Pierre Senesse

Online Presentation
Head and neck (H&N) cancer represents a unique clinical challenge where oncological outcomes are closely tied to nutritional status. Curative treatments, particularly radiotherapy combined with chemotherapy, frequently involve the oral cavity and oropharynx and result in significant toxicities such as dysphagia, odynophagia, xerostomia, pain, and taste or smell alterations. These side effects can severely impair oral intake, with up to 80% of patients experiencing major difficulties in eating and hydration from the second cycle of chemoradiotherapy, often lasting several weeks. Consequently, malnutrition and weight loss are not only common but also prognostic factors, influencing both treatment feasibility and survival.
Despite these realities, most international guidelines (ASCO, ESMO, ESPEN) provide limited direction regarding the role of nutritional support in optimizing oncological treatment. French and Australian recommendations highlight that enteral feeding may reduce unplanned hospitalizations and treatment interruptions compared to oral intake alone. Prophylactic gastrostomy is widely used before concurrent chemoradiotherapy, though its role remains debated due to complications in some patients. Recent multicenter experiences suggest that systematic anticipation, dietary counseling, and timely enteral support remain crucial to maintaining treatment continuity while avoiding unnecessary interventions.
Beyond the curative setting, advanced or recurrent disease must be approached as a “chronic illness,” where therapeutic objectives shift from cure to overall survival, quality of life, and symptom control. Here, malnutrition is driven by reduced food intake, systemic inflammation, and loss of lean body mass, culminating in cancer cachexia. Reduced muscle mass and sarcopenic obesity are particularly strong predictors of treatment toxicity, dose-limiting side effects, and decreased survival, independent of BMI. Practical tools such as the Verbal Analogue Scale for food intake and GLIM diagnostic criteria offer feasible approaches for early identification of patients at risk.
The management of nutrition in H&N cancer patients therefore requires anticipation, personalization, and therefore integrated supportive care. Early and continuous dietary counseling, interdisciplinary coordination, and selective use of artificial nutrition are essential to prevent treatment disruptions and to improve both oncological and quality-of-life outcomes. In the palliative phase, decisions regarding nutritional support must be multidisciplinary, balancing clinical benefit, patient comfort, and ethical considerations. Anticipating nutritional decline, managing treatment-related toxicities, and supporting patients throughout the cancer journey are not secondary considerations, but fundamental components of comprehensive cancer care.

Bio
CURRENT SITUATION (November 2025)
Coordinator of the Supportive Care Department, and Head of the Clinical Nutrition and Gastroenterology Department of the Anticancer of Montpellier (ICM, Val d’Aurelle, France), I’m currently at the Montpellier Cancer Institute.
Montpellier Cancer Institute (ICM) is a not-for-profit private comprehensive cancer center devoted entirely to cancer care, prevention, research and education. Directed by Prof. Marc Ychou, it is one of the two regional (new administrative region “Occitanie”) reference centers for cancer treatment and a member of UNICANCER, the national French group of Cancer Centers. Our centre is accredited as an European Society for Medical Oncology designated centre of integrated oncology and palliative care.
MAIN CLINICAL ACADEMIC PROJECT
 2008- Creation of the Cancer Nutritional Program (CNP)
We assessed in 2007 the extent of the needs on nutritional care and audited our clinical practice at the Montpellier Cancer Institute. After screening for weight loss, we identified that 50% of our inpatients suffered from cachexia. Moreover, parenteral nutrition was prescribed outside of the indications of current guidelines in about 50% of cases. We therefore decided to develop and implement a CNP (J Pain Symptom Manage. 2017 Sep;54(3):387-393.e3. doi: 10.1016/j.jpainsymman.2017.01.010). We developed an interdisciplinary nutrition expert team dedicated to cachexia based on pre-existing facilities. The CNP was institutionally integrated within the supportive care program including social workers, physiotherapists, palliative care professionals, psychologists and ethics experts. First evaluations of this program showed: 1) the CNP can support cachexia screening across the establishment and modify physician practices; 2) Funding for the program is generated by direct and indirect costs savings.
2021- Development of Supportive Care Program
In accordance with the regional health agency, this team is implementing an “integrated care model” backed by a new organization and a new building dedicated to centralize supportive care activities (2.5M€ investment by ICM). Since May 2021, this new Department proposes ambulatory and anticipated care for outpatients in strong connection with home healthcare. It introduces new clinical organization methods including early supportive care inspired by the Canadian model developed by E. Bruera and D. Huiet (JCO, 2010).