Nutritional assessment in Oral cancer patients and nutritional factors associated for postop morbidity

Progress report.

Aim/Objectives –

To assess nutritional statusamong patients with Oral cancer and to know the nutritional factors responsiblefor post op morbidity.

 Methodology-

This was a prospectiveobservational study. A total of 100 patients fulfilling the inclusion criteriai.e. Patient diagnosed with oral squamous cell cancer between 18 to 70 Yearsand planned for curative intent of treatment in form of surgery were includedin the study after obtaining the informed consent form. The clinical,Nutritional, laboratory and physical parameters were evaluated. The physicalparameters analysed in the study were Performance status, Percentage of bodyweight loss, Body mass index (BMI), triceps skin fold thickness (TST), mid-armcircumference (MAC). Laboratory parameters considered were Haemoglobin %,haematocrit, RBC count and total leucocyte count (TLC), Serum albumin, SerumTotal Protein, Serum Urea, serum uric acid, serum AST & ALT.Nutritional parameters were calculated like Prognostic Nutritional Index Wealso calculated Nutritional Risk Index(NRI). In addition patients were assessedfor comorbidities of patient using the preoperative ASA grade, the Charlson’scomorbidity index score and the risk of post-surgical complications wereestimated using the ACS-NSQIP risk calculator. Also, using the FRAIL scale thefrailty index was recorded in nominal scale preoperatively and postoperativelyafter 28 days of surgery. Duration of hospital stay postoperatively,intraoperative blood loss and type of reconstruction were also evaluated. Thepost-surgical morbidity were graded using Clavein dindo’s morbidity gradesafter 7 and 28 days postoperatively. The post-operative morbidity was recordedas early (7days) as well as late (28 days) complication encountered in ourstudy. The correlation was done for the nutritional status directly affectingmorbidity and was also analysed for any indirect correlation. Comorbiditiesfrailty index and surgical risk index calculator used to predict thecorrelation of morbidity with the above factors. All the data collected and analyzedby using IBM SPSS version 25.

 Results

 In our study the overall morbidity was 33%. Out of that 17 % hasearly and 16 % has late morbidity.

Further classifying these into Clavein Dindo grade, in the earlypost operative period,  10 % has lowergrade of morbidity where as 7 % has higher grade of morbidity. While, in the late post operative period 13 %has lower grade of morbidity where as 3 % has higher grade of morbidity.

Physical parameters likeweight, BMI, body weight loss, triceps skin fold thickness on POD 28 isstatistically significant for calculating PostOp Morbidity Late.

Laboratory parameters like hemoglobinPOD 28, RBC POD 28, Sr. albumin POD 28, Sr. AST POD28 is statisticallysignificant for calculating PostOp Morbidity Late and RBC POD 7, TLC POD 1, SrAlbumin POD1, Sr. uric acid POD 7 is statistically significant for calculatingPostOp Morbidity Early.

Nutritional parameters likeNRI POD28, PNI POD 1, PNI POD 28 is statistically significant for calculatingPostOp Morbidity Late.

It is found that ‘IntraOpBlood Loss’, ‘Reconstruction’, Total Protein’ is not statistically significantfor calculating PostOp Morbidity and Clavien Dindo Grade.

 Conclusion

The comprehensive nutritional problems experienced by patientswith Head and Neck cancers require early nutritional assessments and improvedindividually tailored nutritional support.

Effective nutritional risk assessment measures can be adoptedaccording to the research data to improve quality of life of Head and Neckcancer patients

This is a prospective observational study. Furtherinterventional studies can be done to formulate guidelines for nutritionalintervention among patients with Head and Neck cancer, in order to reducemorbidity and improve quality of life.