Knowledge, attitude, and practice of oral nutritional supplements in patients undergoing radiotherapy for head and neck cancer

Yajun Chen¹Shuang Yang²Yuying Li¹Chunlei Li¹Mengyuan Chen¹Ruina Wang²Na Liu²Yu Fang³Mingming Han⁴Hongwei Tang⁵Jun Zhang⁶Yaqi Zeng¹Yueying Li¹Yujie Wang¹Ximei Zhang^2*Peiguo Wang^2*Kun Wang^1*

• ¹Department of Nutrition, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer. Tianjin’s Clinical Research Center for Cancer, Tianjin, China
• ²Department of Radiotherapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer. Tianjin’s Clinical Research Center for Cancer, Tianjin, China
• ³Department of Nutrition, Beijing Cancer Hospital, Beijing, China
• ⁴Department of Nutrition, Tianjin Medical University Genernal Hospital, Tianjin, China
• ⁵Department of Nutrition, Wuqing People’s Hospital, Tianjin, China
• ⁶Department of Nutrition, Tianjin Union Medical Center, Tianjin, China

Background: Oral nutritional supplementation in head and neck cancer radiotherapy. The aim of this study was to explore the knowledge, attitudes, and practice (KAP) of oral nutritional supplementation in patients undergoing radiotherapy for head and neck cancer. Materials and methods: A multi-center cross-sectional study was conducted from December 2023 to July 2024 across four medical institutes. Demographic data and KAP scores were collected and assessed using a self-developed validated questionnaire. A threshold of ≥70.0% of the maximal scores was established to define good knowledge, a positive attitude, and active practice. Results: A total of 437 valid questionnaires were analyzed; the majority of participants were male (70.71%) and aged between 41 and 60 years (50.11%). The median knowledge score was 4 (range: 0-10; possible range: 0-20), the median attitude score was 34 (range: 30-39; possible range: 10-50), and the median practice score was 15 (range: 13-17; possible range: 4-20). The knowledge score exhibited a positive correlation with both attitude (r=0.379, P<0.001) and practice (r=0.395, P<0.001) scores; attitude and practice scores were also positively correlated (r=0.363, P<0.001). Structural equation modeling showed that knowledge had a direct positive effect on attitude (β=0.613, P<0.001) and practice (β=0.807, P<0.001), while attitude had a direct effect on practice (β=0.614, P<0.001). Conclusion: The findings indicate that patients with head and neck cancer undergoing radiotherapy exhibit poor knowledge and unfavorable attitudes toward oral nutritional supplements, despite displaying proactive practices. Considering the positive correlation among KAP, the provision of personalized medical education is essential for effective disease management.