEIGHT: 60KGS BMI:26KG/M2 GRADE I OBESE ENERGY: 30X46(IBW)=1380 +STRESS FACTOR=1450KCALS PROTEINS: 1.5 GM/KG IBW=69GMS CHO:65%=227 GMS FAT:22%=34 GMS

27. HOSPITAL DIET 143 128 GIVEN 1GM SALT 134 Na INTAKE IMPROVED NAUSEA REDUCED WITH FEELING OF FULLNESS SEVERELY NAUSEATED REMARKS 125 128 75 CHO 21.6 20.7 9 FATS 48.2 27.1 7.2 PROT 1157 906 432 ENERGY DAY3(3/6) DAY2(2/6) DAY1(1/6)

29. MRS.SINGH 40/F CA LATERAL BORDER OF TONGUE—T3NOMO SYMP: PAIN WHILE EATING FOOD ADMITTED TO TMH 27/4/10 BIOCHEMICAL NORMAL EXCEPT FOR FLUCTUATING Na OPERATED ON 31/5/10 RT FEEDS STARTED ON 1/6/10

30. HT: 161 CMS WEIGHT:82KG BMI:31.66KG/M2 GRADE II OBESE ENERGY:25KCALS/KG= 1400 PROTEINS: 1.3GM/KG= 73 GMS CHO 65%= 228GMS FATS 15%= 23 GMS

31. HOSPITAL DIET 134 -- 134 Na INTAKE PROPER COCONUT WATER=SWEETLIME JUICE SO LESS OF BLEND FEEDS TAKEN ½ RT FEEDS AS NAUSEATED REMARKS 171 141 57 CHO 44 38.5 20 FATS 72 68 32.6 PROT 1541 1278 554 ENERGY DAY3(3/6) DAY2(2/6) DAY1(1/6)