Assessment of malnutrition in patients with head and neck cancer: a multidimensional
approach
Sealy, Martine Jane
IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below.
Document Version
Publisher's PDF, also known as Version of record
Publication date: 2019
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Sealy, M. J. (2019). Assessment of malnutrition in patients with head and neck cancer: a multidimensional approach.
Copyright
Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).
Take-down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum.
'DQNZRRUG
(HQ SURHIVFKULIW VFKULMYHQ ZRUGW YDDN JH]LHQ DOV HHQ HHQ]DPH EH]LJKHLG (FKWHU GLW SURHIVFKULIWZDVQLHWWRWVWDQGJHNRPHQ]RQGHUGHKXOSYDQYHOHQ
$OOHUHHUVW ZLO LN JUDDJ PLMQ EHJHOHLGHUV EHGDQNHQ 9HHO GDQN DDQ PLMQ HHUVWH SURPRWRUSURIGU-DQ5RRGHQEXUJMHKHOLFRSWHUYLHZKLHOSRPLQKHOHNRUWHWLMGHHQQLHXZH EHQDGHULQJWHYLQGHQYRRUGLOHPPD’VZDDULNVRPVDOZHNHQPHHURQGOLHS-HEHZDDNWH GHYRRUWJDQJYDQKHWSURPRWLHWUDMHFWPDDUKDGRRNYHHOEHODQJVWHOOLQJYRRUKRHKHWYHUGHU met me ging. Je medisch specialistische kennis ten aanzien van patiënten met hoofd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dr. Harriët Jager:LWWHQDDU]RQGHUMRXZVWHXQHQEHPRHLHQLVZDVKHWKHHOHUJPRHLOLMN JHZRUGHQGLWSURHIVFKULIWWHVFKULMYHQ-HKHEWJURWHNHQQLVRSKHWJHELHGYDQNOLQLVFKH RQGHUYRHGLQJPDDUMHEHQWGDDUQDDVWRRNHUJJHGHJHQDOVKHWDDQNRPWRSKHWVFKULMYHQ YDQ DUWLNHOHQ ,N NDQ VWHOOHQ GDW MLM PHHU SHUIHFWLRQLVWLVFK EHQW GDQ LN GLW LV ZHOLVZDDU JHWRHWVWPHWQLHWJHYDOLGHHUGHWHVWMHVRSLQWHUQHWPDDUWRFKGXUILNGLWUXVWLJWHEHZHUHQ ZDDUGRRUMRXZVXJJHVWLHVPLMKLHOSHQRPPLMQVWDQGDDUGQDDUHHQKRJHUQLYHDXWHWLOOHQ,N YRQG KHW HHQ ILMQH VDPHQZHUNLQJ HQ LN NLMN XLW QDDU RQ]H YHUGHUH VDPHQZHUNLQJ LQ GH
WRHNRPVW LQ KHW )$,7+ SURJUDPPD ]RDOV GH +DQ]H +HDOWK DQG $JHLQJ 6WXGLH LQ GH ,QQRYDWLHZHUNSODDWV0DOQXWULWLRQHQDOOHSURMHFWHQGLHYHUGHURSRQVSDGNRPHQ
,ZRXOGOLNHWRWKDQNWKHPHPEHUVRIWKHWKHVLVFRPPLWWHHSURIGU*-1DYLVSURI GU 0 0XVFDULWROL DQG SURI GU )./ 6SLMNHUYHW IRU FDUHIXOO\ UHDGLQJ DQG FULWLFDOO\ UHYLHZLQJWKHPDQXVFULSW
