NUTRITION STATUS OUTCOMES OF ESOPHAGEAL, HEAD AND NECK CANCER PATIENTS UTILIZING GASTROSTOMY TUBE AT KENYATTA NATIONAL HOSPITAL, NAIROBI, KENYA

Abstract

Esophageal, head, and neck cancers present significant challenges in maintaining adequate nutrition due to the anatomical and functional impairments associated with these malignancies and their treatments. The aim of the study was to determine the nutrition status outcomes of esophageal, head and neck outpatients utilizing gastrostomy tubes at Kenyatta National Hospital. The study design was descriptive institutional-based cross-sectional with an analytical component and was carried out between October 2023 to March 2024 with a sample size of 103 outpatients. The study employed a purposive sampling with criterion technique. Nutrition data was collected using Patient Generated-Subjective Global Assessment tool (PG-SGA), with caloric intake from 24-hour recall. Socio-demographics, anthropometrics, biochemical parameters, and subcutaneous fat were recorded via a questionnaire. Statistical Package for Social Sciences version 25.0 was used for data analysis at 0.05 significance level. The Socio-demographic analysis revealed that Central region had the highest number of patients 54.4% (n=56) having esophageal, head and neck cancers. Gender distribution was 61.2% male and 38.8% female, with a mean age of 56.2 years. Majority (81.6%) of patients consumed less than 500 Kcal/day, below the European Society for Parenteral and Enteral Nutrition recommendations of 25-30 Kcal/kg/day for cancer patients, thus indicating a high risk of undernutrition. Protein intake was suboptimal, with 58.1% not meeting the minimum recommendations of 0.8 g/kg body weight. Malnutrition assessment revealed varying degrees of nutritional deficits among patients, with a significant association found between energy intake and nutritional status (p=0.047). The average Body Mass Index (BMI) was 18.03±3.39 kg/m2, with 56.3% underweight, 40.8% normal, and 2.9% overweight. In terms of muscle status, 31.1% had no abnormalities, 23.3% had mild, 22.3% moderate, and 23.3% had severe muscle wasting. According to PG-SGA, 34.0% had normal nutritional status, 45.6% mild and 20.4% were severely malnourished. Independent sample t-test was conducted to compare the mean BMI between patients consuming a modified diet and those consuming a normal diet. There was a significant difference in BMI scores between the two groups where the mean BMI for the modified diet group was 16.1 kg/m² (SD = 1.68), and for the normal diet group was 20.7 kg/m² (SD = 2.10). This difference was statistically significant, t (101) = 8.95, p<0.001, indicating that patients on a modified diet had a significantly lower BMI compared to those on a normal diet. Furthermore, a Pearson correlation coefficient was computed to assess the relationship between food modification and BMI. The analysis revealed a strong, positive significant relationship, r (101) = 0.694, p<0.001. PG-SGA indicated varied levels of malnutrition, highlighting the need for tailored nutritional interventions in cancer care. The findings show the need for establishing a multidisciplinary nutritional support and monitoring programs specifically tailored for esophageal, head, and neck cancer patients utilizing gastrostomy tubes. This will be crucial in improving the nutritional status, treatment outcomes, and overall quality of life for the patients, thereby addressing the critical issue of malnutrition among this vulnerable population.