Head and Neck Carcinoma
Conditions
Brief summary
This randomized clinical trial studies how well Nestle Impact Advanced Recovery works in improving surgery recovery in patients with head and neck cancer. Adding a nutritional supplement, such as Nestle Impact Advanced Recovery to a regular diet before and after head and neck cancer surgery may help to decrease the number of wound complications after surgery.
Detailed description
PRIMARY OBJECTIVES: I. Assess the effect of perioperative use of Nestle Impact Advanced Recovery (AR) on the rate of post-operative wound complications within 30 days after major head and neck surgery. SECONDARY OBJECTIVES: I. Assess whether sarcopenia is an independent risk factor for the development of post-operative wound complications. II. Assess whether Nestle IMPACT AR decreases the rate of other post-operative complications such as pneumonia, urinary tract infection, deep vein thrombosis, and clostridium difficile colitis within 30 days of surgery, as well as length of hospital stay. TERTIARY OBJECTIVES: I. Assess changes in muscle metabolic gene expression at the time of surgery associated with sarcopenia and IMAPCT treatment. OUTLINE: Patients are randomized into 1 of 2 groups. GROUP I: Patients receive Nestle Impact AR for 5 days before and after surgery in addition to regular diet. GROUP I: Patients receive regular diet. After completion of study, patients are followed up for 30 days post-surgery.
Interventions
OTHERBest Practice
Receive regular diet
OTHERLaboratory Biomarker Analysis
Correlative studies
DIETARY_SUPPLEMENTNutritional Intervention
Receive Nestle Impact AR
Sponsors
National Cancer Institute (NCI)
OHSU Knight Cancer Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Members of all races and ethnic groups will be included * Patients must be diagnosed with cancer of the head and neck and must be surgical candidates * Patients must be indicated for major head and neck surgery, defined as surgeries with an anticipated post-surgical hospital stay of 4 or more days; examples of major surgeries include, but are not limited to, total laryngectomy, large oral cavity, oropharyngeal, salivary gland, or soft tissue resections requiring free flap or major regional flap (e.g. pectoralis major flap), and large skull base procedures requiring extensive skull base reconstruction * Patients must have cross-sectional body imaging (positron emission tomography \[PET\]-computed tomography \[CT\] or equivalent) performed within 4 weeks of study enrollment and available for review * Patient must be willing to receive Nestle IMPACT Advance Recovery for five days prior to planned surgery as well as for 5 days after surgery * Ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Patients with known distant metastases or other malignancies * Patients unable to tolerate oral intake by mouth or per enteral feeding tube * Patients with galactosemia * Patients who have received any investigational medication within 6 weeks of enrollment, or who are scheduled to receive an investigational drug during the course of the study * Patients currently taking IMPACT or other immunonutrition products (arginine-containing supplements) will be excluded; other forms of nutritional supplementation, such as caloric supplementation, tube feeding, or other dietary supplements are allowed on study * Patients currently taking anabolic steroids will be excluded; patients taking corticosteroids are allowed on study * Psychiatric illness/social situations that would limit compliance with study requirements * Excluded patients will be allowed to participate in the trial on an observational basis only
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of post-operative wound complications | Within 30 days after major head and neck surgery | A patient is found to have a post-operative complication is one of the following is observed: wound infection, seroma, wound dehiscence, fistula formation, free tissue flap loss. A 2-sided 95% confidence interval will also be calculated for each arm, using exact methods, and chi square testing will be performed to compare the incidence of wound complications within 30 days after surgery between control and experimental groups. A multivariate analysis of the primary endpoint will be performed with logistic regression to include study treatment, presence of sarcopenia, prior radiation therapy, a |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of other post-operative complications | Within 30 days after surgery | Will assess whether Nestle IMPACT Advanced Recovery (AR) decreases the rate of other post-operative complications within 30 days after surgery such as pneumonia, urinary tract infection, deep vein thrombosis, and clostridium difficile colitis as well as length of hospital stay. Will be analyzed using chi square testing. The analysis of the length of the stay (LOS) for patients in each arm will be analyzed using the Kaplan Meier method for estimation of summary statistics including the 25th, 50th (median), and 75th percentiles and associated 95% confidence intervals. Patients that die prior to |
| Sarcopenia | Within 30 days after major head and neck surgery | Will assess whether sarcopenia is an independent risk factor for the development of 30-day post-operative wound complications. Will be analyzed using chi square testing. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Sarcopenia-related gene expression | Up to 30 days post-surgery | Will asses messenger ribonucleic acid expression level of the sarcopenia-related genes MAFbx, MuRF1, Foxo1, Redd1, Sesn1, SELP, IL-6, BNIP3, and CTSL1, within skeletal muscle, and circulating levels of sarcopenia-associated exomes. Will be analyzed using chi square testing. |
Countries
United States
Outcome results
None listed