Progress report.

Aim/Objectives –

To assess nutritional status among patients with Oral cancer and to know the nutritional factors responsible for post op morbidity.

Methodology-

This was a prospective observational study. A total of 100 patients fulfilling the inclusion criteria i.e. Patient diagnosed with oral squamous cell cancer between 18 to 70 Years and planned for curative intent of treatment in form of surgery were included in the study after obtaining the informed consent form. The clinical, Nutritional, laboratory and physical parameters were evaluated. The physical parameters analysed in the study were Performance status, Percentage of body weight loss, Body mass index (BMI), triceps skin fold thickness (TST), mid-arm circumference (MAC). Laboratory parameters considered were Haemoglobin %, haematocrit, RBC count and total leucocyte count (TLC), Serum albumin, Serum Total Protein, Serum Urea, serum uric acid, serum AST & ALT. Nutritional parameters were calculated like Prognostic Nutritional Index We also calculated Nutritional Risk Index(NRI). In addition patients were assessed for comorbidities of patient using the preoperative ASA grade, the Charlson’s comorbidity index score and the risk of post-surgical complications were estimated using the ACS-NSQIP risk calculator. Also, using the FRAIL scale the frailty index was recorded in nominal scale preoperatively and postoperatively after 28 days of surgery. Duration of hospital stay postoperatively, intraoperative blood loss and type of reconstruction were also evaluated. The post-surgical morbidity were graded using Clavein dindo’s morbidity grades after 7 and 28 days postoperatively. The post-operative morbidity was recorded as early (7days) as well as late (28 days) complication encountered in our study. The correlation was done for the nutritional status directly affecting morbidity and was also analysed for any indirect correlation. Comorbidities frailty index and surgical risk index calculator used to predict the correlation of morbidity with the above factors. All the data collected and analyzed by using IBM SPSS version 25.

Results

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

Further classifying these into Clavein Dindo grade, in the early post operative period,  10 % has lower grade 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 like weight, BMI, body weight loss, triceps skin fold thickness on POD 28 is statistically significant for calculating PostOp Morbidity Late.

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

Nutritional parameters like NRI POD28, PNI POD 1, PNI POD 28 is statistically significant for calculating PostOp Morbidity Late.

It is found that ‘IntraOp Blood Loss’, ‘Reconstruction’, Total Protein’ is not statistically significant for calculating PostOp Morbidity and Clavien Dindo Grade.

Conclusion

The comprehensive nutritional problems experienced by patients with Head and Neck cancers require early nutritional assessments and improved individually tailored nutritional support.

Effective nutritional risk assessment measures can be adopted according to the research data to improve quality of life of Head and Neck cancer patients

This is a prospective observational study. Further interventional studies can be done to formulate guidelines for nutritional intervention among patients with Head and Neck cancer, in order to reduce morbidity and improve quality of life.