The overall goal of the proposed study is to contribute to the evidence on which the nutritional management of patients undergoing treatment for head and neck cancer (HNC) can be based. HNC patients are at high risk for experiencing nutritional problems caused by both their cancer and the toxic side effects of its treatment. Recent advances in treatments have resulted in maintenance of organ anatomy, increased tumor control, and prolongation of life;but not without considerable concomitant severe toxic oral side effects. These side effects contribute to poor nutrition which contributes to poor outcomes. Percutaneous endoscopic gastrostomy (PEG) tubes are frequently placed prophylactically prior to treatment in anticipation of problems that may arise, in particular for those undergoing more aggressive therapies (i.e., the majority of patients). As part of an ongoing program of research being conducted in this area at the University of Alabama at Birmingham, a prospective study of 160 HNC patients who have prophylactic PEG tubes placed at our site will address three questions related to this controversy. First, do HNC patients and survivors who have PEG tubes placed actually use their feeding tubes, and, if so, to what extent? Second, does social support reduce the likelihood that HNC patients and survivors will rely upon feeding tubes for nutritional support? Third, how does social support influence dietary behaviors of HNC patients and survivors? The first question addresses a key concern regarding nutritional management of HNC patients: why introduce potential harm if patients do not even use PEG tubes? The second questions address issues of vulnerability of HNC patients-about half of whom may lack social support. We hypothesize that social support, particularly the presence of a partner (but other caregiving sources, as well), will reduce the likelihood that HNC patients and survivors will rely upon feeding tubes for nutritional support. The third question will allow, for the first time, a deeper understanding of precisely how social support influences dietary behaviors of HNC patients and survivors. Patients will be interviewed and complete dietary recalls before treatment and survivors will be followed immediately post-treatment and at a six-month follow-up. Partners, and other relevant sources of social support (when present), will be relied upon to provide supplemental information as needed. The proposed work contributes to the mission of the National Cancer Institute, particularly in the area of Behavioral Research in Cancer Control, with its emphasis on: 1) cross-disciplinary teams of investigators with expertise from the social and behavioral sciences, 2) evaluation of new dietary measures that can be used in future interventions, 3) enhancing quality of life of cancer survivors, and 4) promotion of a healthy diet. The impact of our work is especially timely as the demographics of HNC are changing: age at diagnosis is decreasing and prevalence and longer survival is increasing.

Public Health Relevance

The impact of our work, including its relevance and importance to public health, is that findings will translate: 1) immediately into enhanced evidence vital for clinical decision-making that improves the quality of care and quality of life for head and neck cancer (HNC) patients and survivors and into improved methods for assessing patient-reported outcomes useful for evaluating HNC interventions and 2) over the long-term into providing key information necessary for developing interventions involving the role of social support in influencing dietary behaviors of HNC patients and survivors.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Community Influences on Health Behavior (CIHB)
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O'Mara, Ann M
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University of Alabama Birmingham
Internal Medicine/Medicine
Schools of Medicine
United States
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