Early nutritional support in non-metastatic stage IV oral cavity cancer patients undergoing adjuvant concurrent chemoradiotherapy: analysis of treatment tolerance and outcome in an area endemic for betel quid chewing

Non-metastatic stage IV oral cavity cancer patients undergoing concurrent chemoradiotherapy (CCRT) are at risk of malnutrition because of postoperative eating problems and CCRT-related complications. A high percentage of betel quid use, which is associated with metabolic disorders, is found in oral cavity cancer patients in Taiwan. The aim of this study is to evaluate the effect of an early and intensive nutritional support program, comprising individualized counseling, nasogastric tube feeding, and mandatory hospitalization, throughout the CCRT period for such cases in an area where betel quid use is prevalent. We retrospectively analyzed 35 patients with nutritional support (NI) and 23 patients with no specifically designed nutrition program (NC). The NI group had better maintenance of body weight (p < 0.001) and higher serum albumin levels (p < 0.002) than the NC group. There was no difference in the total dose of radiation completed in the two groups; in contrast, the percentage of NI group patients who had radiation therapy (RT) breaks was lower and who completed planned chemotherapy was higher than in the NC group. Furthermore, more NC group patients suffered from sepsis during the treatment period, and fewer were alive 2 years after treatment. An early and intensive nutrition support may be beneficial to minimizing body weight loss, offering better treatment tolerance and probable survival benefits for patients with non-metastatic stage IV oral cavity cancers undergoing CCRT in endemic betel quid chewing areas.