For more than two decades, patients at the Milton J. Dance, Jr., Head and Neck Center have been offered an integrated and coordinated plan of care tied together by medical oncology, speech pathology, social work, nursing and oral medicine. Most recently, this multidisciplinary program also integrated a nutritional counseling component to ensure that head and neck cancer patients have an ongoing plan to meet their nutritional needs.
The Dance Center recently welcomed Keri L. Culton, RD, LDN, CNSD, as a Registered Dietitian to provide specialized nutrition education to outpatients following surgery or undergoing radiation or chemotherapy treatment. Prior to this appointment, Ms. Culton was a Clinical Dietitian Specialist at The Johns Hopkins Hospital, including the Sidney Kimmel Comprehensive Cancer Center, where she delivered nutritional counseling to patients with cancer, heart disease, diabetes and obesity diagnoses. As a Certified Nutrition Support Dietitian, she has a special interest in the nutritional
needs of head and neck cancer patients.
"Every patient is different in what they can tolerate before and after treatment, but nearly 100 percent of head and neck cancer patients will experience nutritional issues and eating difficulties that result from this type of cancer," says Ms. Culton. "My goal is to provide individualized guidance so each person has an optimal, nutrient-filled diet in a safe and efficient way."
One such individual is 64-year-old Virginia Langley, who, at 105 pounds, is working hard to maintain her current weight and slowly regain some of the 20 pounds she lost over the past year. Ms. Langley was diagnosed with tongue cancer that required three months of radiation and chemotherapy treatments, followed by lymph node surgery. She used a feeding tube from May 2007 through January 2008 while still able to drink liquids.
"The radiation treatments made everything smell and taste like metal," she says, "and I couldn't even swallow my own saliva so I had dry mouth all the time. My taste for food is back now, but chewing and swallowing are still day-to-day challenges for me."
Ms. Langley commends Keri Culton for helping her to expand her food choices, eating schedule and caloric intake. "Week-by-week she helps me to add something new to my menu that will give me more nutrition and calories," she says. "I'm now eating six very small meals a day and keeping a food log so we can balance the foods that I'm able to have like eggs, tuna, soup, V8, ice cream, mashed sweet potatoes, and more."
Ms. Culton sees her role as one of continually assessing what foods patients can tolerate and what eating habits will increase caloric intake so patients can hold and build a healthy body weight that supports recovery. "Our patients seldom want to sit in front of a plate of food and often respond by eating very little at all. But eating issues can sustain for weeks or years depending on their revolving periods of treatment, so I need to encourage small 'hits and bits' that make sense for each patient at a particular time."
Tongue cancer, combined with side effects of the chemotherapy and radiation, left Ms. Langley with weak tongue and throat muscles that created extensive swallowing and speech problems. She also experienced esophageal stricturing that required dilation. As a result, Ms. Langley's nutritional counseling is complemented by extensive speech and swallowing therapy with Barbara Messing, MA, CCCSLP, BRS-S, Clinical Director of the Dance Center.
"I work closely with Virginia on range of movement exercises to avoid tissue atrophy in the face, jaw and throat so she can regain and maintain the muscle strength she needs to move food through the mouth and throat, have enough hydration in that area, and be able to swallow a wider range of foods," says Ms. Messing.
She adds, "The addition of Keri to the multidisciplinary team at the Dance Center adds another important component to the individualized care our patients receive from initial diagnosis through treatment, recovery and rehabilitation."
According to Dorothy Gold, LCSW-C, OSW-C, Senior Oncology SocialWorker, the ability to refer within the Dance Center team greatly impacts the overall recovery of a patient. "So many issues are interrelated and very often by resolving one issue you bring change in another. A patient may come to me in distress because they can't gain weight, so being able to offer nutritional counseling may greatly impact their emotional well-being as well," she says.
"The nutritional counseling program rounds out the comprehensive services that we provide to our patients, and we are extremely grateful to the Dance Endowment Board of Directors for its full support," says John R. Saunders, Jr., MD, Medical Director of the Milton J. Dance, Jr., Head and Neck Center.
For more information about the new nutrition counseling program or any of the comprehensive services available through the Dance Center, call 443-849-2087.