=HVMDDULVYRRUELMJHYORJHQ/LHVHQ:LOOHPNHOLHYHSDUDQLPIHQYHHOGDQNYRRUMXOOLH VWHXQDOGLHWLMGHQZDWILMQGDWMXOOLHGLWVDPHQPHWPLMJDDQGRHQRSDSULO2RNGDQN DDQ7KHD0DUJRW3UL\D--*HUORI5LN&DVSDU$QQHOLHV%DXGLQDHQDOOHDQGHUHQRSKHW +$$/$DQGHJHQHQGLHPLMYRRUJLQJHQPHWSURPRYHUHQGDQNYRRUDOOHVXUYLYDOWLSV$DQ GHJHQHQ GLH QD PLM JDDQ SURPRYHUHQ GDQN YRRU MXOOLH ZDUPH EHODQJVWHOOLQJ YRRU PLMQ YRRUWJDQJLNEHQPHEHZXVWGDWLNQXDDQGHEHXUWEHQPHWGHVXUYLYDOWLSV
Zonder patiënten geen onderzoek. Veel dank aan de patiënten die hebben PHHJHZHUNWDDQGH3$3VWXGLH9DQ]HOIVSUHNHQGRRNYHHOGDQNDDQGHEHWURNNHQFROOHJD’V YDQ GH DIGHOLQJ 0RQG]LHNWHQ .DDN HQ $DQJH]LFKWVFKLUXUJLH HQ GH DIGHOLQJ .HHO1HXV2RUKHHONXQGH YDQ KHW 80&* LQ KHW ELM]RQGHU 0DGHORQ 3RSPD 5DFKHO 'RSKHLGH6LHWVNH+XLWHPDGU&KULVWLDDQ.UDEEHSURIGU9DQGHU/DDQHQGU*\XUL +DOPRVHQ/LHQHNH.OHLYRRUDOOHKXOS
+HHOYHHOGDQNDDQDOOHVWXGHQWHQQXYDDNSURIHVVLRQDOVRIVRPVRQGHUWXVVHQ]HOI RQGHU]RHNHUVGLHLQGHORRSGHUMDUHQKHEEHQJHKROSHQELMKHWYHU]DPHOHQHQVRPVRRNELM KHWDQDO\VHUHQYDQGHGDWD8OULNH,ULV$QQH'DQLTXH0D\D-HOPHU6DVKD(OLQH5RVDQ en Amarins. Daarbij past ook dank aan Voeding en DiëtetieNFROOHJD*HDQQHYRRUDOKDDU GDWDYHU]DPHOZHUNLQGH3$3VWXGLH=RQGHUMXOOLHZDVKHWYHU]DPHOHQYDQGHGDWDYHHO PRHL]DPHUWLMGURYHQGHUHQPLQGHUJH]HOOLJJHZHHVW
D
'DQNZRRUG
(HQ SURHIVFKULIW VFKULMYHQ ZRUGW YDDN JH]LHQ DOV HHQ HHQ]DPH EH]LJKHLG (FKWHU GLW SURHIVFKULIWZDVQLHWWRWVWDQGJHNRPHQ]RQGHUGHKXOSYDQYHOHQ
$OOHUHHUVW ZLO LN JUDDJ PLMQ EHJHOHLGHUV EHGDQNHQ 9HHO GDQN DDQ PLMQ HHUVWH SURPRWRUSURIGU-DQ5RRGHQEXUJMHKHOLFRSWHUYLHZKLHOSRPLQKHOHNRUWHWLMGHHQQLHXZH EHQDGHULQJWHYLQGHQYRRUGLOHPPD’VZDDULNVRPVDOZHNHQPHHURQGOLHS-HEHZDDNWH GHYRRUWJDQJYDQKHWSURPRWLHWUDMHFWPDDUKDGRRNYHHOEHODQJVWHOOLQJYRRUKRHKHWYHUGHU met me ging. Je medisch specialistische kennis ten aanzien van patiënten met hoofd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dr. Harriët Jager:LWWHQDDU]RQGHUMRXZVWHXQHQEHPRHLHQLVZDVKHWKHHOHUJPRHLOLMN JHZRUGHQGLWSURHIVFKULIWWHVFKULMYHQ-HKHEWJURWHNHQQLVRSKHWJHELHGYDQNOLQLVFKH RQGHUYRHGLQJPDDUMHEHQWGDDUQDDVWRRNHUJJHGHJHQDOVKHWDDQNRPWRSKHWVFKULMYHQ YDQ DUWLNHOHQ ,N NDQ VWHOOHQ GDW MLM PHHU SHUIHFWLRQLVWLVFK EHQW GDQ LN GLW LV ZHOLVZDDU JHWRHWVWPHWQLHWJHYDOLGHHUGHWHVWMHVRSLQWHUQHWPDDUWRFKGXUILNGLWUXVWLJWHEHZHUHQ ZDDUGRRUMRXZVXJJHVWLHVPLMKLHOSHQRPPLMQVWDQGDDUGQDDUHHQKRJHUQLYHDXWHWLOOHQ,N YRQG KHW HHQ ILMQH VDPHQZHUNLQJ HQ LN NLMN XLW QDDU RQ]H YHUGHUH VDPHQZHUNLQJ LQ GH
