Effectivity of Prophylactic Enteral Nutrition on Weight Loss in Head and neck Cancer Patients Undergoing Radiotherapy and/or Chemotherapy: A Case Study with Evidence-Based Approaches

Background: Globocan data shows that head and neck cancer in Indonesia ranks as the 5th leading cause of cancer in 2020 with 19,943 new cases per year and 13,399 deaths. Chemotherapy along with radiation therapy is the main management for advanced nasopharyngeal cancer to control local recurrence and prolong survival. However, it can cause side effects such as mucositis, dysphagia, fatigue, and anorexia, which cause weight loss and exacerbate malnutrition. Studies examining the effectiveness of prophylactic enteral nutrition to prevent weight loss in a population of head and neck cancer patients undergoing radiotherapy and/or chemotherapy have not been widely conducted and the results are still controversial. Objective: To determine the effectiveness of prophylactic enteral nutrition in preventing weight loss in head and neck cancer patients undergoing radiotherapy and/or chemotherapy. Method: This study used literature search on PubMed, Cochrane Library, and Scopus databases to retrieve SR-MA and RCT articles that fit the clinical question of this case study. Result: There are three articles that are relevant to the clinical questions and eligibility criteria that have been established, consisting of one Meta-Analysis (MA) article and two Systematic Review (SR) articles. There was one SR that only analyzed RCTs, while one MA and other SRs included both prospective and retrospective cohorts in their analysis. Two SRs reported no significant difference in weight loss between the prophylactic enteral nutrition (EN) intervention group and the reactive EN control group. While one MA found a significant difference in weight loss between the two groups studied. However, high heterogeneity was obtained in the data. Conclusion: The evidence that supports the effectiveness of prophylactic enteral nutrition (EN) in preventing weight loss in head and neck cancer patients has not yet been obtained with certainty, but patients who receiving prophylactic EN were less likely to experience short term critical weight loss. Various studies carried out on this topic report varying results with low research quality. Therefore, further research into better design is needed to find conclusive results. Keywords: chemotherapy, chemoradiotherapy, enteral nutrition, head and neck cancer, radiotherapy, tube feeding, weight loss.