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Guideline Resources

  • Nutrition in Adults with Head and Neck Cancer
  • American Society for Parenteral and Enteral Nutrition
  • March 3, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 3rd, 2026, the American Society for Parenteral and Enteral Nutrition's newest guideline on Nutrition in Adults with Head and Neck Cancer. 

This guideline provides guidance for the nutrition care of patients with head and neck cancer, identifies research gaps, and calls for standardized outcome reporting to further the state of the evidence.

Today we’ll just be going over a summary of these recommendations, so for the full guideline and recommendations, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • In adults with head and neck cancer planning for or receiving radiotherapy with or without chemotherapy or other systemic therapy, the guideline suggests initiation of enteral feeding where there is clinical evidence that nutrition intake or status is compromised, despite other strategies having been attempted. 
  • The guideline suggests early commencement of postoperative nutrition intake to meet estimated nutrition requirements. 
  • In adults with head and neck cancer receiving radiotherapy with or without chemotherapy or other systemic therapy, the guideline recommends weekly consultation with a dietitian during treatment and fortnightly for up to 6 weeks after treatment to maintain nutrition status and quality of life while preventing unplanned hospital admissions and early cessation of treatment. 
  • The guideline recommends that the duration of dietitian intervention preoperatively and postoperatively should be individualized according to the patient's nutrition status; swallowing function; symptom burden; and clinical, psychosocial, and socioeconomic status. 
  • The guideline recommends that all patients be screened for malnutrition using a validated tool at their first presentation to the healthcare facility and regularly throughout treatment and recovery to facilitate timely referral for nutrition intervention.
  • The guideline recommends that patients undergo a comprehensive nutrition assessment if they have been screened and found to be at risk of malnutrition, if they are automatically referred through established protocols because of high malnutrition risk, or if they present with an enteral access device, either planned or already in situ. 
  • In adults with head and neck cancer receiving any modality of treatment, the guideline recommends a protein intake of 1.2–1.5 g/kg/day, which would meet the needs of most patients with head and neck cancer. 
  • In adults with head and neck cancer receiving any modality of treatment, the guideline recommends an energy intake of at least 30 kcal/kg/day. Nutrition status should be monitored regularly to determine if energy intake is sufficient, noting that sufficient energy intake is also important to ensure protein intake is used for the preservation of muscle mass. 
  • In adults with head and neck cancer receiving any treatment modality, because of insufficient evidence at present to demonstrate a benefit from individualizing protein requirements based on body composition, the guideline suggests estimating protein requirements based on actual body weight. The guideline recommends ongoing monitoring of nutrition intake alongside nutrition status, muscle mass, muscle strength, and physical performance as an indication of adequacy of protein intake. 
  • In adults with head and neck cancer receiving any treatment modality, the guideline suggests estimating energy requirements based on actual body weight because of insufficient evidence at present to demonstrate a benefit from individualizing energy requirements based on body composition. The guideline recommends ongoing monitoring of nutrition intake alongside weight, nutrition status, muscle mass, muscle strength, and physical performance as an indication of adequacy of energy intake. 
  • In adults with head and neck cancer receiving any treatment modality, the guideline suggests that the decision to place a percutaneous endoscopic gastrostomy, or PEG tube, or radiologically inserted gastrostomy, or RIG tube vs a nasogastric tube, or NGT, is made through discussion among interdisciplinary team members, including a dietitian or other member with nutrition training.
  • In adults with head and neck cancer receiving any treatment modality, the guideline recommends consultation by a speech pathologist before treatment for baseline assessment and education if the treatment is likely to affect swallowing function, or in the case of preexisting dysphagia. The guideline recommends that the frequency of consultation by a speech pathologist during and after radiotherapy and after surgery be guided by the treatment plan, as well as the severity of dysphagia and other treatment toxicities.
  • In adults with head and neck cancer, the guideline recommends an interdisciplinary approach to nutrition management. The guideline recommends that the core team for nutrition management include dietitians, nurses, pharmacists, physicians, and speech pathologists. 
  • In adults with head and neck cancer who are experiencing anorexia and receiving any treatment modality, the guideline suggests dietary counseling and management of other symptoms that are affecting oral intake as first-line strategies to address anorexia and improve nutrition intake. 
  • In adults with head and neck cancer who have commenced EN and who can safely continue oral intake per consult with a speech pathologist, the guideline suggests that continuing any degree of oral intake may be beneficial for maintaining swallow function. 
  • Given the limited evidence on progression-free and overall survival and some evidence of benefit for decreased fistula development and length of stay in adults with head and neck cancer, the guideline suggests that using arginine-supplemented nutrition may be acceptable at the discretion of the interdisciplinary team.
  • The guideline suggests that the use of oral/enteral glutamine in patients with head and neck cancer may be acceptable at the discretion of the interdisciplinary team. The guideline suggests not adding parenteral glutamine to standard nutrition therapy in patients with head and neck cancer until further research becomes available to confirm its safety.
  • The guideline suggests that ω-3–supplemented nutrition is unlikely to be harmful and may be used or not at the discretion of the interdisciplinary team. 
  • The guideline suggests that combined special-purpose nutrient or immunonutrition-supplemented formulas are unlikely to be harmful and may be used or not at the discretion of the interdisciplinary team. 

And there you have it. Make sure to check out the full guideline from the American Society for Parenteral and Enteral Nutrition and other related clinical decision support tools at guidelinecentral.com.

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