WRHNRPVW LQ KHW )$,7+ SURJUDPPD ]RDOV GH +DQ]H +HDOWK DQG $JHLQJ 6WXGLH LQ GH ,QQRYDWLHZHUNSODDWV0DOQXWULWLRQHQDOOHSURMHFWHQGLHYHUGHURSRQVSDGNRPHQ
,ZRXOGOLNHWRWKDQNWKHPHPEHUVRIWKHWKHVLVFRPPLWWHHSURIGU*-1DYLVSURI GU 0 0XVFDULWROL DQG SURI GU )./ 6SLMNHUYHW IRU FDUHIXOO\ UHDGLQJ DQG FULWLFDOO\ UHYLHZLQJWKHPDQXVFULSW
=HVMDDULVYRRUELMJHYORJHQ/LHVHQ:LOOHPNHOLHYHSDUDQLPIHQYHHOGDQNYRRUMXOOLH VWHXQDOGLHWLMGHQZDWILMQGDWMXOOLHGLWVDPHQPHWPLMJDDQGRHQRSDSULO2RNGDQN DDQ7KHD0DUJRW3UL\D--*HUORI5LN&DVSDU$QQHOLHV%DXGLQDHQDOOHDQGHUHQRSKHW +$$/$DQGHJHQHQGLHPLMYRRUJLQJHQPHWSURPRYHUHQGDQNYRRUDOOHVXUYLYDOWLSV$DQ GHJHQHQ GLH QD PLM JDDQ SURPRYHUHQ GDQN YRRU MXOOLH ZDUPH EHODQJVWHOOLQJ YRRU PLMQ YRRUWJDQJLNEHQPHEHZXVWGDWLNQXDDQGHEHXUWEHQPHWGHVXUYLYDOWLSV
Zonder patiënten geen onderzoek. Veel dank aan de patiënten die hebben PHHJHZHUNWDDQGH3$3VWXGLH9DQ]HOIVSUHNHQGRRNYHHOGDQNDDQGHEHWURNNHQFROOHJD’V YDQ GH DIGHOLQJ 0RQG]LHNWHQ .DDN HQ $DQJH]LFKWVFKLUXUJLH HQ GH DIGHOLQJ .HHO1HXV2RUKHHONXQGH YDQ KHW 80&* LQ KHW ELM]RQGHU 0DGHORQ 3RSPD 5DFKHO 'RSKHLGH6LHWVNH+XLWHPDGU&KULVWLDDQ.UDEEHSURIGU9DQGHU/DDQHQGU*\XUL +DOPRVHQ/LHQHNH.OHLYRRUDOOHKXOS
+HHOYHHOGDQNDDQDOOHVWXGHQWHQQXYDDNSURIHVVLRQDOVRIVRPVRQGHUWXVVHQ]HOI RQGHU]RHNHUVGLHLQGHORRSGHUMDUHQKHEEHQJHKROSHQELMKHWYHU]DPHOHQHQVRPVRRNELM KHWDQDO\VHUHQYDQGHGDWD8OULNH,ULV$QQH'DQLTXH0D\D-HOPHU6DVKD(OLQH5RVDQ en Amarins. Daarbij past ook dank aan Voeding en DiëtetieNFROOHJD*HDQQHYRRUDOKDDU GDWDYHU]DPHOZHUNLQGH3$3VWXGLH=RQGHUMXOOLHZDVKHWYHU]DPHOHQYDQGHGDWDYHHO PRHL]DPHUWLMGURYHQGHUHQPLQGHUJH]HOOLJJHZHHVW
9DQ]HOIVSUHNHQGRRNYHHOGDQNDDQGH+DQ]HKRJHVFKRRO*URQLQJHQYRRUKHWELHGHQ YDQGH]HSURPRWLHSODDWV,QKHWELM]RQGHUZLOLNPLMQYRRUPDOLJHWHDPOHLGHUELMGHRSOHLGLQJ Voeding en Diëtetiek1\QNH-DQVHQJUDDJEHGDQNHQYRRUKHWIHLWGDWMHPHGHUXLPWHKHEW JHERGHQHQKHEWDDQJHPRHGLJGRPGLWSURPRWLHWUDMHFWWHVWDUWHQ0LMQKXLGLJHWHDPOHLGHU 0RQLTXH:HLWHULQJZLOLNEHGDQNHQYRRUKHWIHLWGDWMHPHGHUXLPWHKHEWJHERGHQRPGLW SURPRWLHWUDMHFWRRNDIWHURQGHQ
