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The Science Nook on Health Behavior Change and Patients with Head and Neck Cancer

by Jenna Koroly, MS, RD, CSOWM, CDN

Individuals with head and neck cancers have high rates of malnutrition [Capuano et al., 2010 as cited in Britton et al., 2018]. Although studies show that nutrition support from dietitians during radiation therapy improves nutrition for those with head and neck cancers, the focus is primarily on nutrition education [Isenring et al., 2004 & Langius et al., 2013 as cited in Britton et al., 2018]. The following study explores the nutritional status of those with head and neck cancers after receiving behavioral change interventions by dietitians.



Eating As Treatment (EAT): A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Intervention Provided by Dietitians to Improve Nutrition in Patients With Head and Neck Cancer Undergoing Radiation Therapy

Journal: International Journal of Radiation Oncology

This randomized controlled trial included just over 300 individuals with head and neck cancers (HNC) receiving radiation therapy at 5 hospitals in Australia. The authors compared those receiving an Eating as Treatment (EAT) intervention and controls.

The EAT intervention was piloted by a clinical psychologist and subsequently refined to be delivered by dietitians. It is aimed to prevent malnutrition in individuals with HNC receiving radiation therapy. The intervention involves cognitive behavioral therapy and motivational interviewing strategies, using key principles that can be applied differently depending on the context of the conversation with patients. Principles included collaborative, empathic conversations that encouraged patients to come up with their own reasons for behavior change. Participants and dietitians also worked on a collaborative nutrition plan, with daily behaviors for participants to complete.

Outcomes included: nutrition assessment via the Patient-Generated Subjective Global Assessment (PG-SGA), which includes factors such as weight change, dietary and nutritional intake, gastrointestinal symptoms, metabolic stress, and muscle wasting; nutrition outcomes using the dietitians’ Subjective Global Assessment (SGA); depression using the Patient Health Questionnaire-9; and quality of life using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. Tests were administered the first week of, the last week of, 1 month after, and 3 months after radiation therapy.


The authors found that those in the EAT intervention group:

1. Had significantly better nutritional status scores on the PG-SGA than those in the control group at the end of radiation therapy

2. Were significantly more likely to be in category A (well-nourished) on the SGA. 304 of 307 participants lost weight, with those in the control group losing a significantly higher percentage of weight and significantly more in the control group with 10% weight loss

3. Significantly lower depression scores

4. Significantly fewer radiation therapy treatment interruptions

5. Non-significantly fewer unplanned hospital admissions, fewer total days, and shorter average length of stay

6. Significantly better quality of life, likely due to significant differences in nausea, vomiting, loss of appetite, physical, and cognitive function [i]

For the Patient and Caregiver

When going through treatment, following up with both a therapist and dietitian will allow you to stay on track and may improve your nutritional outcomes. Explore what motivates you and share this with your healthcare team. This can blossom into a collaborative effort to devise a plan for which behaviors to focus on during treatment to better your body and mind.

For the Healthcare Team

Consider using motivational interviewing and cognitive behavioral therapy techniques when working with your patients. When patients devise their own goals, it allows them to be empowered with their behaviors and decisions. Forming partnerships between dietitians and therapists offers the opportunity to share tools and counseling techniques.


[i] Britton B, Baker AL, Wolfenden L, Wratten C, Bauer J, Beck AK…Carter G. (2018). Eating as treatment (EAT): a stepped-wedge, randomized controlled trial of a health behavior change intervention provided by dietitians to improve nutrition in patients with head and neck caner undergoing radiation therapy. Int J Radiation Oncol Biol Phys, 103(2):353-362. doi: 10.1016/j.ijrobp.2018.09.027

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