Nutrition Practices Around Surgery for Head & Neck and Esophageal Cancer: Results from the International Nutrition Audit in Foregut Tumors (INFORM)

Publication Date


Document Type



Nutrition, Food Science and Packaging


Cancer Biology | Dietetics and Clinical Nutrition | Nutrition

Publication Title

ESPEN Virtual Congress

Conference Location



Rationale: The delivery of nutrition around surgery in head and neck (HN) and esophageal (E) cancers (CA) is poorly described. The INFORM study describes current nutrition practices across 11 international cancer care settings.
Methods: Adult patients (pts) with curative HN or E CA were enrolled in a multicenter prospective audit. Nutrition practices received before and after cancer related surgeries over six months were collected and are descriptively presented.
Results: Between 2016 and 2018, 170 pts (119 HN and 51 E CA) were enrolled. A total of 71 pts (HN=33, E=38, mean age 63 years, mean BMI 27.2, 70% male) underwent 85 cancer related surgeries within six months of being admitted to a cancer care center. Target rates of nutrition received were assessed within a week prior to surgery in 15% HN and 29% E pts and within 1 week after surgery in 36% HN and 92% of E pts.
Prior to surgery, 82% HN pts received oral diet alone (39% received a high calorie-protein diet). A total of 12% pts were on oral diet with oral nutrition supplementation (ONS) for median of >3.5 weeks and 6% were on enteral nutrition (EN) for 2.5 weeks. After surgery, 42% pts were on oral diet alone (21% on a high calorie-protein diet), 55% received EN for 1.5 weeks and 3% received oral diet with ONS for <1 week. Mean ± SD target rates of energy and protein received were 80% ± 24% and 78% ± 28% respectively assessed at a median [Q1, Q3] of 3 [1, 25] days after surgery.
Prior to surgery, 45% E pts received oral diet alone (74% were on high calorie-protein diet), 45% were on oral diet with ONS for >4 weeks, 10% received EN for >4 weeks of which 1 patient also received parenteral nutrition (PN) for <1 week. After surgery, 21% pts received oral diet alone (10% were on a high protein-calorie diet), 24% on oral diet with ONS for >4 weeks and 55% received EN for >4 weeks, of which 1 patient also received PN for <1 week. Mean ± SD target rates of energy and protein received were 33% ± 29% and 31% ± 23% respectively at a median [Q1, Q2] of 2 [1,4] days after surgery.
Conclusion: In this international study, HN and E cancer patients predominantly received oral diets, ONS or EN around surgery, however energy and protein intakes were suboptimal in the early post op period in E cancer patients. Perioperative nutrition support with better delivery of EN or PN if EN is not feasible, should be considered, especially in E cancer patients to minimize the nutrition gap.

Funding Sponsor

Fresenius Kabi Deutschland GmbH and Baxter