1DWXUDOO\ , ZRXOG OLNH WR WKDQN GU )DLWK 2WWHU\ :H ZRUNHG WRJHWKHU RQ PDQXVFULSWV DQG \our “word surgery” greatly LPSURYHG P\ (QJOLVK ZULWLQJ :H DOVR FROODERUDWHG LQ ZRUNVKRSV DQG , KDG WKH SOHDVXUH RI VSHQGLQJ PDQ\ KRXUV ZLWK \RX LQ PHHWLQJVGLVFXVVLQJWKH‘LQVDQGRXWV’ RIWKH3*6*$DQGWKHLPSRUWDQFHRIVFUHHQLQJ DVVHVVPHQWDQGPRQLWRULQJRIPDOQXWULWLRQDQGLWVULVNIDFWRUVLQSDWLHQWVZLWKFDQFHU
,QDGGLWLRQ,ZRXOGDOVROLNHWRWKDQNWKHWHDPRI&DFKH[LD&HQWUDOLQ(GPRQWRQ $OEHUWD)LUVWO\,DPPRVWJUDWHIXOWRSURIGU9LFNLH%DUDFRVIRULQYLWLQJXVIRUDVSHFLDO SURMHFW LW ZDV DQ KRQRU DQG D SOHDVXUH WR ZRUN ZLWK \RX 7KDQN \RX IRU \RXU ZDUP KRVSLWDOLW\DQGIRUKHOSLQJPHLQDQ\ZD\SRVVLEOHWRFRPSOHWHWKHZRUNWKDWZDVQHHGHGLQ DVKRUWZLQGRZRIWLPH<RXUWUDLQLQJDQGH[SHUWLVHLQERG\FRPSRVLWLRQDVVHVVPHQWLQ SDWLHQWV ZLWK FDQFHU ZDV RI JUHDW LPSRUWDQFHWR WKH PDQXVFULSW WKDW UHVXOWHG IURP WKLV SURMHFW$OVRPDQ\WKDQNVWR$VLID/LVD&DWK\%HQ.HYLQDQG0RKDPPDG7KDQN\RXDOO IRU WUDLQLQJ DQG KHOSLQJ PH IRU \RXU JUHDW FRPSDQ\ DQG IRU VKRZLQJ PH WKH IDPRXV &DQDGLDQKRVSLWDOLW\,KDGDQXQIRUJHWWDEOHWLPH
,QDGGLWLRQ,ZRXOGOLNHWRWKDQNDOORIP\FRDXWKRUVIRUDOO\RXUYDOXDEOHLQSXWDQG IRULPSURYLQJHDFKSURMHFWZLWK\RXUH[SHUWLVH,ZRXOGOLNHWRVD\DVSHFLDOWKDQNVWRDIHZ FRDXWKRUV WKDW ZHUH QRW PHQWLRQHG \HW GU :LP .ULMQHQ WKDQN \RX IRU GLVFXVVLQJ
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’s van de opleiding Voeding en Diëtetiek die meeleefden metGLW KHOHDYRQWXXU2QGDQNVGDWLNKHEJHWUDFKW]RYHHOPRJHOLMNPHQVHQWHQRHPHQ]DOLNYDVW ZHOLHPDQGRQEHGRHOGRYHUKHWKRRIGKHEEHQJH]LHQGDDURPRRNGDQNDDQLHGHUHHQGLHLN YHUJHWHQKHEWHEHQRHPHQ
7HQVORWWH GDQN DDQ )UDQV HQ GH NLQGHUHQ $OV MXOOLH PLM QLHW GH UXLPWH KDGGHQ JHJXQGRPGLWWUDMHFWWHGRRUORSHQZDDURQGHUYHOHDYRQGHQZHHNHQGHQHQYULMHGDJHQ DFKWHUGHFRPSXWHUYHOHZHHNHQGHQRSFRQJUHVHQHHQPDDQGLQKHWEXLWHQODQGGDQZDV GLWSURHIVFKULIWHUQLHWJHNRPHQ-XOOLHZDUHQRQPLVEDDULQGH]HSHULRGHHQ]LMQVLPSHOZHJ JHZHOGLJ
D
