Date

June 2013

Document Type

Thesis

Degree Name

M.S.

Institution

Oregon Health & Science University

Abstract

Background: Head and neck cancer is one of the top ten cancers diagnosed in the United States, accounting for 53,640 new cases in 2013. Patients suffering from head and neck cancer are at higher risk for dehydration due to the site of the tumor and negative effects of cancer treatment on the ability to swallow. Clinical dehydration is believed to: negatively impact the efficacy of cancer treatment, increase frequency and severity of side effects, and increase the number of unplanned hospital admissions and treatment breaks and unplanned hospital admissions. Improved hydration status may decrease some of these adverse effects and reduce the number of unplanned treatment breaks. Artificial hydration, the intravenous administration of normal saline, is an intervention used to treat clinical dehydration. Objective: The goal of this study was to determine if regularly scheduled artificial hydration decreased the number of unplanned hospital admissions and treatment breaks, protected renal function and improved hydration status among head and neck cancer patients undergoing radiotherapy-based treatment. Methods: A retrospective chart review was performed to determine if frequency of regularly scheduled artificial hydration administration affected treatment outcomes of head and neck cancer patients treated with radiotherapy at Oregon Health & Science University (OHSU). Sixty patients who received regularly scheduled artificial hydration and were treated before August 2011 were compared with 45 patients who did not receive regularly scheduled artificial hydration and were treated after August 2011. The electronic medical records, Electronic Privacy Information Center (EPIC), were queried to obtain the following information: date of birth, treatment initiation and completion dates, cancer diagnosis, treatment type, feeding tube placement and location, renal function values (blood urea nitrogen and plasma creatinine), hydration status values (hemoglobin, hematocrit), number of unplanned hospital admissions, number of treatment breaks, number of times and volume of artificial hydration administered, registered dietitian exposure, height, and weight throughout treatment. The number of unplanned hospital admissions, number of treatment breaks, and number of times artificial hydration administered throughout treatment were compared between groups. Patients who were under the age of eighteen, had a diagnosis other than head and neck cancer, were treated at any facility other than OHSU, or were treated with only one treatment modality such as only surgery, only chemotherapy, or only radiation were excluded. The data were analyzed using a Poisson regression model comparing the two group’s number of unplanned hospital admissions and number of unplanned treatment breaks between groups. Paired t-tests were used to determine differences in mean lab values at the beginning, middle and end of treatment within groups. Unpaired t-tests were used to compare, the mean number of times artificial hydration was administered, registered dietitian exposure, and weight change, between groups. Chi square analysis was used to compare the proportion of patients that were outside the established normal reference ranges. Results: 1) There were no significant differences in mean number of unplanned hospital admissions and mean number of treatment breaks between those receiving regularly scheduled artificial hydration and those not receiving regularly scheduled artificial hydration. 2) Mean change in renal function values were not significantly different between groups. Blood urea nitrogen and plasma creatinine concentrations increased and hemoglobin and hematocrit decreased similarly throughout treatment in both groups. 3) Both groups had a mean weight loss of greater than 1.5% of pre-treatment weight per month. This rate of weight loss is considered excessive by OHSU nutritional care standards because, if weight loss continued at this rate, it would result in a total weight loss of greater than 10% of pre-treatment body weight in six months. 4) Patients who saw or who did not see a dietitian had no differences in number of unplanned hospital admissions, number of unplanned treatment breaks, or percent of body weight lost. This subsample of patients was difficult to compare because there were registered dietitian staffing changes in the middle of the dates of data collection. Conclusions: 1) Treatment outcomes were similar for those who received regularly scheduled artificial hydration and those who did not receive regularly scheduled artificial hydration. The use of regularly scheduled artificial hydration did not result in fewer unplanned hospital admissions or unplanned treatment breaks compared to those who did not receive regularly scheduled artificial hydration. 2) Similar to previously reported research, treatment modality appeared to play the largest role in the number of unplanned hospital admissions and treatment breaks. Those who received chemoradiation had the highest rates of unplanned hospital admissions and treatment breaks.

Identifier

doi:10.6083/M47S7KTC

Division

Graduate Programs in Human Nutrition

School

School of Medicine

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