Page 120 - HHR-HNR 2.0

This form of malnutrition arises as the result of the disease process itself and can occur despite sufficient intake of nutrition. Inflammation (inflammatory processes) arises in response to stimuli such as tumour growth and stimuli of a chemical nature. Inflammation may bring about increased levels of acute phase proteins (such as the C-reactive protein) and cytokines. Cytokines are proteins that play a role in immunity and appetite. Under-nutrition as a result of this mechanism is called the anorexia-cachexia syndrome. Cachexia is characterised by progressively severe weight loss and extreme malnutrition, which means that both the fat mass and the lean body mass have decreased and that muscle atrophy and severe loss of muscle strength occur.\u000DCharacteristic of cancer is the fact that loss of muscle mass may occur not only with weight loss but also with weight gain. This is called sarcopenia (Vogel, Beijer et al. 2012, Beelen, Van Dooren et al. 2013). The occurrence of sarcopenia is multifactorial, an interplay of the factors mentioned under 1 and 2 that influence and reinforce one another. Especially with elderly cancer patients sarcopenia may lead to progressive function loss and reduced independence (Vogel, Beijer et al. 2012).\u000D5.4.1.2 Dehydration\u000DIn addition to malnutrition dehydration is a highly prevalent problem in the head and neck cancer population (IKNL 2006, Peterson, Shinn et al. 2013). Dehydration is a deficit of body water caused by a disturbance of the balance between intake and excretion of water due to a reduced intake of fluid, an increased loss of fluid or a combination of the two (Vogel, Beijer et al. 2012). There is currently no consensus-based criterion for determining dehydration. In some cases a deficit of total body water of 3% of the total body weight is used as a cut-off point (IKNL-d 2010).\u000DDehydration may be caused by one or more of the fallowing factors (IKNL 2006, IKNL-d 2010):\u000D- Reduced intake of fluid due to nausea, swallowing impairments, pain, mental status, etc.\u000D- Increased water requirements due to oncological treatment, fever, inflammation or sepsis\u000D- Increased excretion of water due to wound, vomiting, diarrhoea, drain, blood loss, etc.\u000D- Side effect of medication\u000D5.4.1.3 Effects of malnutrition and dehydration\u000DMalnutrition is associated with shorter survival times, increased morbidity and reduced quality of life (Chasen and Bhargava 2009, Vogel, Beijer et al. 2012, Langius, Bakker et al. 2013). With surgery malnutrition brings about a higher risk of complications, slower wound healing, increased mortality and a greater chance of infections and long-term hospitalisation (Vogel, Beijer et al. 2012). Nutritional deficits before and during RT and CRT decrease the chance of response to the treatment and a higher risk of complications and side effects (IKNL-a 2012, Vogel, Beijer et al. 2012, Chang, Yeh et al. 2013, Langius, Zandbergen et al. 2013). A study by Langius et al. shows that \u201Ccrucial weight loss during RT is independently associated with a 1.7 times higher risk of dying from head and neck cancer\u201D (Langius, Bakker et al. 2013).\u000DLittle has so far been described in the literature on the effects of dehydration in the head and neck cancer patient population. Some of the effects associated with cancer-related dehydration are problems with cognition and perception, the occurrence of delirium and electrolyte deficiencies (Dalal and Bruera 2004). Dehydration may lead to temporary or permanent kidney damage. With chemoradiation, nephrotoxic effects of cytostatic drugs (cisplatin and carboplatin), fever, and bladder and kidney function disorders, the water requirements increase and an increased water intake is recommended to protect the kidneys (IKNL-a 2012) . The water requirement may go up during the\u000D119\u000D