9DQ]HOIVSUHNHQGRRNYHHOGDQNDDQGH+DQ]HKRJHVFKRRO*URQLQJHQYRRUKHWELHGHQ YDQGH]HSURPRWLHSODDWV,QKHWELM]RQGHUZLOLNPLMQYRRUPDOLJHWHDPOHLGHUELMGHRSOHLGLQJ Voeding en Diëtetiek1\QNH-DQVHQJUDDJEHGDQNHQYRRUKHWIHLWGDWMHPHGHUXLPWHKHEW JHERGHQHQKHEWDDQJHPRHGLJGRPGLWSURPRWLHWUDMHFWWHVWDUWHQ0LMQKXLGLJHWHDPOHLGHU 0RQLTXH:HLWHULQJZLOLNEHGDQNHQYRRUKHWIHLWGDWMHPHGHUXLPWHKHEWJHERGHQRPGLW SURPRWLHWUDMHFWRRNDIWHURQGHQ1DWXUDOO\ , ZRXOG OLNH WR WKDQN GU )DLWK 2WWHU\ :H ZRUNHG WRJHWKHU RQ PDQXVFULSWV DQG \our “word surgery” greatly LPSURYHG P\ (QJOLVK ZULWLQJ :H DOVR FROODERUDWHG LQ ZRUNVKRSV DQG , KDG WKH SOHDVXUH RI VSHQGLQJ PDQ\ KRXUV ZLWK \RX LQ PHHWLQJVGLVFXVVLQJWKH‘LQVDQGRXWV’ RIWKH3*6*$DQGWKHLPSRUWDQFHRIVFUHHQLQJ DVVHVVPHQWDQGPRQLWRULQJRIPDOQXWULWLRQDQGLWVULVNIDFWRUVLQSDWLHQWVZLWKFDQFHU
,QDGGLWLRQ,ZRXOGDOVROLNHWRWKDQNWKHWHDPRI&DFKH[LD&HQWUDOLQ(GPRQWRQ $OEHUWD)LUVWO\,DPPRVWJUDWHIXOWRSURIGU9LFNLH%DUDFRVIRULQYLWLQJXVIRUDVSHFLDO SURMHFW LW ZDV DQ KRQRU DQG D SOHDVXUH WR ZRUN ZLWK \RX 7KDQN \RX IRU \RXU ZDUP KRVSLWDOLW\DQGIRUKHOSLQJPHLQDQ\ZD\SRVVLEOHWRFRPSOHWHWKHZRUNWKDWZDVQHHGHGLQ DVKRUWZLQGRZRIWLPH<RXUWUDLQLQJDQGH[SHUWLVHLQERG\FRPSRVLWLRQDVVHVVPHQWLQ SDWLHQWV ZLWK FDQFHU ZDV RI JUHDW LPSRUWDQFHWR WKH PDQXVFULSW WKDW UHVXOWHG IURP WKLV SURMHFW$OVRPDQ\WKDQNVWR$VLID/LVD&DWK\%HQ.HYLQDQG0RKDPPDG7KDQN\RXDOO IRU WUDLQLQJ DQG KHOSLQJ PH IRU \RXU JUHDW FRPSDQ\ DQG IRU VKRZLQJ PH WKH IDPRXV &DQDGLDQKRVSLWDOLW\,KDGDQXQIRUJHWWDEOHWLPH
,QDGGLWLRQ,ZRXOGOLNHWRWKDQNDOORIP\FRDXWKRUVIRUDOO\RXUYDOXDEOHLQSXWDQG IRULPSURYLQJHDFKSURMHFWZLWK\RXUH[SHUWLVH,ZRXOGOLNHWRVD\DVSHFLDOWKDQNVWRDIHZ FRDXWKRUV WKDW ZHUH QRW PHQWLRQHG \HW GU :LP .ULMQHQ WKDQN \RX IRU GLVFXVVLQJ
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’s van de opleiding Voeding en Diëtetiek die meeleefden metGLW KHOHDYRQWXXU2QGDQNVGDWLNKHEJHWUDFKW]RYHHOPRJHOLMNPHQVHQWHQRHPHQ]DOLNYDVW ZHOLHPDQGRQEHGRHOGRYHUKHWKRRIGKHEEHQJH]LHQGDDURPRRNGDQNDDQLHGHUHHQGLHLN YHUJHWHQKHEWHEHQRHPHQ
7HQVORWWH GDQN DDQ )UDQV HQ GH NLQGHUHQ $OV MXOOLH PLM QLHW GH UXLPWH KDGGHQ JHJXQGRPGLWWUDMHFWWHGRRUORSHQZDDURQGHUYHOHDYRQGHQZHHNHQGHQHQYULMHGDJHQ DFKWHUGHFRPSXWHUYHOHZHHNHQGHQRSFRQJUHVHQHHQPDDQGLQKHWEXLWHQODQGGDQZDV GLWSURHIVFKULIWHUQLHWJHNRPHQ-XOOLHZDUHQRQPLVEDDULQGH]HSHULRGHHQ]LMQVLPSHOZHJ JHZHOGLJ