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The experience of food, eating and meals following radiotherapy for head and neck cancer: a qualitative study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.ORCID iD: 0000-0002-3731-6565
2013 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 7-8, 1034-1043 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe the experience of food, eating and meals following radiotherapy in patients with head and neck cancer.

Background. Eating problems are common in patients with head and neck cancer and may remain for a long period of time after treatment.

Design. A qualitative study design using in-depth semi-structured interviews.

Methods. Interviews were conducted nine months after the termination of radiotherapy. A purposive sample of thirteen patients with head and neck cancer participated in the study. The interviews were tape-recorded, transcribed verbatim and analysed using content analysis.

Results. The experience of food, eating and meals up to nine months after radiotherapy was captured in six categories: ‘Along journey – taking small steps to an uncertain future’, ‘A new way of eating’, ‘Eating without satisfaction’, ‘Challenging meals outside the family’, ‘Support and information – the key to a successful journey’ and ‘The creation and acceptance of a new normal’.

Conclusion. This study provides new information on the long-term aspects of food, eating and meals in patients with head and neck cancer. Head and neck cancer signifies a long journey with problems affecting physical, psychological and social aspects of food. Information and support and the use of strategies are important for patients with head and neck cancer to adapt to new possibilities for living after cancer treatment. Relevance to clinical practice. All members of the multiprofessional team need to be aware of the struggles with food and eating experienced by patients with head and neck cancer during the convalescent period. It is therefore important that the follow-up focuses on all aspects of food, eating and meals as a part of a holistic approach.

Place, publisher, year, edition, pages
2013. Vol. 22, no 7-8, 1034-1043 p.
Keyword [en]
content analysis, eating; food, head and neck cancer, lived experience, meals, radiotherapy
National Category
Cancer and Oncology Nursing
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-67118DOI: 10.1111/jocn.12151ISI: 000316148500015OAI: oai:DiVA.org:umu-67118DiVA: diva2:610842
Available from: 2013-03-13 Created: 2013-03-13 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Impact of disease and treatment on body weight and eating in patients with head and neck cancer: experiences from a multicenter study
Open this publication in new window or tab >>Impact of disease and treatment on body weight and eating in patients with head and neck cancer: experiences from a multicenter study
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Nutritional deterioration in patients with head and neck cancer (HNC) has a multifactorial etiology mainly associated with tumor and treatment related factors. The objective of the present thesis was to investigate the impact of the disease and treatment on body weight and eating in patients with HNC treated with radiation therapy (RT) as the single modality treatment or as preoperative RT by analyzing body weight and body mass index (BMI) over time, predictive factors for weight loss and BMI, weight loss and BMI as prognostic factors for survival, and by studying the patients’ own experience of food and eating.

Methods ARTSCAN is a randomized prospective multicenter trial conducted between the years of 1998 - 2006. Data were collected during and after RT with a total follow-up time of five years. Nutritional data from the whole study cohort (n = 712), from patients with oropharyngeal cancer (n = 232) and from two of the participating treatment centers (n = 101) were retrospectively analyzed in the present thesis. In addition, interviews (n = 13) were conducted nine months after the termination of RT as part of a care development project.

Results On a group level, the patients lost weight during and after RT with a nadir at five months after the termination of RT. Factors related to a higher weight loss were oropharyngeal cancer, a high BMI at the start of RT, post-treatment aspiration, no tube feeding at the start of RT, and larger treated volumes. Furthermore, a high BMI at the start of RT was shown to be significantly related to a better five-year overall survival in patients with oropharyngeal cancer, whereas weight loss was not. The patients’ own narratives showed that all aspects of food, eating and meals were affected by the remaining sequelae, and that the patients found ways to accept and cope with the changes that had to be done to facilitate eating.

Conclusions and clinical implications The disease and treatment gave persistent effects on the HNC patients’ weight and BMI which calls for a prolonged nutritional follow-up. The predictive factors found for weight loss can be used during patient history to find patients at risk for nutritional deterioration. In oropharyngeal cancer, patients with a high BMI at the start of RT had the best survival. This finding indicates that patients with a low BMI should be encouraged to gain weight before RT start. All aspects of food, eating and meals were affected during and after RT, and therefore the nutritional treatment should be given with a holistic approach to meet the multifaceted need patients with HNC experience.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1608
Keyword
Head and neck cancer, weight loss, body mass index, tube feeding, radiation therapy, survival, treated volume, swallowing dysfunction, patient experience.
National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-82562 (URN)978-91-7459-753-0 (ISBN)
Public defence
2013-11-29, Hörsal C, Samhällsvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-11-07 Created: 2013-11-05 Last updated: 2015-11-04Bibliographically approved

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