Challenges in malnourished nasopharyngeal carcinoma patient, undergoing concomitant chemoradiotherapy with thrombocytopenia

Abstract

Multiple health complications resulting from disease progression and toxicity of cancer treatment amongst nasopharyngeal carcinoma (NPC) patients on chemoradiotherapy may lead to malnutrition as it is associated with increased metabolism, malabsorption or reduced food intake. A 51-year-old woman, coming from Orang Asli background, was electively admitted for concomitant chemoradiotherapy and referred to a dietitian due to poor oral intake associated with oral candidiasis, sore throat and radiation dermatitis. The patient is severely underweight with a history of 20.7% weight loss within 6 months. An assessment using the Patient-Generated Subjective Global Assessment scored more than 9 points which indicated as severely malnourished. Both calculated total energy and protein intake were <50% of the requirement. Therefore, oral nutritional supplement was prescribed to help achieve 60% of energy requirement, and nutrition counselling was provided with purpose to improve the patient’s nutritional status, minimise treatment-related side effect and improve quality of life. Nonetheless, on assessment during follow-up, the patient’s oral intake was progressively decreased to 35% of the energy requirement due to worsening condition. Therefore, a proper nutrition intervention with consideration to various aspects of patient condition is crucial to produce a safe and desirable goal of management.