‘Eating As Treatment’ Linked to Improved Survival in HNC

TOPLINE:

“Eating As Treatment” (EAT), a psychological intervention led by oncology dietitians, significantly improves nutritional status and survival in patients with head and neck cancer receiving radiotherapy, new research showed.

METHODOLOGY:

• Malnutrition is common in nearly 80% of patients with head and neck cancer and is associated with a higher burden of disease, poorer treatment outcomes, and increased mortality.
• With the EAT intervention, trained oncology dietitians provide a combination of motivational interviewing and cognitive behavior therapy strategies to improve nutritional behaviors in patients with head and neck cancer receiving radiotherapy at six different Australian hospitals.
• The initial EAT trial — which randomly allocated 307 patients with head and neck cancer undergoing radiotherapy between 2013 and 2016 to the EAT intervention or standard diet advice — demonstrated improved nutritional status and quality of life in patients assigned to the EAT intervention.
• The researchers are now reporting an exploratory analysis of 5-year mortality among trial participants.

TAKEAWAY:

• There were 64 deaths over 5 years — 36 (24%) in the control group and 28 (18%) in the intervention group.
• Adjusted logistic regression analyses showed statistically significantly reduced odds of dying in the 5 years following radiotherapy in the intervention group (odds ratio, 0.33; P = .04).
• With the EAT intervention, there was a 17% (P = .03) absolute risk reduction and a 55% relative risk reduction in 5-year mortality (P = .04), with 6 being the number needed to treat to avoid one death.
• Using the Kaplan-Meier survival curve, there was an unadjusted 5-year actuarial survival rate of 76% (0.68-0.82) for the control group and 82% (0.75-0.87) for the intervention phase (P = .22).

IN PRACTICE:

“Our findings provide evidence that a behavioral intervention delivered during [radiotherapy] may substantially reduce mortality rates for patients with [head and neck cancer],” researchers wrote. “Although the mechanism of this reduction is unknown, the randomized study design and the results of this trial strengthen the association between improved nutritional status and oral intake during radiotherapy, and survival benefit.”

SOURCE:

The study, with first author Ben Britton, PhD, from the University of Newcastle, Callaghan, Australia, was published online on February 4 in the International Journal of Radiation Oncology, Biology, Physics.

LIMITATIONS:

The study relied on the accuracy of the National Death Index, and it was unknown if the recorded deaths were due to cancer or another cause.

DISCLOSURES:

The EAT trial was funded by the Australian National Health and Medical Research Council. The authors had declared no conflicts of interest.